19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Community Connect
Strengthen Systems of TB Survivors and Civil Society
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Strengthen Systems of TB Survivors and Civil Society
Strengthening community systems is key to a strong and vibrant TB response. However, TB has yet to really tap into this opportunity through Global Fund Grants. This session will talk a little to CSS - what it is and how to engage with opportunities, and will also look to focus more specifically on the needs of people affected by TB and how to utilise CSS opportunities to strengthen national TB responses.

RD Marte, APCASO
David Bryden, RESULTS US
Olive Mumba, EANNASO
Olya Klymenko, Tbpeople
Achut Prasad Sitaula 
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Channel 1
OA-22-Improving the quality of care
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OA-22-Improving the quality of care
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-22-633-23-Enhancing early detection of TB through targeted outreach in hotspots: an experience of Amref Health Africa in Kenya Targeted tuberculosis (TB) outreaches in hotspots to enhance early detection of TB in schools, prisons, health facilities, market places and public transport termini: an experience of Amref Health Africa in Kenya in collaboration with the national TB programme.

Alice Wanyonyi

11:13 - 11:21: OA-22-634-23-A precision public health approach to identify at-risk population segments and their drivers for not seeking care for TB We conducted an 84,625 household community-based survey in 2017-2018 in Chennai, India, and prospectively followed 1,667 people with tuberculosis (TB) suggestive symptoms. We identified contextual and perceptual drivers of care-seeking, segmented respondents by care-seeking behaviour using unsupervised clustering, and estimated the percent of population with TB that would fall into each segment.

Tichakunda Mangono

11:21 - 11:29: OA-22-635-23-Implementing the standardised patient method to evaluate quality of TB care among private practitioners in South Africa We evaluated the feasibility of utilising patient actors (standardised patients) to determine the quality of tuberculosis care among private GPs in two South African cities. We describe the feasibility, challenges and implementation outcomes of this mixed methods project.

Jody Boffa

11:29 - 11:37: OA-22-636-23-Using low-cost interventions to improve availability of TB medicine in Uganda Tuberculosis (TB) commodities management in a resource-limited setting is vital in ensuring access to quality TB care and services. This can be achieved through implementation of low-cost, inventory management interventions to improve the availability of, and uninterrupted access to, TB medicine, resulting in better TB treatment outcomes.

Henry Kizito

11:37 - 11:45: OA-22-637-23-How the dual role of community facilitators as sample transporters and TB patient contact tracers increased contacts coverage and TB case finding in Kampala The laboratory network in Uganda is linked by motorcycles transporting samples. The Uganda tuberculosis (TB) prevalence survey highlighted inadequate systems for TB patient contact tracing in communities. Challenges to TB diagnosis included delays in reaching/linking TB patients contacts to facilities. To address these, The United States Agency for International Development's Defeat TB project integrated sample transportation systems with community TB contact tracing.


Ronald Mangeni

11:45 - 11:53: OA-22-638-23-Quality of TB and HIV care among private general practitioners in two South African cities Little is known about the quality of tuberculosis (TB) and TB-HIV care in South Africa's private sector, despite 29% of people with TB symptoms seeking private care first. We report on the quality of TB and HIV management received by patient actors presenting to private GPs in Durban and Cape Town.

Sizulu Moyo

11:53 - 12:01: OA-22-639-23-Understanding the dynamics of antibiotics and steroids prescription prior to TB diagnosis in South Africa’s private sector Antibiotic and steroid use can lead to tuberculosis (TB) diagnostic delay and/or complications with TB treatment. We report insights into prescription dynamics based on the qualitative findings from a quality of TB care study among private general practitioners in an urban centre of South Africa.

Jeremiah Chikovore

12:01 - 12:20: Q&A


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Channel 7
OA-25-TB: deep into molecular structure
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OA-25-TB: deep into molecular structure
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-25-655-23-Transmission of Mycobacterium tuberculosis genotypes and their association with drug resistance in Mumbai, India Transmission of drug-resistant Mycobacterium tuberculosis complex (DR Mtbc) strains of particular subtypes/genotypes in high burden areas like Mumbai, poses a scenario of rapid spread of DR Mtbc strains.  We attempt to determine transmission levels, through genome-based cluster analysis of Mtbc strains from Mumbai city, using whole genome sequencing.

Viola Dreyer

11:13 - 11:21: OA-25-656-23-Delineate TB transmissions for outbreak investigations using whole genome sequencing in Taiwan For facilitating tuberculosis (TB) control, whole genome sequencing needs to be combined with classical epidemiological methods for improving resolution of transmission networks and for improving outbreak investigation. Preliminary results showed that higher SNP threshold might be required to define a multidrug-resistant TB outbreak. 

Tai-Hua Chan

11:21 - 11:29: OA-25-657-23-Characterisation of mutations in the rifampicin resistance-determining region of the rpoB gene associated with multidrug-resistant TB in Zambia For many low-income settings, access to full drug susceptibility testing (DST) is limited. Innovative ways of interpreting laboratory results, informed by existing laboratory data, can contribute positively to management of drug-resistant tuberculosis in the absence of full DST results.

Winnie Mwanza

11:29 - 11:37: OA-25-658-23-MIRU-VNTR genotyping indicates marked heterogeneity of TB transmission in the United States, 2009–2018 Heterogeneity in the number of secondary tuberculosis (TB) cases per source case is important in modelling the impact of control strategies on incidence. We used genotyping data from U.S. TB cases to estimate the distribution of the number of secondary cases per source case and found a highly skewed distribution.

Carly Rodriguez

11:37 - 11:45: OA-25-659-23-Tuberculosis Molecular Bacterial Load Assay (TB-MBLA): a method to speed early phase tuberculosis TB clinical trials Pharmacodynamic (PD) biomarkers in Phase II studies measure drug efficacy to define phase III studies would be appropriate. Current culture-based techniques impose significant delay and cannot be used for treatment monitoring. TB-MBLA is a molecular measure of the number of live bacteria by detecting16S rRNA, allowing rapid treatment monitoring.

Evelin Dombay

11:45 - 11:53: OA-25-660-23-Impact of Randomised, blinded rechecking programme on the performance of the acid-fast bacilli microscopy laboratory network in Uganda: an eleven years' retrospective study Microscopy’s yield highly depends on the staining technique and reading ability of laboratory personnel. Uganda set up a randomised, blinded rechecking in 2008, an external quality assessment programme. We conducted an eleven-year, retrospective study to evaluate the programme impact on the performance of Uganda’s microscopy laboratory network.

Andrew Nsawotebba

11:53 - 12:20: Q&A


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Channel 2
OA-23-TB: finding the missing millions
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OA-23-TB: finding the missing millions
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-23-640-23-Improving detection of persons with TB during national polio immunisation plus days and polio outbreak response activities in Kaduna State, Nigeria Nigeria remains among the high burden tuberculosis (TB), TB-HIV and drug-resistant TB countries. Leveraging on the polio immunisation plus days (NIPD), where virtually every household in the state is visited by the house-to-house vaccination teams, presents an avenue for identifying the missing or un-diagnosed people with TB in the community.

Dauda Samuel Hananiya

11:13 - 11:21: OA-23-641-23-Results of active case finding with, and without, the joined approaches of the seed-and-recruit model We have shown that roving, one-off active case finding, along with a joint seed-and-recruit model, can have a significant impact on the number of people receiving tuberculosis (TB) treatment, even in the context of a well-functioning TB programme with declining notifications. We are very happy with the success of both projects generating high additionality.

Monyrath Chry

11:21 - 11:29: OA-23-642-23-Missing no more: improved case detection of childhood TB through active case finding in hard-to-reach riverine communities in southern Nigeria We report the results of a focused, community-wide project intervention in hard-to-reach riverine communities in southern Nigeria, and the corresponding impact on childhood tuberculosis case notification within the intervention period. Our findings highlight enablers that can improve TB case finding in resource-constrained settings.

Ngozi Murphy-Okpala

11:29 - 11:37: OA-23-643-23-Thinking outside the (TB) box: intensified paediatric TB case finding in non-TB entry points in nine sub-Saharan countries Paediatric tuberculosis (TB) is under-diagnosed, highlighting a need for effective case finding. We introduced systematic TB screening using a child-adapted, symptom-based tool in waiting areas of non-TB entry points across nine countries. We found low numbers needed to screen in order to diagnose one case in outpatient departments, paediatric wards and nutrition services.

Shirin Kakayeva

11:37 - 11:45: OA-23-644-23-Implementing structured TB screening as part of routine child care services at orphanage homes in a Nigerian local government area Five large orphanage homes were engaged to include regular tuberculosis (TB) screening as part of their routine care package for the children. Over a nine-month period, TB cases were diagnosed among the children and their caregivers. We recommend that periodic evaluation for TB be considered for all such settings.

Ukamaka Onyima

11:45 - 11:53: OA-23-645-23-Data-driven TB active case finding in South Kivu, Democratic Republic of the Congo, leveraging innovative predictive and surveillance reporting software applications We designed and tested a two-step methodology for the systematic screening of tuberculosis (TB) for active case findings. This encompasses the development of an incidence-rates prediction map at a very granular level and the usage of the Mediscout© applications for individual risk assessment. The pilot test in South Kivu showed promising results.

Mauro Faccin

11:53 - 12:01: OA-23-646-23-Finding missing patients: yield of targeted universal testing for TB in high-risk groups presenting to 30 primary healthcare facilities in South Africa We report yield of a risk factor-based testing strategy in South Africa. To be tested, clinic attendees had ≥1 tuberculosis (TB) risk factor; HIV infection; recent contact with a TB patient or recent prior TB, irrespective of symptoms of TB. Participants provided a single specimen for Xpert Ultra and MGIT culture.

Rebecca Berhanu

12:01 - 12:20: Q&A


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Channel 3
SP-27-Exploring existing and potential uses of artificial intelligence for TB programming
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SP-27-Exploring existing and potential uses of artificial intelligence for TB programming
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The relevance of artificial intelligence (AI) is increasingly apparent in the domain of public health: machine learning and deep learning algorithms allow models to make predictions (about individual or geographical tuberculosis [TB] risk). The potential for AI autonomous systems to enable TB programmes to prioritise resources is predominantly unexplored territory. This symposium showcases novel AI applications which can support TB and COVID-19 risk profiling across geography and populations and the optimisation of diagnostic resource placement. Advances in digital image and cough recognition will also be presented, including dedicated discussions on how these, and all presented AI technologies, can support sub-national decision making.

11:00 - 11:05: Introduction

11:05 - 11:15: Geographic TB risk profiling: real-time geospatial electronic case-based surveillance of TB active case finding in PakistanAlthough tuberculosis (TB) continues to affect us all, it is predominantly a disease that disproportionately impacts certain geographic and risk communities greater than others. External factors such as climate, population density, urbanity and geographic location are  known to have an effect on disease transmission and burden, but how do we create the evidence to support these probably causal relationships for TB? And how does that help us in understanding the subnational variations in TB risk? This presentation addresses how a predictive model for subnational TB risk, grounded in a Bayesian framework, helps us to discover the unknown unknowns to unlock TB case detection and to optimise TB programme steering. Early outputs of subnational TB risk variation from the use of the model in several districts of Pakistan will be presented.
Matthys Potgieter

11:15 - 11:25: Reinforcement learning to support public health decision making and optimise geographic allocation of diagnostic resourcesMaximising efficiency of preventive public health strategies is an essential part of the response to infectious disease epidemics. To properly understand epidemiological processes, and to study emergency scenarios, epidemiological models that enable us to make predictions and to study the effect of prevention strategies in simulation are necessary. As the development of prevention strategies remains challenging, it is important to study how optimisation techniques can be used to support decision makers. To this end, reinforcement learning approaches can help us to determine optimal prevention strategies. We discuss different reinforcement learning approaches, from multi-armed bandits to deep reinforcement learning, and discuss how these methods can be used to assist decision makers in the context of pandemic influenza. Finally, we conclude with a look at the potential of using these methods to optimally locate GeneXpert machines to serve the population tuberculosis and COVID-19 diagnostic needs.
Pieter Libin

11:25 - 11:35: Using optimisation and heuristic algorithms to improve diagnostic networks and sample referral system designThis presentation will discuss how optimisation software, such as LLamasoft’s Supply Chain Guru, and a recently developed open-access tool can help improve the design and performance of diagnostic networks and specimen referral systems. Country examples will be given across Kenya, Tanzania, Philippines, India etc and topics will include key questions that this type of software can address (machine placement in existing facilities, optimal locations for new facilities for machine placement, and specimen transportation system), necessary data to input into the software, potential improvement in performance, challenges and limitations, and the shift from design to implementation.

11:35 - 11:45: How artificial intelligence can significantly improve the efficiency of TB programmes by automatic interpretation of chest X-rays?This presentation will focus on QURE.AI’s use of deep learning artificial intelligence (AI) technology for interpreting chest X-rays (analogue and digital) to radically improve tuberculosis (TB) detection efficiencies. It will also address how an android app-based, end-to-end screening process can streamline the usage of AI, detect fraud and simplify programme reporting. Lessons learned from the usage of AI across programmes funded by The Global Fund, TB REACH and USAID will also be shared.
Prashant Warier

11:45 - 11:55: TB and COVID-19 cough pattern recognition using artificial intelligenceDocturnal’s cough screening app for detection of pulmonary tuberculosis (TB) - TimBre - based on a machine learning algorithm, shows a sensitivity of 80% and specificity of 92%, updated from recent trial results and cross validated against GeneXpert and chest X-ray. The underlying training data covered a wide spectrum of labelled lung- based cough including asthma, COPD, pulmonary TB, drug-resistant TB, people living with HIV and TB, empyema, emphysema as well as controls across both the genders. TimBre’s existing infrastructure for a smartphone with a built in microphone naturally extends to screen for ncovid19 and has been repurposed, using existing pneumonia cough sounds, and also by obtaining annotated ncovid19 cough sounds. This presentation will present up-to-date results on the sensitivity and specificity of the app, which currently stands at around 79% and 87%, respectively, and is undergoing a global pilot.
Rahul Pathri

11:55 - 12:20: Q&A session

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OA-24-TB and diabetes
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OA-24-TB and diabetes
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-24-647-23-High proportion of transient hyperglycemia at TB diagnosis among people living with, and without, HIV in South Africa In a prospective cohort study of culture-confirmed, drug-susceptible tuberculosis (TB) patients in South Africa, we evaluated hyperglycemia before, and after, TB treatment. We assessed whether HIV status was associated with differences in resolution of hyperglycemia after completion of TB treatment.

Yuri van der Heijden

11:13 - 11:21: OA-24-650-23-Optimising diagnosis of diabetes mellitus among TB patients: preliminary findings from a multicentre study in Tanzania Active tuberculosis (TB) has a three-fold increase in populations with diabetes mellitus (DM) with overlapping clinical presentations to compromise clinical outcomes.  A study was conducted to implement an algorithm for DM screening in TB patients for early intervention of DM related complications. 

Kenneth Byashalira

11:21 - 11:29: OA-24-652-23-Prevalence of diabetes mellitus among people tested for TB in urban Uganda The increase in type 2 diabetes mellitus in sub-Saharan Africa where tuberculosis (TB) is also endemic has raised interest in diabetes as a risk factor for TB. We estimated the prevalence of diabetes using hemoglobin A1c among people tested for TB in urban Uganda.

Kamoga Caleb Erisa

11:29 - 11:37: OA-24-653-23-Screening hospitalised patients with diabetes mellitus for TB in rural South Africa This study describes the yield of systematic tuberculosis (TB) screening in hospitalised diabetic patients in two hospitals in rural South Africa where the burden of both diseases is high. The yield in different study sub-groups is described and the incremental yield of different diagnostic methods is shown.

Abera Balcha Bulti

11:37 - 11:45: OA-24-654-23-Performance of random plasma glucose compared to glycated hemoglobin in screening for diabetes in Filipino persons with TB This research assessed the performance of the use of random plasma glucose (RPG) and two-step RPG/HbA1c ≥6.5% to screen diabetic patients (HbA1c ≥6.5%) with tuberculosis in the Philippines. The sensitivity/specificity of RPG 200mg/dL was 38%/100%. Using two-step RPG≥110mg/dL as a first screen, then HbA1c≥6.5%, would have missed 25/100 diabetic cases.

Shuichi Jack Suzuki

11:45 - 12:20: Q&A


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SP-29-TB in pregnancy: what’s new in prevention and treatment?
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SP-29-TB in pregnancy: what’s new in prevention and treatment?
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Diagnosing, preventing and treating tuberculosis (TB) disease is essential to reduce poor maternal and infant outcomes known to be associated with TB during pregnancy. In this session, speakers will discuss current challenges in TB prevention, use of new short course TB prevention regimens during pregnancy, and long-term outcomes of bedaquiline for pregnant women with multidrug-resistant TB. The session will conclude with a discussion on innovative methods to study TB in pregnancy.

11:00 - 11:05: Introduction

11:05 - 11:17: Controversies of TB prevention during pregnancyPregnant and postpartum women are at an increased risk of contracting tuberculosis (TB) disease, particularly in the context of HIV-co-infection. Morbidity is often severe, with adverse maternal, pregnancy and infant outcomes. TB preventive therapy (TPT) is effective in preventing TB disease in women living with HIV, but there are concerns about the risks and benefits to both mother and foetus of TPT during pregnancy. Regimen choice, and the optimal timing and duration of therapy to maximise benefits and safety, are also unclear. Decisions may be context-specific depending on TB and HIV prevalence and national screening, diagnostic and treatment practices. Current evidence and outcomes of TPT in pregnancy and the postpartum period are summarised and the challenges discussed.
Emma Kalk

11:17 - 11:29: 3HP, a new option for TB prevention during pregnancy?Pregnancy increases the risk of progressing from latent tuberculosis infection (LTBI) to active TB. A recent randomised controlled trial reported increased risk of adverse pregnancy outcomes in women with HIV, who initiated isoniazid preventive therapy during pregnancy, versus in the postpartum period. These results have left national and international programmes at a loss for what to recommend for TB prevention in pregnant women at high risk of developing active TB. IMPAACT 2001 was a multisite Phase I/II study evaluating the pharmacokinetics and safety of 3HP among pregnant women with, or without, HIV. In this talk, the results of this important study and its implications for antenatal policies will be presented.
Jyoti Mathad

11:29 - 11:41: The short bedaquiline regimen in pregnant women with rifampicin-resistant TB: treatment, pregnancy and infant outcomesThe South African Medical Research Council (MRC) studies an ongoing cohort of pregnant women with rifampicin-resistant tuberculosis (RR-TB). We previously reported maternal treatment, pregnancy and infant outcomes in the first 108 women enrolled, comparing outcomes in the injectable versus bedaquiline-containing regimens. We now report maternal treatment, pregnancy and infant outcomes at six months in 18 women treated with the short (nine–12 month) bedaquiline regimen. Sixteen (89%) of the women were co-infected with HIV and on antiretroviral treatment, the median age was 28.5 years. Thirteen (72%) have successfully completed treatment. Of 16 babies born, 4 (25%) were premature and 5 (31%) low birth weight(<2500g). There were no foetal or neonatal deaths. Eleven babies have been clinically assessed at six weeks, all are thriving (following the normal growth trajectory) and achieving their developmental milestones timeously. Pregnant women treated with the short bedaquiline regimen have similar treatment outcomes to non-pregnant adults. All who have delivered have healthy babies.
Marian Loveday

11:41 - 11:53: Innovative research study designs on TB in pregnancy: challenges and solutionsThe risk of developing tuberculosis (TB) for a woman is highest during pregnancy and the early postpartum period. Unlike non-pregnant adults, we have a poor grasp of best practices for screening, diagnosing and preventing TB in pregnant women. Pregnant women need to be followed from pregnancy through delivery and postpartum to understand the immunological dynamics during this period. A significant challenge is enrolling and retaining pregnant and postpartum women. Since 2016, we have conducted an observational cohort study of HIV-infected and –uninfected pregnant women with latent TB infection (PRACHITi) to improve our understanding of the intersection of TB and pregnancy immunology. In this talk, the results of PRACHITi will be presented as well as strategies employed to maintain >90% retention rate for 12 months postpartum.
Mallika Alexander

11:53 - 12:20: Q&A session

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SP-28-My care, my metrics: why patient definitions of person-centred care are critical
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SP-28-My care, my metrics: why patient definitions of person-centred care are critical
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Globally, definitions and metrics of high quality tuberculosis (TB) care are informed primarily by clinical perspectives. These definitions exclude what patients define as high quality care and are often at odds with patients’ socioeconomic realities. This affects both their experience of care and their ability to battle TB. Hence, it is critical that person-centred care is defined by patients and communities themselves. Departing from medicalised models of care, this session combines expert and patient perspectives to create an inclusive patient-led conversation around person-centred care, emphasising the importance of patient perspectives in ensuring high quality of care in TB.

11:00 - 11:05: Introduction

11:05 - 11:15: Why we need a patient-led and person-centric solution in TBThis presentation talks about the need for patient-led models of person-centric care. It examines the relevance of this approach for large populations at risk globally, especially those most vulnerable, and how to best cater to them, based on examples and case studies. It examines this by looking at current challenges that need to be addressed through such models in global approaches to stemming the tuberculosis epidemic.
Madhukar Pai

11:15 - 11:25: A patient's definitions of care: challenges and opportunitiesThis presentation draws on the presenter’s experience as a tuberculosis (TB) patient. Using lived experience identifies the systemic, treatment, economic and personal challenges that patients face in accessing appropriate care. In doing so, it seeks to identify the key challenges faced by patients and communities at risk, and how understanding these perspectives gives opportunities to define high quality care that the health system ought to provide to patients.
Ashna Ashesh

11:25 - 11:35: Community and patient participation in defining health needs and health policy: what does TB need?This presentation illustrates significant approaches to participative approaches to defining health needs and using it to inform policy. It compares participation and community-led models of communities' making and defines quality of care across diseases and in different countries. In doing so it seeks to draw lessons for enhancing community and patient participation in identifying needs and the framing of policies and interventions for defining tuberculosis care.
Amrita Daftary

11:35 - 11:45: Patients defining care as consumers: what we can learn from other diseasesDrawing from the presenter’s experience as a tuberculosis (TB) survivor and a person living with HIV, this presentation will do a comparative analysis of the experience of patients defining care in both diseases. It will examine how this has impacted the patient experience of receiving care and the lessons that can be drawn to make TB care person-centric. In particular it will focus on issues of how care can become more person–centred, address issues of patient support, mental health and stigma.
Sunil Gupta

11:45 - 11:55: A model of care from a survivor’s perspective: key elementsThis presentation seeks to present some fundamental aspects that a patient and community-led model of person-centred care must include. The presenter draws on presented challenges and opportunities and his experiences as a tuberculosis survivor, and sketches out the key elements that community and patient-led models of care must include.  
Saurabh Rane

11:55 - 12:20: Q&A session

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Community Connect
TB Champions respond to COVID-19: Narratives from India
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TB Champions respond to COVID-19: Narratives from India
The COVID-19 pandemic limited access to TB services across India. This was reflected in Nikshay data, media reporting and reports by TB advocates showing that TB case notification had declined considerably and loss to follow up cases had surged. COVID-19 presented new challenges for healthcare providers as well as affected communities, particularly during the nation-wide lockdown period.  Through this session at Community Connect, TB Champions will share their experiences of supporting the TB response in India as the COVID-19 pandemic unfolded. They will speak about how they were able to first protect themselves and their families; about their position as leaders within their communities; and how they adapted to using mobile phones to keep supporting people with TB. They will also share the challenges they have faced in acting as an interface between people with TB and health system during this extremely stressful period. 

Chairs:
1. Anuradha Panda 
2. Subrat Mohanty

Speakers:
1. Ravindra Karma, TBC Chhattisgarh 
2. Sheet Kumar TBC Jharkhand 
3. Bibhuti Bhusan Sahu, TBC Odisha 
4. Sushma Mahali,TBC Jharkhand 
5. Abhishek Kumar, TBC Bihar 
6. Khageshwar Kumar, TBC Jharkhand 
7. Kalyani Nishad, TBC Chhattisgarh 
8. Anjana Kumari TBC Bihar
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SP-32-Regional studies that are improving the zoonotic TB scientific evidence base
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SP-32-Regional studies that are improving the zoonotic TB scientific evidence base
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The Roadmap for Zoonotic TB highlights the needs and opportunities for improving the scientific evidence base through a 'one health' approach. This includes the systematic assessment of the burden and impact of zoonotic tuberculosis (zTB) in people and the development of strategies for reducing the risk of spillover from livestock. This symposium brings together internationally recognised multidisciplinary experts who successfully planned and implemented zTB programmes in endemic areas, demonstrated how this disease is generally under-reported and who highlighted the challenges and opportunities for assessing zTB burden as well as developing fit for purpose strategies for zTB control and reduction of health impacts.

12:30 - 12:35: Introduction

12:35 - 12:45: A comprehensive one- health approach to combat bovine TB in Santa Catarina state, BrazilBovine tuberculosis (TB) cases in humans often go undetected or misdiagnosed because current laboratory tests cannot differentiate the bacteria that causes bovine TB, leading to death or delayed treatment in patients. Dr Anzai is assessing new diagnostic tests that will reduce cost, enable rapid detection and significantly aid in preventing transmission of bovine TB between animals and from animals to humans.
Eleine Anzai

12:45 - 12:55: Tackling zoonotic TB through animal disease control: the French experienceHer programme at ANSES has demonstrated that a group of second line molecular tests could confidently be added as an official test in order to accelerate the diagnosis process and improve bovine tuberculosis (TB) surveillance in Europe and to render control and eradication programmes more efficient in the future. This programme will also aid in the assessment of bovine TB cases transmitted to humans.
María Laura Boschiroli

12:55 - 13:05: Surveillance of animal-adapted Mycobacterium tuberculosis complex in clinical and bovine carcasses in Ghana: a call for active one-health approach for TB controlThe true burden of zoonotic tuberculosis (zTB) remains unknown, due to lack of specific diagnostics for distinguishing the animal-adapted variants from the human-adapted Mycobacterium tuberculosis complex. Furthermore, due to lack of funding and, to some extent manpower, routine surveillance is not done. My presentation will span from earlier screening activities we conducted with the veterinary services on herds from a tertiary research facility and from free-range as well as findings from the population-based molecular epidemiological study and an on-going study analysing for mycobacteria among carcasses from selected slaughterhouses.
Dorothy Yeboua-Manu

13:05 - 13:15: M. bovis infection in Baja California: a cattle-cheese-human trifectaBaja California in Mexico has a longer border with the US than with other Mexican states and is home to the busiest land border crossing region in the world. There are an estimated 50 million legal human crossings per year, making it a region highly susceptible to the movement of pathogens. This is thought to be one of the main reasons why Baja California is the Mexican state with one of the highest rates of tuberculosis (TB) in humans and food animals in the country. This area should be a model area for generating robust scientific evidence to further advocate for funding and political commitment to address the challenges posed by zoonotic TB.
Alejandro Perera

13:15 - 13:25: Defining genes essential for the survival of Mycobacterium bovis to identify novel therapeutic targets for zoonotic TBLineages of the are highly similar genetically yet show distinct host preferences. Several studies identifying the impact of sequence variation on differences in gene expression have provided useful insights into the differences between Mycobacterium tuberculosis complex lineages. However, studies examining the impact on sequence variation on the genetic requirements for survival have been limited to the human adapted lineages.
We are using TnSEQ in order to identify the genetic requirements for survival of the reference strain of Mycobacterium bovis. We have used the MycomarT7 phagemid system which inserts into permissive TA sites across the genome. Transposon insertions were randomly distributed throughout the genome and 34,178 out of a total of 73,536 TA sites contained insertions. CRISPRi interference has been successfully established in the laboratory and will be utilised to validate putative essential genes.

Sharon Kendall

13:25 - 13:50: Q&A session

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