CHALLENGES, LESSONS LEARNED AND INTERNATIONAL COLLABORATION IN PROVIDING PREVENTIVE TREATMENT OF MULTIDRUG-RESISTANT TUBERCULOSIS (DR TPT) IN CHILDREN IN SERBIA

Drug-resistant forms of TB continue to be the global public health threats. Multidrug-resistant TB (MDR-TB) is defined as TB resistant to rifampicin and isoniazid, essential anti-TB drugs. Both MDR-TB and rifampicin-resistant TB (RR-TB) are treated with second line anti-TB drugs. Preventing the progression of a drug-resistant tuberculosis (DR-TB) infection to disease is an important pillar of the DR-TB elimination strategy. International guidelines have recently proposed fluoroquinolones for tuberculosis preventive therapy (TPT) in DR-TB contacts. Till 2019, no preventive therapy for MDR TB contacts has been performed in Serbia since it was not included in the national TB treatment and contact tracing guidelines. In 2019 and 2022 for the first time, several children and adolescents appeared as close contact with MDR TB cases. DR TB preventive treatment was performed at Hospital for Children's Lung Diseases and TB, “Dr Dragisa Misovic” Clinic in Belgrade, Serbia in two children aged 2 and 3, in line with latest WHO guidelines, due to international collaboration and national multidisciplinary expert support. During the implementation of TPT for child contacts of MDR TB, we have learned that our capacities for TB program coordination, international and in-country multidisciplinary expert collaboration, epidemiological investigation, contact tracing as well as DS and DR TB management in children are good. However, we faced a lot of legislation and systemic challenges that affected the implementation of DR TPT. The main challenges were lack of pediatric drug formulations, lack of indications for levofloxacin use for TB and use in this age group.