{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:55:48Z","timestamp":1791482148700,"version":"4.3.4"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UNITAID","award":["2019-36-SUN-MDR"],"award-info":[{"award-number":["2019-36-SUN-MDR"]}],"id":[{"id":"https:\/\/ror.org\/05t99je22","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Joint Global Health Trials","award":["MR\/M007340\/1"],"award-info":[{"award-number":["MR\/M007340\/1"]}]},{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MRC","award":["MC_UU_00004\/04 and MC_UU_00004\/09"],"award-info":[{"award-number":["MC_UU_00004\/04 and MC_UU_00004\/09"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tuberculosis (TB) preventive treatment (TPT) is a core component of TB control. Levofloxacin was recently recommended by the World Health Organization as TPT in children exposed to multidrug-resistant tuberculosis (MDR-TB). However, the affordability and feasibility of TPT provision for governments, health services, individual households and global donors is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This costing analysis used empirical data collected alongside the TB-CHAMP clinical trial which investigated levofloxacin TPT in children exposed to MDR-TB in South Africa. We modelled the societal (health system and household) cost of levofloxacin TPT, other potential future (but not currently recommended) MDR-TB exposure TPT options and compared with drug-susceptible TPT options in children and adolescents under 15 years old. We modelled costs across 12 different medicine and formulation options for 11 paediatric dosing weight-bands using TB-CHAMP and household survey data, with national and international procurement medicine pricing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Total societal costs of providing levofloxacin TPT and its monitoring per child were US$252 (0-\u2009&lt;\u20095 years) and US$256 (5-\u2009&lt;\u200915-years) and had comparable costs to drug-susceptible TPT regimens when using Global Drug Facility pricing. Pharmaceutical costs for a course of TPT using child-friendly formulations in children &lt;5 years varied between US$38 (levofloxacin), US$80 (bedaquiline) and US$582 (delamanid). Household costs associated with accessing TPT and ongoing monitoring ranged from 1.6%\u22122.1% of median annual income of affected households, with shorter TPT courses incurring lower household costs. Global Drug Facility procurement achieved TPT pricing at 70% of the costs of national South African procurement, and enabled access to a wider range of child-friendly formulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Costs of TPT are influenced by factors including medicine pricing and procurement, the use of child-friendly formulations, implementation approach, the duration of treatment, and choice of TPT regimen across weight and age distributions. Costs to households are relatively small but may be significant for impoverished households already managing the financial disruption of a family member with MDR-TB disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336561","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:26:59Z","timestamp":1791480419000},"page":"e0336561","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health system and household costs of preventive treatment delivery for children exposed to multidrug-resistant tuberculosis in South Africa"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0806-2196","authenticated-orcid":true,"given":"Thomas","family":"Wilkinson","sequence":"first","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Health Economics Unit, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8148-7807","authenticated-orcid":true,"given":"Suereta","family":"Fortuin","sequence":"additional","affiliation":[{"name":"Stellenbosch University","place":["Cape Town, South Africa"],"department":["Division of Molecular Biology and Human Genetics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke C.","family":"Hesseling","sequence":"additional","affiliation":[{"name":"Stellenbosch University","place":["Cape Town, South Africa"],"department":["Desmond Tutu TB Centre, Department of Paediatrics and Child Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5755-4133","authenticated-orcid":true,"given":"H. Simon","family":"Schaaf","sequence":"additional","affiliation":[{"name":"Stellenbosch University","place":["Cape Town, South Africa"],"department":["Desmond Tutu TB Centre, Department of Paediatrics and Child Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trinh","family":"Duong","sequence":"additional","affiliation":[{"name":"University College London","place":["London, United Kingdom"],"department":["Innovative Clinical Trials Unit, Institute of Clinical Trials and Methodology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana M.","family":"Gibb","sequence":"additional","affiliation":[{"name":"University College London","place":["London, United Kingdom"],"department":["Innovative Clinical Trials Unit, Institute of Clinical Trials and Methodology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Purchase","sequence":"additional","affiliation":[{"name":"Stellenbosch University","place":["Cape Town, South Africa"],"department":["Desmond Tutu TB Centre, Department of Paediatrics and Child Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5327-1734","authenticated-orcid":true,"given":"Lee","family":"Fairlie","sequence":"additional","affiliation":[{"name":"University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Wits Research Health Institute"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Staples","sequence":"additional","affiliation":[{"name":"THINK, THINK South Africa","place":["Durban, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Martinson","sequence":"additional","affiliation":[{"name":"University of Witwatersrand","place":["Johannesburg, South Africa"],"department":["Perinatal HIV Research Unit (PHRU) and Infectious Diseases and Oncology Research Institute"]},{"name":"Johns Hopkins University","place":["Baltimore, United States of America"],"department":["Division of Infectious Diseases, School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edina","family":"Sinanovic","sequence":"additional","affiliation":[{"name":"University of Cape Town","place":["Cape Town, South Africa"],"department":["Health Economics Unit, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Seddon","sequence":"additional","affiliation":[{"name":"Stellenbosch University","place":["Cape Town, South Africa"],"department":["Desmond Tutu TB Centre, Department of Paediatrics and Child Health"]},{"name":"Imperial College London","place":["London, United Kingdom"],"department":["Department of Infectious Disease"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"issue":"9","key":"pone.0336561.ref001","article-title":"The global burden of tuberculosis mortality in children: A mathematical modelling study","volume":"5","author":"PJ Dodd","year":"2017","journal-title":"Lancet Glob Health"},{"key":"pone.0336561.ref002","volume-title":"Political declaration of the UN General Assembly high-level meeting: Resolution A\/RES\/73\/3 adopted on 10 October 2018 following approval by the high-level meeting of the General Assembly on the fight against tuberculosis on 26 September 2018","author":"United Nations","year":"2018"},{"key":"pone.0336561.ref003","volume-title":"Global Tuberculosis Report 2024","author":"World Health Organization","year":"2024"},{"issue":"24","key":"pone.0336561.ref004","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1056\/NEJMoa2314318","article-title":"Levofloxacin preventive treatment in children exposed to MDR tuberculosis","volume":"391","author":"AC Hesseling","year":"2024","journal-title":"N Engl J Med"},{"issue":"24","key":"pone.0336561.ref005","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1056\/NEJMoa2314325","article-title":"Levofloxacin for the prevention of multidrug-resistant tuberculosis in Vietnam","volume":"391","author":"GJ Fox","year":"2024","journal-title":"N Engl J Med"},{"key":"pone.0336561.ref006","unstructured":"ClinicalTrials.gov. 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