TABLE 6 Research priorities Epidemiology Improve estimates of adolescent TB incidence and outcomes, including loss from treatment and mortality. Estimate burden of nonsevere and severe PTB disease in children Understand the burden, including incidence of disease and sequelae of distinct forms of EPTB, particularly CNS TB and other severe forms associated with poor outcomes Determine burden estimates for the post-TB morbidity spectrum in children and adolescents to inform policy and planning Determine age-disaggregated and risk group estimates for TB case notification and treatment outcomes in children at country level Measure child and adolescent TB underreporting at country level through broader TB inventory studies Characterise the co-occurrence of mental health disorders, including depression and anxiety, among older children and adolescents with TB Prevention Assess practical methods to optimise the full TPT cascade of care (identifying contacts, excluding TB disease, starting TPT and completing TPT) Evaluate shorter TPT regimens, especially in the context of drug-resistant exposure and in children 2 years of age, including drug dosing and safety Develop optimal point-of-care diagnostic tests for TBI among high-risk groups Evaluate effectiveness, pharmacokinetic and safety data for TPT in the context of multimorbidity and MDR-TB among children Estimate the duration of protection among at-risk subpopulations including within the context of high-TB-prevalence settings Estimate the risk of drug resistance following TPT Develop a more effective vaccine against TB disease for use in infants and all ages Diagnosis Develop better-performing TB screening tools and approaches with age-disaggregated and subpopulation performance data Determine the regularity and outcomes of TB screening among at-risk subgroups Develop more accurate tests to confirm TB disease from respiratory samples Evaluate the role of mWRD in TB screening among children and adolescents and nonrespiratory samples. In those with microbiologically confirmed disease, develop rapid drug-resistance tests that also include isoniazid Validate the WHO treatment decision algorithms in diverse settings Develop and validate computer-aided reading of digital CXRs for young children and improve the accuracy of this technology for older children and adolescents Treatment Conduct more timely dosing and safety studies of new drugs in children and adolescents before their licensing Conduct treatment-shortening studies for DS-TB in children and include adolescents in adult TB treatment-shortening studies Optimise treatment for TB meningitis, including adjuvant anti-inflammatory therapies Optimise treatment of corticosteroid-refractory paradoxical inflammatory reactions in CNS TB Design and evaluate artificial intelligence programmes for TB disease classification in children to facilitate uptake and rollout of the shorter TB treatment regimen Conduct pharmacokinetic and safety studies on newer and repurposed TB drugs for DS-TB and MDR-TB among children including subpopulations Operational research Identify the causes of missed and delayed TB diagnoses in children and adolescents, and the best-practice interventions to promote earlier diagnosis of TB in children Determine the most appropriate and most cost-effective TB service delivery models for children and adolescents Develop and evaluate strategies to improve treatment adherence in adolescents Evaluate programme integration strategies for paediatric TB, including those with HIV, maternal, neonatal and child health, adolescent health, nutrition and other relevant programmes Evaluate the performance of the different WHO-recommended screening algorithms and tools for children in programmatic settings Continued https://doi.org/10.1183/2312508X.10025322 229 CHILDREN AND ADOLESCENTS |E. LÓPEZ-VARELA ET AL.