Tuberculosis research principles and priorities in children and adolescents: an international consensus statement

Each year, an estimated 1·9 million children (aged 0-9 years) and adolescents (aged 10-19 years) develop tuberculosis disease. Tuberculosis ranks among the top ten causes of death in children younger than 5 years. The primary driver of tuberculosis-related mortality in children and young adolescents is the failure to detect and treat the disease; more than 95% of tuberculosis deaths occur in children who were never initiated on tuberculosis treatment. To increase the quantity and quality of tuberculosis research required to strengthen clinical care and public health practice, the Child and Adolescent TB Working Group and its Secretariat at the WHO led a modified Delphi consensus process to generate core research principles and priorities along each step of the tuberculosis care cascade. An 11-member writing group drafted an initial list of principles and priorities, which were ranked by members of the consensus panel in each Delphi round. Principles and priorities that did not meet the consensus threshold were modified based on written qualitative feedback from the consensus panel and one-time input from other members of the Child and Adolescent TB Working Group at the group's 2024 annual meeting. Eight research principles and 21 research priorities emerged from two Delphi rounds. The research priorities have strong potential for translation into interventions, particularly in relation to diagnostics, shorter regimens, and tuberculous meningitis. With recently reduced tuberculosis research funding, these principles and priorities will focus research efforts to maximise clinical and public health impact.