19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 4
OA-30-The HIV-TB and diabetes late-breaker session
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OA-30-The HIV-TB and diabetes late-breaker session
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15:00 - 15:05: Introduction


15:05 - 15:17: LB-1903-23-Diagnostic accuracy of a novel point-of-care urine lipoarabinomannan assay for the detection of TB among adult outpatients in Zambia: a prospective cross-sectional study The SILVAMP FujiLAM assay is a promising, new, rapid point-of-care test for tuberculosis (TB). However, to date, it has not been evaluated using fresh urine specimens. We prospectively determined the diagnostic accuracy of the SILVAMP FujiLAM assay among HIV-positive and HIV-negative outpatients with presumptive TB in Zambia.

Monde Muyoyeta

15:17 - 15:29: LB-1930-23-Glycemic trajectories after TB diagnosis and treatment outcomes of new TB patients: a prospective cohort study in Eastern China Tuberculosis (TB) patients with either transient hyperglycemia or glycemic instability, were multifold higher risk of poor treatment outcomes compared to patients with normal glycemic trajectories. These patients represented half of treatment failures in the cohort. Glycemic kinetics, regardless of diabetes status, may be an important marker for  response to TB treatment.

Leonardo Martinez

15:29 - 15:41: LB-2044-23-Prevalence of diabetes mellitus among patients with TB in low- and middle-income countries: a systematic review of 39 cross-sectional studies Diabetes mellitus (DM) and tuberculosis (TB) are both among the top ten global causes of death and affect low- and middle-income countries (LMIC). The objective of this paper is to assess the prevalence of DM among patients with TB in LMIC and the percentage of those newly diagnosed with DM.

Jessica Lewis

15:41 - 15:53: LB-2071-23-Exploring barriers and facilitators of diabetes mellitus management within the Philippines TB programme: a mixed methods patient-centred health systems study This study aims to understand barriers and facilitators to diabetes mellitus (DM) service delivery within tuberculosis (TB) DOTS clinics that impact on patient-level DM management, using a quantitatively driven mixed methods approach within a cohort of more than 800 patients undergoing TB treatment in the Philippines.

Lauren Oliveira Hashiguchi

15:53 - 16:20: Q&A


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Channel 2
OA-28-New and old tests for latent TB infection
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OA-28-New and old tests for latent TB infection
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15:00 - 15:05: Introduction


15:05 - 15:13: OA-28-673-23-Systematic review on the diagnostic performance of specific skin test for latent TB infection compared to interferon-gamma release assays and tuberculin skin tests We systematically reviewed the performance of newer skin tests - C-Tb, Diaskintest and ESAT6-CFP10 - for latent tuberculosis infection including 31 previous studies in the data synthesis. Test performance was comparable to the tuberculin skin test and interferon-gamma release assays. Prospective head-to-head diagnostic accuracy studies and longitudinal evaluations are needed.

Maria Krutikov

15:13 - 15:21: OA-28-674-23-An evaluation of community-based TB infection testing using the QuantiFERON-TB Gold Plus assay and preventive treatment linkage in Ho Chi Minh City, Viet Nam Friends for International TB Relief (FIT) piloted the integration of tuberculosis (TB) infection testing using 5,000 QuantiFERON-TB Gold Plus assays at mobile chest X-ray screening events in Ho Chi Minh City, Viet Nam. This analysis examines testing yields, TB preventive treatment linkage using nine months of isoniazid, and treatment outcomes.

Nga Thuy Thi Nguyen

15:21 - 15:29: OA-28-675-23-The magnitude of interferon-gamma release assay response among children with household contact in a high burden setting is associated with TB exposure and active disease The magnitude of IFNy response in children with tuberculosis (TB) household contact correlated with the degree of Mycobacterium tuberculosis (M.tb) exposure using QFT-GIT and T-SPOT.TB. Among contacts ≥2 years, QFT-GIT IFNy levels were significantly higher in children with TB disease compared to children with M.tb infection.

Lena Ronge

15:29 - 15:37: OA-28-676-23-Correlation between monocyte to lymphocyte ratio and tuberculin skin test positivity among antiretroviral treatment-naïve adults Tuberculin skin test (TST) is known to be a barrier to isoniazid preventive therapy implementation. Therefore, alternative tests to assess tuberculosis (TB) risk, such as peripheral blood monocyte to lymphocyte ratio (MLR), have been explored. This study documents the correlation between TST positivity and peripheral MLR in people living with HIV.

Eva Van Ginderdeuren

15:37 - 15:45: OA-28-677-23-Novel strategies for tuberculin skin testing at primary care clinics: an economic evaluation A self-reading, fast-tracking and task-shifting model - combining patient empowerment and differentiated care models - proved to be an innovative, reliable and cost saving approach to tuberculin skin test-guided screening for tuberculosis (TB) preventive therapy in both high and low TB prevalence settings.

Eva Van Ginderdeuren

15:45 - 15:53: OA-28-678-23-TB screening in healthcare workers in Mozambique: where are we? Healthcare workers are a high risk group for tuberculosis (TB) infection. Knowing the burden of TB in this group, it is important to design better strategies towards control and elimination of the disease in this population. Infection control practices are necessary in this population.

Pereira Zindoga

15:53 - 16:01: OA-28-679-23-Identification of barriers and facilitators of TB contact investigation in Cali, Colombia Through a cross-sectional, qualitative study combining human-centred design, social science methods and a knowledge-growing strategy, we conducted different activities with stakeholders to examine their perceptions and lived experiences and, finally, identify barriers to, and facilitators, of tuberculosis (TB) contact investigation in Cali, the third largest Colombian city.

Juan Jiménez-Garcia

16:01 - 16:20: Q&A


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Community Connect
Results of TB community, rights and gender assessments in EECA region
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Results of TB community, rights and gender assessments in EECA region
From 2016 to date several communities, rights and gender (CRG) assessments and reviews were conducted in Eastern Europe/Central Asia (EECA) countries: Georgia, Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine. The purpose of this presentation is to introduce and discuss the common bottlenecks and solutions. Assessments supported by the Global Fund through the regional program on advancing people-centered quality TB care, or TB-REP 2.0, went through multi-stakeholder prioritization processes, evaluating epidemiological data and a number of risk factors, in order to form a short-list of the most vulnerable to TB key populations. These key populations were subsequently engaged to collect additional qualitative information about human rights, gender, and stigma/discrimination barriers at the level of the health system and individual patient’s level. 

Nonna Turusbekova, Netherlands
Liliana Caraulan, Moldova, PAS Center
Nonna Turusbekova, Netherlands, TBC Consult
Mariam Jibuti, Georgia, New Vector
Oxana Ibragimova, Kazakhstan, Kazakhstan Union of People Living with HIV
Chair: James Malar, Stop TB Partnership
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Channel 6
SP-35-Migration journeys and the risk for TB – what do we know and what do we need to find out?
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SP-35-Migration journeys and the risk for TB – what do we know and what do we need to find out?
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Migration is an important determinant for tuberculosis (TB) epidemiology, both in low and high TB incidence
countries. It can change exposure risk and host vulnerabilities. Especially dangerous transit routes that include crowded and unsafe transport and stopovers may increase the risk for TB
infection and development of disease. This, however, remains largely underexplored. This symposium aims to review migration routes and their health impacts - including TB - outline comparative TB epidemiology and review policy implications, including for screening and early detection.

15:00 - 15:05: Introduction

15:05 - 15:15: Migration routes and their health hazardsThis talk will focus on common routes of migration with evolving patterns of health hazards en route and in detention, and the access to basic services and healthcare. It will set the scene to gain better understanding about differential tuberculosis epidemiologies within the context of migration.
Dominik Zenner

15:15 - 15:25: IOM’s migration health assessment programmesMigration health assessments (MHAs) are one of the International Organization for Migration's (IOM) most well-established migration management services. At the request of receiving country governments, IOM provides migrants with physical and mental health evaluations for the purpose of assisting them with resettlement, international employment, obtainment of temporary or permanent visas, or enrolment in specific migrant assistance programmes. This presentation will outline the MHAs and how the clinics and tuberculosis laboratories have been repurposed in the context of the COVID-19 pandemic.
Christopher Gilpin

15:25 - 15:35: Influence of the migration route on TB epidemiology in Israel: PH Tel AvivThis talk will review the tuberculosis epidemiology of Israel-bound migrants from the horn of Africa, comparing those who were airlifted from Ethiopia and those who made a land journey from Eritrea or Sudan. This talk will use screening and follow-up data from the Israeli programmes, which screened almost 200,000 persons over several decades.
Zohar Mor

15:35 - 15:45: How can we make TB screening for migrants patient-centred? (Dr Matt Burman and Dr Jess Potter)The talk will be co-presented by Matt Burman and Jess Potter. It will consider whether our current models of care for tuberculosis (TB) screening provide a patient-centred approach for migrants and what impact this has on patient experience and health outcomes. The talk will take both a patient-perspective, using recent research in India to understand access to TB screening along the migratory journey to the UK, and a programmatic-perspective using data from a community-based latent TB infection screening and treatment programme in East London.
Matt Burman

15:45 - 15:55: Influence of the migration route on TB epidemiology: how the TB incidence of Netherlands-bound migrants comparesThis talk will provide an overview of descriptive epidemiology of tuberculosis (TB) in migrants in relation to their duration of stay in the Netherlands. It will show the dynamics of migrants developing TB. In 2019, one out of six patients in the Netherlands was born Eritrean and almost all came to the Netherlands as an asylum seeker. The talk will also demonstrate the use of whole genome sequencing in identifying pre-migration outbreaks. Lastly, the talk will discuss interventions to early identify and prevent TB in different migrant groups.
Gerard De Vries

15:55 - 16:20: Q&A session

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Channel 1
SP-NAP-TB educational material discussion session
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SP-NAP-TB educational material discussion session
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15:00 - 15:05: Introduction

15:05 - 15:17: Building Australian nursing workforce capacity through the Masters of Nursing (TB Management)
Kerrie Shaw
Linda Gregory

15:17 - 15:29: U.S. CDC TB education and training materials
Allison Maiuri

15:29 - 15:41: Development of a nursing job aid for managing side effects to DR-TB treatment
Carrie Tudor

15:41 - 15:53: Impactful advocacy capacity strengthening
Lynette Mabote

15:53 - 16:20: Q&A session

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Community Connect
Tuberculosis/Covid19 - barriers, lessons, actions
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Tuberculosis/Covid19 - barriers, lessons, actions
With the onset of the COVID-19 pandemic, we are witnessing the deterioration in access to medical and social services in tuberculosis, which in the future may have irreparable consequences. We will present a pool of barriers and medical services for the EECA region and in the world that have become less accessible for TB patients, as well as possible solutions that we, as a community, see as possible to improve the situation in tuberculosis. We will show the results of monitoring through the oneImpact application (Ukraine), disaggregated by gender, as well as the results of a survey for people with TB or covid 19 (STP).

Chair
Olya Klymenko

Speakers
1.Olya Klymenko - chairman of the board CO TBpeopleUkraine. 
2.James Malar Country and Community Support for Impact | CCS4i Team
1. Vitalina Ustenko 
2. James Malar 
3. Olga Pavlova 
4. Paul Sommerfeld

 
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Channel 4
SP-38-Hidden, but for how much longer? The epidemiological and economic burden of post-TB
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SP-38-Hidden, but for how much longer? The epidemiological and economic burden of post-TB
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Tuberculosis (TB) sequelae are likely among the most important causes of chronic lung disease globally, but we know little about the health and economic impact of TB after treatment completion. This multidisciplinary session aims to summarise novel research estimating the health and economic burden borne by TB survivors, followed by a facilitated panel discussion to stimulate conversation on what analytical, data and policy issues remain. The session starts at the bedside, describing the clinical characteristics of post-TB lung disease, before taking a macro perspective to estimate the number of TB survivors worldwide and the morbidity, mortality and economic burden of post-TB.

16:30 - 16:35: Introduction

16:35 - 16:45: Post-TB lung disease at the bedsideThis talk will begin with the definition of post-tuberculosis lung disease (PTLD), highlighting the strengths and limitations of the currently proposed definition. It will then describe a clinical classification of PTLD and explain areas of complexity, which can hamper measurement of PTLD, using single instruments (e.g. spirometry alone). The talk will use case studies of patients with PTLD as illustrations suitable for both non-clinicians and clinicians not familiar with the management of PTLD. Difficulties in clinical management of such patients will be briefly mentioned.
Brian Allwood

16:45 - 16:55: How many TB survivors are there alive today?We estimate the number of people alive in 2020 who have survived tuberculosis (TB) since 1980. We focus on those who have received treatment for TB (including restricting to those who have received treatment within the last five years), but also estimate the number of survivors whose TB went untreated. We report results by age, sex and HIV status at the World Health Organization (WHO) regional level and global level. To do this, we created post-TB life-tables by adapting UN life tables for each country and sex to single calendar years and ages, separating out HIV-specific mortality and applying hazard ratios for increased mortality among TB survivors. We applied these life-tables to interpolated WHO data on new TB notifications accounting for deaths on treatment. To estimate the number of survivors of untreated TB, we applied our post-TB life-tables and TB case fatality rates to WHO estimates of the gap between notifications and incidence.
Pete Dodd

16:55 - 17:05: Estimating the global morbidity and mortality burden of post-TBEstimates of the global burden of tuberculosis (TB) have focused on the morbidity associated with prevalent TB disease and the years of life lost due to death during the disease episode. In this analysis we estimate the additional burden of disease (years of life lived with disability, years of life lost and disability adjusted life years) resulting from post-TB. We estimated these outcomes for the cohort of individuals that developed TB disease in 2018, as compared to a counterfactual of no TB disease. We estimated outcomes using a mechanistic model that simulated health outcomes over the lifetime, stratified by age, sex, HIV status and multidrug-resistant TB status. We report results by country and regional groupings. Post-TB represents a substantial additional burden of disease caused by TB. These results provide additional motivations for TB prevention and for limiting the accumulation of lung damage and other morbidity for those who do develop disease.
Nicolas Menzies

17:05 - 17:15: Estimating the economic burden of post-TB to the householdReduction of catastrophic costs due to tuberculosis (TB) is a key policy priority globally, but estimates of catastrophic cost currently assume costs are only incurred during the disease episode. In this analysis we estimate patient and household-incurred costs due to post-TB. We describe a framework of post-TB costs incurred by households, including direct medical, direct non-medial and indirect costs. We estimate costs incurred to households for the cohort of individuals that developed TB disease in 2018 in selected countries. We describe preliminary estimates of costs and catastrophic costs incurred by TB-affected households across countries and by category.
Sedona Sweeney

17:15 - 17:25: Hidden, but for how much longer? Synthesising the next steps for post-TB researchIn the final part of this session, we will first synthesise key points raised by panelists and identify key areas of similarity and difference across presentations. Then, we will facilitate a panel discussion to identify important areas for future work to identify what analytical, data and policy issues remain.
Matthew Quaife

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

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SP-39-National TB prevalence surveys in Southern Africa: key results, lessons learned and programmatic implications
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SP-39-National TB prevalence surveys in Southern Africa: key results, lessons learned and programmatic implications
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Accurate measurement of the burden of disease through national tuberculosis (TB) prevalence surveys is part of the work of the World Health Organization's Global Task Force on TB Impact Measurement. Four such surveys were recently conducted in high TB-HIV burden countries in Southern Africa - Eswatini, Lesotho, Mozambique and South Africa. This symposium will present the key results, major lessons learnt and the programmatic implications, followed by how these survey results were used to re-estimate TB burden.

16:30 - 16:35: Introduction

16:35 - 16:45: The road to TB elimination in Eswatini: who are we missing and why?Eswatini, a high TB-HIV burden country, successfully conducted its first national tuberculosis (TB) prevalence survey in 2018. Results showed a significant number of TB cases were being missed with the current symptom screening strategy. Innovative approaches are needed to guide the strategic direction for TB elimination against the high background of HIV. This presentation will share the country’s experience and the policy/programmatic implications of the survey findings.
Welile Sikhondze

16:45 - 16:55: Lesotho national TB prevalence survey 2019: results, lessons learned and implications for the national TB programmeLesotho, a high TB-HIV burden country, conducted a national tuberculosis (TB) prevalence survey in 2019 that was led by University Research Company jointly with its partners NEXT2PEOPLE and AQUITY Innovations. The presentation will focus on the rationale for conducting the survey, methodology (including the use of Xpert Ultra – one of the first countries to do so), lessons learned during implementation, key results (that included a high burden among men compared with women, a burden that increased with age, and a very large TB-HIV co-infection rate) and implications for the national TB programme.
Bridget Maama Llang

16:55 - 17:05: The first national TB prevalence survey of Mozambique, 2018-2019: challenges and achievementsMozambique is on all three World Health Organization high burden lists for tuberculosis (TB), HIV-TB co-infection, and multi-drug resistant TB. The country conducted its first national TB prevalence survey to gain more insight in the country's TB epidemic and used the results to guide TB control in the country. This presentation will discuss the methodological approach, key findings and lessons learned including how to guide quality assurance in culture and manage discordant results between Xpert MTB/RIF and culture. It will also underline key operational and technical challenges faced during the field work. Finally, it will describe the impact of the survey results on the design of future strategies for TB control in Mozambique.
Ivan Manhiça

17:05 - 17:15: Insights into the TB epidemic of South Africa: findings from the first national TB prevalence survey, 2019The first ever national prevalence survey in South Africa was completed in 2019; a country with a high TB-HIV burden and where high levels of community transmission of tuberculosis (TB). Screen-positive survey participants ≥15 years were tested for TB by culture and Xpert MTB/RIF Ultra. Findings from the survey are that the country has a high burden of pulmonary TB, that there is a considerable gap in prevalence to notification, and that many prevalent TB cases were not reported by the routine surveillance system of the national TB programme. TB was not uniformly distributed across age groups, prevalence in men was 1.6 times than that of women, prevalent TB was often not symptomatic, and HIV infection was a major risk factor for symptomatic TB. Previous TB was common among survey participants, which showed the limitation of molecular-based tests in the absence of signs and symptoms. 
Lindiwe Mvusi

17:15 - 17:25: Estimating incidence from national prevalence survey results in Southern AfricaA presentation of statistical methods, key results and their limitations will be made, covering the following countries: Eswatini, Lesotho, Mozambique and South Africa.
Philippe Glaziou

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

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SP-40-Implementation and scale-up of TB preventive treatment: overcoming challenges to reach people living with HIV
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SP-40-Implementation and scale-up of TB preventive treatment: overcoming challenges to reach people living with HIV
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The President's Emergency Plan For AIDS Relief (PEPFAR) has committed to providing tuberculosis preventive treatment (TPT) to all people living with HIV (PLHIV) by 2021. Several countries have launched successful TPT surge efforts to achieve this goal and overcome long standing challenges. This session will describe lessons learned from: i) Uganda’s 100-day surge experience where >300,000 PLHIV were initiated on TPT; ii) TPT scale-up in Kenya, which has achieved near universal TPT coverage; iii) TPT scale-up in the context of COVID-19 in Zambia; and iiii) considerations for implementing effective TPT programmes from the World Health Organization.  We will have moderated discussion with our presenters to discuss country-specific questions and challenges from the audience.

16:30 - 16:35: Introduction

16:35 - 16:47: TB preventive treatment scale-up among adults and children living with HIV: best practices from UgandaIn 2019, Uganda established a task force to dramatically scale-up tuberculosis preventive treatment (TPT) through a coordinated, nationwide 100-day campaign to place all eligible adults and children with HIV on TPT. Because of the strong commitment from political leadership and the technical expertise of their task force, from August to October 2019 Uganda initiated 300,000 people on TPT and reached high levels of TPT completion for those initiating.  The Ugandan experience will be shared, including the importance of building the support needed to mobilise the campaign, as well as executing procurement and supply chain logistics during rapid scale-up.  
Deus Lukoye

16:47 - 16:59: TB preventive treatment scale-up among adults and children living with HIV: best practices from KenyaAfter implementing an aggressive TB preventive treatment (TPT) scale-up effort, the number of people receiving TPT in Kenya increased sixty-fold from just under 10,000 in 2014 to more than 600,000 in 2016.  By December 2018, Kenya had provided TPT to 85% of the one million Kenyans receiving antiretroviral treatment. Since 2014, the number of new TB cases among people with HIV has fallen by 40% and Kenya has achieved the highest proportion of eligible children living with HIV receiving TPT in the region, as well as initiating 35% of eligible child contacts under five years of age on TPT, higher than regional averages. The Kenyan approach pairs political will and supply chain innovations, with local action by health facility and community-based health workers, to reach those most vulnerable to TB disease.  This presentation will demonstrate best practices and step-wise implementation guidance for replicating this success.
Christine Wambugu

16:59 - 17:11: TB preventive treatment scale-up in the context of COVID-19: early experiences from ZambiaSince 2017, Zambia has been scaling-up tuberculosis preventive treatment (TPT) among people living with HIV (PLHIV), though challenges with supply chain stymied efforts. In 2018 and 2019, Zambia doubled the number of eligible PLHIV receiving TPT each year, though nearly 75% of eligible PLHIV had yet to complete TPT.  In December 2019, the ministry of health set an ambitious goal of providing TPT to all PLHIV by the end of 2020.  In February 2020, Zambia launched a campaign to rapidly scale-up TPT at high-volume facilities across the country, aiming to initiate 100,000 eligible PLHIV each month.  Just as Phase One of TPT scale-up was underway and achieving early success, COVID-19 caused the ministry of health to abruptly shift course, adjusting screening protocols, scripting intervals, medication delivery, and the pace of its surge. This presentation will provide an overview of these challenges and early experiences with the strategies and approaches used to tailor the response in the midst of COVID-19.
Patrick Lungu

17:11 - 17:23: Considerations for implementing effective TB preventive treatment programmesUptake of tuberculosis preventive treatment (TPT) among people living with HIV (PLHIV) has increased substantially in recent years, especially through the US President’s Emergency Plan for AIDS Relief, which has prioritised TPT as part of routine and comprehensive care for all PLHIV. As part of planning, implementation and scale-up of TPT among PLHIV, more focus and information are needed around how to assure effective and quality programme implementation. Important considerations for TPT programmes include how to develop processes and systems to monitor potential adverse events associated with TPT, how to develop innovative approaches to support treatment adherence and completion, how to engage communities and civil society in creating demand for these services, and how to approach and manage TPT among pregnant women. This presentation will highlight a number of these key considerations to promote quality and effectiveness of TPT programmatic implementation and ensure its desired impact on reducing TB morbidity and mortality.
Avinash Kanchar

17:23 - 17:48: Q&A session

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TBS3B-Latest research in drug resistance detection, mechanism and treatments: oral abstract presentations
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TBS3B-Latest research in drug resistance detection, mechanism and treatments: oral abstract presentations
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Multiple active anti-mycobaterial drugs are required to cure tuberculosis. Monotherapy or treatment with insufficient active drugs accelerates the development of mycobacterial resistance resulting in treatment failures and ultimately undermines elimination strategies. For this reason, understanding the detailed mechanisms of resistance as well as interactions between the host and different drugs is important as it allows in vivo activity to be predicted. This session aims to discuss recent findings with respect to our understanding of anti-mycobacterial drug resistance and the prediction of susceptibility notably based on genome sequence data.

16:30 - 16:32: Session introduction


16:32 - 16:40: TBS-OA-09-Association of delamanid concentrations with treatment outcomes or drug resistance among patients with MDR-TB.

Daniel S. Graciaa

16:40 - 16:48: TBS-OA-10-High frequency of bedaquiline resistance in programmatically treated drug-resistant TB patients with sustained culture-positivity in Cape Town, South Africa

Brigitta Derendinger

16:48 - 16:56: TBS-OA-11-ncRv0842c, a smallRNA regulating the efflux pump Rv0842 involved in rifampicin tolerance in M. tuberculosis

Paolo Miotto

16:56 - 17:04: TBS-OA-12-Genomic sequence characteristics and the empirical accuracy of short-read sequencing in Mycobacterium tuberculosis

Maximillian Marin

17:04 - 17:12: Live Q&A


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