19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 2
SP-22-Advancing a prevention research agenda for TB
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SP-22-Advancing a prevention research agenda for TB
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Prevention is essential to achieving global targets to end the tuberculosis (TB) epidemic and should be considered an essential human right. In recent years there has been increased focus on advancing research and development of new tools to support TB prevention, including diagnostics to detect latent TB infection, therapeutics to prevent progression to active disease and vaccines to prevent Mycobacterium tuberculosis infection or to prevent progression to disease. This session will provide an overview of the status of development of new vaccines, drugs and diagnostics to diagnose and prevent TB disease. A human rights framework for TB prevention will also be presented.

16:30 - 16:35: Introduction

16:35 - 16:47: Prevention through vaccination: advancing research and development of new vaccines to prevent TBVaccines are one of the most successful and effective public health interventions to decrease the spread of life-threatening infectious diseases. Worldwide, incidence and death due to measles, diptheria, influenza, polio, meningitis and numerous other diseases have been greatly reduced through effective vaccines and immunisation programmes. However, BCG, the only licensed vaccine to prevent tuberculosis (TB), has been inadequate in halting the global epidemic. Over the past two decades there has been a significant global effort to develop new, more effective TB vaccines and recent promising results have demonstrated that developing new vaccines is feasible, bringing increased enthusiasm and optimism to the field. This presentation will discuss the latest advances in the research and development of new, more effective vaccines to prevent TB, the potential impact a new TB vaccine could have on TB incidence, and what will be necessary to further advance the TB vaccine pipeline.
Grace Kaguthi

16:47 - 16:59: Diagnosing TB infection to prevent TB: an overview of the landscape of TB infection and incipient TB testsExisting tests for TB infection (TBI), tuberculin skin test (TST) and Interferon Gamma Release Assays (IGRA), have limited value in predicting risk for the progression from infection to active TB. Furthermore, implementation of TBI tests faces operational challenges such as cold chain requirements and needs for sophisticated laboratory infrastructure. Partly as a result of logistic challenges and limitations in their accuracy, TBI tests are not required prior to the start of TB preventive treatment (TPT) in priority risk groups such as people living with HIV and household contacts aged less than 5 years. For others, TBI tests are generally recommended to identify those who benefit most from treatment.  New tests for TBI are emerging such as the C-Tb (Serum Institute of India), Diaskin Test (Generium, Russian Federation) and QFT access (Qiagen, SA). It is important to review the landscape of TBI tests and identify gaps that need to be filled to facilitate development and introduction of new tests.
Morten Ruhwald

16:59 - 17:11: TB preventive therapy: treatment of latent TB infection with a shorter course regimenRoughly one quarter of the world is infected with latent tuberculosis infection (LTBI) and treating this population is critical to achieving the end of the TB epidemic. While treatment of active TB has remained a top priority, this strategy alone will not yield the needed results to meet these END TB targets. Current treatments for LTBI can take up to nine months and adherence to such lengthy treatments have proved inconsistent in the past. Newer, shorter-course preventative therapies are needed if we are to achieve the reductions in TB cases needed to meet the END TB targets.
Richard Chaisson

17:11 - 17:23: What's law got to do with it? New technologies for TB prevention and emerging human rights issuesThe role of law and human rights in the global tuberculosis (TB) response have been increasingly recognised as central to achieving global targets set in the End TB strategy and the United Nations Political Declaration on TB. Despite this, there is a lack of understanding and implementation of a human rights-based disease response. As new vaccine, diagnostic and treatment technologies emerge, including to prevent TB infection and/or disease and to diagnose and treat latent TB infection, the law and rights will play an even greater role in either supporting or hindering efforts to end the epidemic. Building on the other talks in this session, this presentation will consider the opportunities and risks associated with legal frameworks and human rights law to promote the availability and accessibility of new TB preventive technologies. The talk will focus on intellectual property and trade law and the rights to health and science.
Brian Citro

17:23 - 17:50: Q&A session

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SP-24-The impact of COVID-19 on TB research and development and access: it’s a two-way street
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SP-24-The impact of COVID-19 on TB research and development and access: it’s a two-way street
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The impact of COVID-19 is far reaching, spanning research, programmes, affected communities and the global access to innovations movement. This session will explore the multitude of ways in which COVID-19 is affecting the global response to TB as well as how COVID-19 is benefiting from decades of investments in TB programmes and research. Finally, this session will conclude with an exercise in imagination and where we might be in the COVID-19 response today had we fully funded the global response to TB.

16:30 - 16:35: Introduction

16:35 - 16:45: COVID-19 and TB researchTB research initiatives have largely been put on pause, throwing off trial timelines and delaying long-anticipated results necessary for rolling out new tools to optimize the prevention, diagnosis, and treatment of TB. Yet, TB research investments, innovations, and infrastructure are being leveraged to help advance research and development initiatives focused on addressing the global COVID-19 pandemic. This talk will explore both how TB research is being impacted by and benefitting COVID-19 related research.
Frank Cobelens

16:45 - 16:55: COVID-19 and access to TB toolsTB program investments, interventions, and infrastructure are supporting government efforts to mitigate the spread and severe effects of COVID-19. The need to scale up the response to COVID-19 in high TB burden countries is urgent and necessary to save lives. Still, TB program activities and services must continue and expand, both to prevent unnecessary morbidity and mortality and to keep us on track for ending TB. This talk will discuss the synergies between the global response to COVID-19 and TB, and how to ensure that TB tools which may be able to assist in the COVID-19 response are used in a way that does not reduce access to them by TB programs.  
Madhukar Pai

16:55 - 17:05: COVID-19 and TB survivorsEven when successfully cured, TB can leave a lasting effect on lung health and function, making TB survivors among the populations especially vulnerable to COVID-19. This talk will focus on the experience of a TB survivor, her reaction to surviving one deadly disease only to face another, and her approach to preserving her health, wellbeing, and remaining lung function amidst the COVID-19 pandemic.
Debshree Lokhande

17:05 - 17:15: COVID-19 and access to TB innovationsThe urgency of the COVID-19 pandemic has mobilized unprecedented political will and consensus regarding ideas long promoted by the global access to medicines and innovations movement. This talk will cover access principles and proposals that have gained traction, and how they may have lasting benefits and applications for activists working to promote access to TB innovations and the benefits of TB research and scientific progress.
Suraj Madoori

17:15 - 17:25: COVID-19 in a parallel universe, with adequate funding for TB R&DInvestments in global health, and TB in particular, have translated to many benefits to the global response to COVID-19. But imagine a world in which research and the global response to TB hadn’t been underfunded for the last 50 years. What scientific gains would have been possible, and how could these gains have given us an advantage in our ability to control the COVID-19 pandemic and prevent unnecessary deaths and suffering?
Grania Brigden

17:25 - 17:50: Q&A session

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Channel 7
TBS2C-Dead or alive? Implications of spectrum of M. tuberculosis infection: round table
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TBS2C-Dead or alive? Implications of spectrum of M. tuberculosis infection: round table
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Recent research has suggested that M. tuberculosis can present as more subtle states than just 'latent' infection and active disease. This has relevant diagnostic, preventive, therapeutic, transmission, modelling and economic analyses implications. This session is intended to discuss different implications of the spectrum of tuberculosis infection.

17:20 - 17:45: Round table

Simone Joosten
Rein Houben
Paul Drain

17:45 - 18:05: Live Q&A

Simone Joosten
Rein Houben

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SS-06-Discussion on COVID-19: is there a role for the 100-year-old BCG vaccine?
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SS-06-Discussion on COVID-19: is there a role for the 100-year-old BCG vaccine?
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This session has been made possible by an educational grant from AJVaccines

For almost a century, BCG vaccination has been widely used to protect against tuberculosis (TB). Non-specific effects, such as reducing overall infant mortality or the observation of fewer respiratory infections, have been attributed to the vaccine. Underlaying immune mechanisms have been proposed. Early on in the COVID-19 pandemic, epidemiological data suggested that populations with longstanding BCG vaccination may be less affected. Also, some homology between SARS-CoV-2 and Mycobacterium bovis, has been described. Several clinical trials in first responders and vulnerable populations are evaluating whether BCG mitigates the clinical course of COVID-19. Investigators will discuss the context and details of their trials.

18:15 - 18:20: Introduction by Camille Locht


18:20 - 18:40: COVID-19: is there a role for the 100-year-old BCG vaccine? Denmark For almost a century, BCG vaccination has been widely used to protect against tuberculosis (TB). Non-specific effects, such as  reducing overall infant mortality or the observation of fewer respiratory infections, have been attributed to the vaccine. Underlaying immune  mechanisms have been proposed. Several clinical trials in first responders and vulnerable populations are evaluating whether BCG mitigates the clinical course of COVID-19. Investigators will discuss the context and details of their trials.

Christine Benn

18:40 - 18:50: BCG vaccination to reduce the impact of COVID-19 in Australian healthcare workers following coronavirus exposure: BRACE trial Healthcare workers are at increased risk of contracting COVID-19, caused by SARS-CoV-2. Currently, there are no  vaccines or proven preventative interventions available to protect healthcare workers. The Bacille Calmette-Guérin (BCG) vaccine is  designed to protect against tuberculosis (TB). However it also boosts immunity to protect against other infections. The purpose of the BRACE  trial is to find out whether BCG vaccination protects against COVID-19 or reduces severity of COVID-19 in healthcare workers.

Nigel Curtis

18:50 - 19:00: COVID-19: is there a role for the 100-year-old BCG vaccine? The South African study For almost a century, BCG vaccination has been widely used to protect against tuberculosis. Non-specific effects, such as  reducing overall infant mortality or the observation of fewer respiratory infections, have been attributed to the vaccine. Underlaying immune  mechanisms have been proposed.
Several clinical trials in first responders and vulnerable populations are evaluating whether BCG mitigates the clinical course of COVID-19.
Investigators will discuss the context and details of their trials.

Andreas Diacon

19:00 - 19:10: COVID-19: is there a role for the 100-year-old BCG vaccine? The Dutch study For almost a century, BCG vaccination has been widely used to protect against tuberculosis. Non-specific effects, such as  reducing overall infant mortality or the observation of fewer respiratory infections, have been attributed to the vaccine. Underlaying immune  mechanisms have been proposed.
Several clinical trials in first responders and vulnerable populations are evaluating whether BCG mitigates the clinical course of COVID-19.
Investigators will discuss the context and details of their trials.

Reinout van Crevel

19:10 - 19:20: COVID-19: is there a role for the 100-year-old BCG vaccine? Extension of the BRACE trial in Brazil For almost a century, BCG vaccination has been widely used to protect against tuberculosis. Non-specific effects, such as  reducing overall infant mortality or the observation of fewer respiratory infections, have been attributed to the vaccine. Underlaying immune  mechanisms have been proposed.
Several clinical trials in first responders and vulnerable populations are evaluating whether BCG mitigates the clinical course of COVID-19.
Investigators will discuss the context and details of their trials.

Julio Croda

19:20 - 19:45: Discussion Q&A session chaired by Camille Locht


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SS-07-Advancements in the TB diagnostics pipeline: FIND and NDWG annual  symposium
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SS-07-Advancements in the TB diagnostics pipeline: FIND and NDWG annual  symposium
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Organised by: FIND and NDWG
Tuberculosis (TB) diagnostics are needed to detect exposure, diagnose disease and drug resistance, and to monitor improvement under treatment in both primary healthcare and laboratory settings. The Foundation for Innovative New Diagnostics (FIND) and the Stop TB  Partnership’s New Diagnostics Working Group (NDWG) bring to you the latest developments in TB diagnostics R&D. You will hear from leading  global experts on the advancements in the TB diagnostics pipeline, improvements in the detection of drug-resistant TB, next-generation  sequencing and the diagnosis of TB infection.

18:15 - 18:20: Introduction

Daniela Cirillo

18:20 - 18:40: TB diagnostics pipeline update: 2020 and beyond While we can accelerate progress, we cannot end the tuberculosis (TB) epidemic with the tools that we have today. We need rapid, and  affordable, non-sputum based tests for diagnosis or triage, accurate drug-susceptibility testing for critical medicines, and better tools to detect TB infection and testing for risk of progression to active disease. We are working with our partners and donors to make easy-to-use, robust, reliable and highly accurate tests a reality in routine clinical settings, particularly at the lower levels of care. Our R&D efforts are  focused on areas of critical unmet needs. Our session brings to you the most comprehensive update on the TB diagnostics pipeline in 2020  and beyond.

Morten Ruhwald

18:40 - 18:50: Recent advances in the diagnosis of drug-resistant TB The development and implementation of rapid molecular diagnostics for tuberculosis (TB) drug-susceptibility testing (DST) is critical to inform patient treatment and to prevent the emergence and spread of resistance. We report results from two recently completed  multicentre diagnostic accuracy studies: 1. the Xpert MTB/XDR assay (Cepheid, USA) for detecting resistance to isoniazid (INH), ethionamide (ETH), fluoroquinolones (FQs) and secondline injectables,amikacin (AMK), kanamycin (KAN), and capreomycin (CAP), and 2) the Molbio Truenat molecular diagnostic assays for detection of M.tb and RIF-resistance.

Adam Penn-Nicholson

18:50 - 19:00: Seq&Treat project: bringing next generation TB care to underserved communities Targeted next-generation sequencing (tNGS) has the potential to revolutionise tuberculosis (TB) drug-susceptibility testing (DST) as it can provide fast, accurate, safe and comprehensive results to inform clinical decision-making for current and upcoming drug-resistant TB  treatment regimens. The Unitaid-funded Seq&Treat project is designed to generate evidence and boost in-country capacity to support  global policy and adoption of end-to-end tNGS solutions for affordable, scalable and rapid TB DST. We report results from analytical validation  of three tNGS end-to-end solutions for detecting resistance to rifampicin (RIF), isoniazid (INH), ethionamide (ETH), fluoroquinolones (FQs),  second-line injectables (amikacin (AMK), kanamycin (KAN), and capreomycin (CAP), and pyrazinamide (PZA), among others.

Anita Suresh

19:00 - 19:10: Improving interpretation of pncA gene mutations for sequencing-based drug-susceptibility testing of pyrazinamid Pyrazinamide (PZA) is a key first line anti-tuberculosis (TB) drug, which is also recommended in regimens for treating isoniazid-resistant TB and for the completion of multidrug/rifampicin-resistant TB regimens. Because of the lack of appropriate infrastructure and technical difficulties,  phenotypic drug-susceptibility testing (pDST) for PZA is not carried out in many high-incidence countries and PZA is, therefore, used  empirically. The World Health Organization has concluded that sequencing of pncA may be the most reliable method to rule-in PZA resistance.  An increasing number of low-incidence countries are introducing routine next-generation sequencing from the first positive culture for all TB  cases. In this scenario, the question becomes how to interpret the pncA sequence data and whether pDST is still needed. This study  introduces a strategy to guide the initial treatment decision and a set of rules regarding confirmatory testing and the resolution of discordant  results.

Paolo Miotto

19:10 - 19:20: Advancing the TB prevention agenda Diagnosis of tuberculosis infection (TBI) remains challenging. To estimate the public health impact and cost-effectiveness  of screening for, and treating incipient TB (ITB), a deterministic, dynamictransmission model was developed by the New Diagnostics Working Group, assuming an ITB test which meets the World Health Organization target product profile. It predicted that, to be cost-effective, the cost of an ITB test will differ widely between countries,  depending on the costing approach and control strategy. Additionally, a systematic review was performed to synthesise current evidence on the  diagnostic value of novel in vivo specific skin tests for TBI compared to currently available in vitro IGRA tests and the PPD-TST. Test  performance of novel skin tests did not differ significantly to that reported for IGRA. Finally, a framework for evaluation of new  immunodiagnostic tests for TBI was developed to facilitate their standardised evaluation. The framework describes the principles to be  considered when evaluating new tests for TBI.

Alberto Matteelli

19:20 - 19:45: Q&A session


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MTE-05-Meet the expert: Bacteriology and Immunology
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MTE-05-Meet the expert: Bacteriology and Immunology
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The external Quality assessment of Cepheid GeneXpert® diagnostic assays
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Community Connect
Researchers sharing with communities: TBTC Study
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Researchers sharing with communities: TBTC Study
TBTC Study 31/ACTG A5349 is a phase 3 trial examining the possibility of shortening the duration and reducing the pill burden of therapy for drug-sensitive pulmonary TB. To this end, the study tested the efficacy and safety of two four-month alternatives to the current six-month treatment. In both experimental regimens, rifampicin is replaced by high dose rifapentine. In one of the regimens, moxifloxacin replaces ethambutol. The trial enrolled over 2,500 people aged 12 and older, as well as people living with HIV. The study was a collaboration between the TB Trials Consortium (TBTC)/U.S. CDC and the AIDS Clinical Trials Group (ACTG)/U.S. NIH.
The study has come to an end and the research team will present its results during the Union Conference (Session No. 523: High-dose rifapentine with or without moxifloxacin for shortening treatment of tuberculosis: TBTC Study 31/ACTG A5349 phase 3 clinical trial results). It is now paramount to share the results with communities, answer their questions, and plan next steps together.
This 90-minute session with the study’s principal investigators, CRAG members, and a study participant/volunteer (TBC) is an opportunity to be transparent and accountable with communities by sharing results from a major clinical trial with the potential to change the global standard of care for drug-sensitive TB soon after they are first presented to a scientific audience.

1. Payam Nahid (TBTC primary investigator, USCF, USA)
2. Dick Chaisson (ACTG and TBTC primary investigator, JHU, USA)
3. Dorothy Namutamba (Community Research Advisors Board Co-chair, Uganda)
4. Barbara Seaworth (Community Research Advisors Board Co-chair, USA)
5. Cynthia Chirwa (Study team community representative, Zambia/USA)
6. Mike Frick (Treatment Action Group, USA)
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SS-08-Role of policy and community in addressing Latent TB in India: leaving no one behind
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SS-08-Role of policy and community in addressing Latent TB in India: leaving no one behind
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Organised by: KHPT, NTEP, USAID

Latent TB infection is a clinical condition defined by a positive tuberculin skin test in patients who have no clinical or radiological evidence of active disease. While India carries the highest burden of TB, with an estimated 2.69 million cases in 2018, there exist a high number of people with latent TB infection, with nearly 40% of the country’s population harboring this ‘silent infection’. In India, patients are not only burdened by their illness, but are concomitantly afflicted by tremendous social stigma due to being tested TB positive. This in turn has detrimental effects on the patients’ health and well-being, and is also one of the main drivers for negative health-seeking behavior. To this already dire situation are a large number of patients who are more at-risk of contracting TB, and less likely to seek or receive medical help for the same. In this light, we want to utilize a human-centric approach to best address the needs, create policy changes and provide access to treatment to the most vulnerable section of society, those who have been suffering in silence for far too long.


09:45 - 09:49: Introduction


09:49 - 10:06: Role of community in addressing LTBI in India

H.L Mohan

10:06 - 10:16: Leveraging community networks for addressing LTBI

Karuna Sagili

10:16 - 10:26: Role of Policy in addressing LTBI in India

Dalbir Singh

10:26 - 10:34: The key role of global partnerships: USAID and LTBI in India

Reuben Swamickan

10:34 - 10:37: Role of TB survivors in addressing LTBI in India

Sunitha David

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MTE-06-Meet the expert session: HIV
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MTE-06-Meet the expert session: HIV
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HIV and COVID-19
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MTE-07-Meet The Expert session: Adult and Child Lung Health
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MTE-07-Meet The Expert session: Adult and Child Lung Health
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Health and wellbeing post TB

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