Tuberculosis Clinical Trial
Official title:
An Open Cohort of Childhood Tuberculosis in Mbarara National Referral Hospital, Uganda
The aims at investigating how the diagnosis of Tuberculosis in children in a setting of high TB and HIV prevalence can be improved and to assess the treatment outcomes and tolerance of the new WHO recommended TB drug dosages.
Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. The
situation for children in this epidemic is complex because they are usually considered less
infectious and therefore, not to represent an important public health problem. Uganda ranks
among the countries with the highest TB burden with 330/100,000 person-year TB incidence. Up
to 16% of new TB infections are estimated to occur in children. Diagnosis of childhood TB is
usually based on exposure history and a set of clinical, radiological and biological signs
that considered separately have rather low predictive values. There is no consensus on the
optimal way to combine these signs. This is even more complex when the child is infected
with HIV. The risk of TB infection and disease, and the TB clinical presentation depend on
the child's age, the youngest being at highest risk. An important first step in improving
the management of childhood TB is to better define the clinical and radiological
characteristics of children with suspected TB at first presentation to a health service in
an endemic setting; also to document the feasibility and tolerability of TB treatment in
this age cohort. This initial descriptive study would help to pave the way for more rigorous
studies evaluating novel diagnostics and conducting clinical trials on first and second line
TB treatment in children, in the future.
The main objective of the study is to improve the diagnosis of TB in children in a setting
of high TB and HIV prevalence and to assess the treatment outcomes and tolerance of the new
WHO recommended TB drug dosages.
The investigators will conduct an observational cohort study of paediatric TB suspects
attending the Mbarara National Reference Hospital (MNRH). All included TB suspects will have
an initial comprehensive assessment including clinical examination, chest X-ray, tuberculin
skin test, smear microscopy, Mycobacterium tuberculosis culture, XpertMTB/RIF® of
respiratory or extra-pulmonary specimen for diagnosis of tuberculosis. For children who
cannot produce sputum, sputum induction will be proposed. Children with indication of TB
treatment will be followed up to 6 months after completion of TB treatment (total 12 months)
with treatment efficiency, tolerability and acceptability assessment. Children without
indication of TB treatment will undergo a systematic clinical assessment after 3 months.
Finally, clinical files from all TB suspects will be retrospectively reviewed by 2
independent paediatric TB experts in order to classify the cases as Confirmed TB, Certain
TB, Probable TB and Unlikely TB cases. A total of 385 paediatric TB suspects (1 month-14
years) will be screened from the paediatric ward, OPD, HIV clinic of the MNRH, Holy
Innocents children's hospital and The AIDS support organisation (TASO) in Mbarara.
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Observational Model: Cohort, Time Perspective: Prospective
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