A historical narrative review of the emerging priority of acceptability in tuberculosis treatment in children

Abstract

Children affected by tuberculosis (TB) are a historically neglected group. In the past two decades, researchers have made significant advances towards developing new drugs and formulations for treating and preventing TB in children. Organizations like the World Health Organization (WHO) and Stop TB Partnership have advocated for the development of child-friendly antituberculosis treatment (ATT) regimens. However, ATT is notoriously unpalatable, the drugs complicated to prepare, and the regimens long, making the treatment difficult to adhere to. Improving the acceptability of new ATT regimens for children is gaining attention. We conducted a historical narrative review to better understand emergent interest in the acceptability of childhood ATT. This review presents a historical overview of advances in ATT for children, policy shifts affecting the childhood TB landscape, and how global shifts in the conceptualization of children, their agency, have influenced children's inclusion in clinical trials and drug development processes. ‘Acceptability’ has emerged alongside safety and efficacy, as a central tenet around which child-friendly drugs should be developed. We discuss the implications of improving ‘acceptability’ of ATT in children. Although more ‘acceptable’ treatment could improve individual adherence and aid the control of the TB epidemic in children, existing guidelines on what evidence is required to prove acceptability are lacking. We must standardize and broaden existing measures of ‘acceptability’ to account for contextual factors as new ATT regimens are introduced.