Research Questions and Priorities for Pediatric Tuberculosis: A Survey of Published Systematic Reviews and Meta-Analyses
Table 3
Summary of research priorities identified.
Category and subcategory
Pediatric TB research priority identified
Proportion (%)
Underpinning research: 06 of (7.1%)
Normal biological development and functioning
Assessing interventions in low- and middle-income countries that explicitly analyze pediatric-inclusive and pediatric-distinct needs and outcomes
2/6 (33.3)
Resources and infrastructure (underpinning)
Comparing the difference in Xpert results if done at, or close to, point of care (for example, in clinics) as compared with in-hospital laboratories for TB diagnosis
1/6 (16.7)
Assessing close collaboration between clinicians, public health authorities, and field-workers in the management of TB
1/6 (16.7)
Operational considerations and training strategy in choosing the appropriate collection method for implementation at low health facility level for pediatric TB management
2/6 (33.3)
Aetiology: 03 of (3.6%)
Research design and methodologies (etiology)
Assessing the use of mixed-method approaches that can assess the pathways linking context-dependent factors with outcomes of TB in children
3/3 (100)
Prevention of disease and conditions and promotion of well-being: 10 of (11.9%)
Primary prevention interventions to modify behaviors or promote well-being
(i) Assessing the use of IPT in reducing TB-associated morbidity. Assessing the provision of preventive therapy to young children exposed to or infected with tuberculosis
5/10 (50)
Interventions to alter physical and biological environmental risks
Evaluating the prioritization of an IPT-friendly healthcare environment. Providing additional guidance for the use of isoniazid in the prevention of TB in HIV-infected children
4/10 (40)
Vaccines
Evaluating BCG vaccine and HVI status for preventing TB in children
1/10 (10)
Detection, screening, and diagnosis: 38 of (45.2%)
Discovery and preclinical testing of markers and technologies
(i) How do results with Xpert differ in children with different stages of disease severity, from nonsevere to very severe or disseminated?
3/38 (8)
Evaluation of markers and technologies
Evaluating bacteriological TB diagnostic tests
08/38 (21)
Influences and impact
Evaluating TB diagnosis by improving yield through improvements in specimen collection or preparation (i) Assessing the impact of gene Xpert on patient outcome (e.g., time to diagnosis, time to treatment, disease outcomes, health-system cost, and cost for families)
15/38 (39.5)
Assessing the rollout of Xpert and its implication on empirical tuberculosis treatment initiation
Applying transparent definitions for the certainty of diagnosis (e.g., confirmed tuberculosis and clinical tuberculosis)
Population screening
(i) Assessing active case-finding for early diagnose of TB in children (ii) Assessing the development of screening algorithms and effective implementation of novel diagnostic tool (iii) Determining the incidence and prevalence of tuberculosis in children
4/38 (10.5)
Resources and infrastructure (detection)
(i) Assessing the specific needs of TB in children, particularly around enhanced infrastructure such as early diagnosis and treatment (ii) Evaluating the promotion of clinical diagnoses and empirical treatment when required (iii) Assessing the role of other respiratory and nonrespiratory specimens (e.g., stool and urine cerebrospinal fluid in the diagnosis of TB in children) (iv) Assessing the role of Xpert in nontraditional tuberculosis settings (e.g., HIV clinics and malnutrition units) (v) Evaluating the challenges of integrating Xpert into the health system
2/38 (5)
2/38 (5)
1/38 (3.2)
3/38 (7.8)
Development of treatments and therapeutic interventions: 13 of (15.5%)
Pharmaceuticals
Developing treatment for active and latent TB in children
10/13 (76.9)
Cellular and gene therapies
Monitoring of electrolytes (potassium and magnesium) as well as albumin in the management of TB in children
2/13 (15.4)
Resources and infrastructure (development of treatments)
Standardized language to describe barriers to TB treatment initiation, within the TB research and advocacy community
1/13 (7.7)
Evaluation of treatments and therapeutic interventions: 06 of (7.1%)
Pharmaceuticals
(i) Evaluating the treatment of MDR-TB in children (ii) Evaluating TB/HIV treatment (iii) Assessing the combined use of delamanid and bedaquiline in children
2/06 (33.3)
1/6 (16.7)
1/6 (16.7)
Psychological and behavioral
Evaluating IPT treatment of TB in children
2/06 (33.3)
Management of diseases and conditions: 04 of (4.8%)
Individual care needs
Assessing both patients- and system-level barriers is to improve patient outcomes, especially among young populations
04/04 (100)
Health and social care service research: 4 of (4.8%)
Organization and delivery of services
Research on improving shorter treatment regimens of TB in children
1/4 (25)
Research designs and methodologies
Development of methods of research assessment and evaluation
1/4 (25)
Resources and infrastructure (health services)
(i) Developing structures, processes, and tools to implement and monitor CCM; health education interventions for HCWs, caregivers, index cases, and the community (ii) Developing a focused approach toward every aspect of child contact management to decrease TB-related morbidity and mortality in children
1/4 (25)
1/4 (25)
Denominator represents the total number of research priorities identified by all the included studies.
