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The diagnosis and management of tuberculosis (TB) in children under 10 years of age represent a major global public health issue and are a priority for the WHO¹. In 2022, it is estimated that 1.25 million children and young adolescents (ages 0-14) contracted TB, but 51% of them were not diagnosed and reported². It is urgent to develop rapid, accurate, and les s invasive tests that do not rely on sputum for the triage and confirmation of childhood TB.

Several activities and initiatives are being developed within the GABRIEL network to contribute to this overarching objective:

• Xpert Ultra stool evaluation as a diagnostic tool for TB in children: The icddr,b in Bangladesh has long been working on this approach³. Testing stools with Xpert-Ultra provides a more effective way of diagnosing bacteriologically positive childhood pulmonary TB. However, positivity varies by presenting symptoms/criteria suggesting requirement of carefully designed diagnostic pathway evaluation to ensure optimum use of limited diagnostic resources. Dr. Sayera Banu's team will soon publish the results and share their experience of a nationwide roll-out of this approach.

• Evaluation of RISK6 as a diagnostic tool for childhood TB: RISK6 is a non-sputum-based blood test that was evaluated in 2021 within the GABRIEL network for diagnosing TB in adults⁴. It is currently being assessed as a triage test for TB in children in Bangladesh (DEDICATE study⁵).

• Operational research aiming to improve the diagnosis of childhood TB: In line with the latest WHO roadmap to end TB among children and adolescents, the Mérieux Foundation, in collaboration with Institute national research biomedical and the non-profit organization ‘One Health Conservation Initiative' (Democratic Republic of the Congo), Institut Pasteur de Madagascar (Madagascar), and Institut Pasteur du Cambodge (Cambodia), has co-developed the IDTB4Child operational research protocol. This protocol aims to enhance the diagnosis of childhood TB through the implementation, performance evaluation, and cost-effectiveness assessment of TB Treatment Decision Algorithms (TDA), the new RISK6 rapid test using a fingertip blood sample, and other innovative approaches such as breath tests⁶ and computer-aided detection digital chest X-rays⁷, to improve the detection of TB in children and their household contacts.

Innovative strategies and new approaches for the prevention and diagnosis of childhood TB developed by several members of the GABRIEL network will be highlighted this year through a series of publications in the International Journal of Tuberculosis and Lung Disease (IJTLD). A session on this topic will also be held during the GABRIEL network meeting (November 27-29, 2024), with the aim of sharing experiences and exploring new opportunities for partnerships and funding for operational research projects to be implemented within the network.

¹WHO. Global tuberculosis report 2023
²WHO | Roadmap towards ending TB in children and adolescents
³Kabir, S. et al. Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children. Clin Infect Dis 73, 226–234 (2021)
⁴Bayaa, R. et al. Multi-country evaluation of RISK6, a 6-gene blood transcriptomic signature, for tuberculosis diagnosis and treatment monitoring. Sci Rep 11, 13646 (2021)
⁵DEDICATE (blooD-basEd DIagnostiC of pAucibacillary Tb in bangladEsh) Fondation Mérieux (2013)
⁶EBC-LAM Fondation Mérieux

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