RetourSimilar to the approach recommended for TB treatment regimens, future research should be adequately powered and should report on a harmonized set of outcomes, aligned with WHO-defined TB treatment outcomes and measures of nutritional recovery, to maximize the possibility for future meta-analyses (151). Examples of outcomes to measure include death during TB treatment, TB cure, TB treatment completion, TB treatment success, loss to follow-up from TB treatment, relapse, time to sputum conversion and nutritional outcomes (e.g. change in weight using anthropometric measurement and other outcomes) (151).
Where feasible, research investigators should consider analyses of the following subpopulations: people with TB with mild, moderate or severe undernutrition (using WHO age-appropriate cut-off measurements); people without undernutrition; people with and without micronutrient deficiency; people living with HIV; people with diabetes; pregnant, postpartum and breastfeeding women; children; infants; elderly people; and people with substance use disorders.
Research gaps identified during the GDG meeting are listed below:
Nutritional assessment and counselling of people with TB and their household contacts
- Effective criteria and thresholds for weight change at different time points for monitoring nutritional and clinical recovery or deterioration in people with TB who have undernutrition.
- Effectiveness, feasibility and acceptability of different methodologies to simplify nutritional assessment of household contacts in the community.
- The best measure of nutritional status in pregnant women, with and without TB, considering both maternal and infant outcomes.
- The optimal BMI for healthy maternal and infant outcomes in pregnant women with TB.
- Effectiveness, feasibility and acceptability of different approaches and frequency of nutritional counselling that enhance the effectiveness and uptake of advice on nutritional outcomes.
Nutritional interventions (e.g. food baskets, ready-to-use therapeutic foods, food vouchers or cash transfers) for people with TB
- Ideal composition and duration of nutritional supplementation for people with TB, during TB treatment and afterwards.
- Comparison of the effectiveness, feasibility, acceptability and cost–effectiveness of different interventions such as food baskets, food vouchers and cash transfers, including in communities that experience food insecurity.
- Optimal nutritional management among people with TB and diabetes.
Micronutrient supplementation for people with TB
- The effectiveness of vitamin D supplementation as an additional component of nutritional interventions (e.g. food baskets) provided to people with TB and vitamin D deficiency, or in populations with high levels of vitamin D deficiency, compared with nutritional interventions only.
- The most effective, acceptable and feasible dose, frequency and duration (during and after treatment) of vitamin D supplementation.
- The most effective, acceptable and feasible method of administration of vitamin D (pills, sprays or fortified foods).
- The cost–effectiveness of vitamin D supplementation and fortified foods in different contexts, including the cost per additional cure for people with TB.
- The acceptability and feasibility among people with TB and care providers of testing vitamin D levels and the provision of vitamin D to people with TB.
- The association of undernutrition, measured by low BMI and weight-for-height, weight-for-age in people with TB and vitamin D deficiency in settings with high and low burden of vitamin D deficiency.
- The risk of micronutrient deficiencies in people with TB in relation to people without TB.
- The micronutrient requirements, including dosing and duration, of people with TB.
- The additional benefit of multiple micronutrient supplements and food baskets for people with TB, compared with food baskets alone.
- The cost–effectiveness of micronutrients and food baskets for people with TB with and without undernutrition, compared with food baskets alone.
Food assistance for household contacts of people with TB
- Comparison of the effectiveness, acceptability, feasibility and cost–effectiveness of different forms of interventions (e.g. food baskets, food vouchers or cash transfers) in preventing TB in household contacts in different settings.
- The effectiveness of multiple micronutrient supplements as an additional component of food baskets, compared with food baskets alone for household contacts in preventing TB.
- The optimal composition of nutritional supplementation for household contacts of people with TB, and people in prisons and other places of incarceration in preventing TB.
- The effectiveness of food assistance combined with TPT compared with TPT alone in preventing TB among household contacts in settings of food security.