19 October-30 November 2020
The 51st Union World Conference On Lung Health
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E-posters
EP03-Digital technology in the fight against TB
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EP03-Digital technology in the fight against TB
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP03-118-21-Implementation of artificial intelligence for presumptive TB screening in Nagpur, IndiaIntroduction of newer technologies such as artificial intelligence in detection of diseases including tuberculosis (TB) are being piloted for efficacy and effectiveness. One such tool - qXR - was implemented for chest x-ray screening followed by microbiological testing for confirmation of TB. Lessons learned from the pilot can be used for scale-up.
Shibu Vijayan

EP03-119-21-Decentralised drug-resistant TB treatment challenges in South Africa and options for implementation of a smartphone application based on latest guidelinesSouth Africa has the third highest number of notified cases of drug- resistant tuberculosis. We discuss use of behaviour change theory to understand key barriers to awareness of, and access to, new care and treatment guidelines, as well as the development of a novel point-of-care decision supporting smart phone application.
Susanne Luedtke

EP03-120-21-Disease patterns on computer-assisted chest radiography in a community-based prevalence survey for TBCommunity-wide active case finding (ACF) for tuberculosis (TB) is a proposed intervention to reduce the burden of the disease. Computer-assisted radiography is an essential tool in the ACF intervention and can potentially be used to screen for undiagnosed, non-communicable diseases. We described the observations from a prevalence survey in communities in Blantyre.
Hussein Twabi

EP03-121-21-Integrated digital adherence technologies for TB: determinants of technology-derived adherenceThe Integrated Digital Adherence Technology Initiative (IDAT) enroled 12,100 patients in various technologies - 99DOTS (directly observed treatment, short course), MERM (medication event reminder monitor system, and video observed therapy (VOT) - across eight districts and three states in India. Heterogeneity in the outcome measure of technology-derived adherence is observed with various systems, technology and temporal and patient-level factors, affecting DAT uptake and engagement. 
Sirisha Papineni

EP03-122-21-Implementing a referral system for drug-resistant TB patients to maximise treatment linkages to the public sector and minimise the treatment initiation time in Mumbai, IndiaAchieving early elimination requires a strong referral mechanism where patient and private hospitals engage throughout the treatment. PATH is collaborating with the Mumbai Corporation to link privately diagnosed drug-resistant tuberculosis patients to the public sector. Effective referral mechanism and implementation strategy has resulted in successful patient linkages to the public sector.
Dnyaneshwar Waman

EP03-123-21-Methods for estimating spatial and time-varying transmission patterns of TB in Espirito Santo, Brazil, between 2005-2013Tuberculosis (TB) case notification data is often collected for surveillance. We describe a method to estimate reproductive numbers with spatial variability using this data. We correlate estimated reproductive numbers in four municipalities in Espirito Santo, Brazil, with data from a concurrent household contact study and RFLP to understand transmission dynamics.

Benjamin Rader

EP03-124-21-eHealth in the future of TB medicines management: a case of a TB medicines web-based ordering and reporting system in UgandaIn developing countries, healthcare systems face major challenges with tuberculosis (TB) medicines management and reporting. Electronic TB medicines ordering and reporting systems facilitate information gathering for healthcare decision support by enhancing the speed and accuracy of data transmission and better stock monitoring, thus ensuring uninterrupted medicine availability.
Hawa Nakato

EP03-125-21-How can we find TB patients not linked to care? Lessons learned from a systematic tracing process implemented in the Western Cape Province, South AfricaTuberculosis (TB) case finding and treatment initiation is a major challenge in the Western Cape, South Africa. Linkage to care has individual benefits and reduces risk of onward transmission. Patient case finding requires use of different strategies, creativity and flexibility. 
Nosivuyile Vanqa

EP03-126-21-An assessment of the effectiveness of mobile community-based TB screening in Blantyre, Thyolo and Mwanza, in MalawiMobile van intervention has proved to be a viable strategy in finding missing active tuberculosis (TB) cases. All cases have been referred to the nearest hospitals for treatment and proper management. Sustainability of this intervention within the National TB Control Programme will see Malawi achieving its goal of ending TB infection in the country.
Allan Chimpeni

EP03-127-21-Decentralising access to digital information management to treatment supporters level for efficient real-time patient managementTreatment supporters (TS) counsel and follow up with TB patients until treatment completion. With Nikshay, India’s TB patient management system, treatment supporters can log in and update a TB patient’s health record. On treatment completion, the TS' honorarium can be processed digitally without delay.
Manu Easow Mathew

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E-posters
EP06-TB: data matters
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EP06-TB: data matters
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November. .

EP06-152-21-Assessment of TB underreporting by level of reporting system in Lagos, NigeriaAssessment of tuberculosis (TB) underreporting by level of reporting system, Nigeria. It was a quantitative, descriptive study using secondary data from an inventory study on TB reporting knowledge, attitude and behaviour conducted in 2017 in Lagos State to assess TB underreporting by type and level of health facilities, including associated factors.  
Mustapha Gidado

EP06-153-21-Improving TB treatment outcomes through effective linkage of transfer out patientsThe transfer out tool proved to be an effective strategy in referral and linkage for all tuberculosis (TB) patients who prefer continuum of care at facilities of their convenience. TB control programmes should consider adopting this tool and roll it out to all TB sites to improve quality of care. 
Stella Omulo

EP06-154-21-Nationwide surveillance of emerging isoniazid resistance after implementation of isoniazid preventive therapy for TB contactsAlthough population isoniazid resistance does not increase due to isoniazid preventive therapy, consider to provide isoniazid resistance as a priority of developing rapid drug susceptibility test for individuals who have developed TB after isoniazid preventive therapy can further advance propagation of prevention programme with trust.
Pei-Chun Chan

EP06-155-21-Review of the epidemiological mathematical modelling literature to inform TB vaccination development and strategiesMathematical models provide valuable information to aid the development of tuberculosis (TB) vaccines and vaccination strategies. Evaluating the impact of different vaccine characteristics in varied epidemiological settings such as exploring age, spatial hotspot and risk group targeting, as well as accounting for HIV, multidrug-resistance and population endemicity, can inform country-level implementation of novel TB vaccines.
Rebecca A. Clark

EP06-156-21-Strengthening hospital DOTS linkage using ad hoc staff to find missing TB cases: The Aminu Kano Teaching Hospital ExperienceAminu Kano Teaching Hospital (AKTH) is the largest tertiary facility in Kano state with an average daily hospital attendance of 862 patients. We sought to improve facility based active case finding by engaging trained ad hoc staff and deploying them across service delivery points over a period of time.
Mamman Bajehson

EP06-157-21-Incorporating patient reporting patterns to evaluate geographically targeted TB interventions in Dhaka, BangladeshTuberculosis (TB) is geographically heterogeneous and geographic targeting can improve the impact and efficiency of TB interventions. However, standard TB notification data may not sufficiently capture this heterogeneity. Better understanding of patient reporting behaviour may improve our ability to use notifications to appropriately target interventions.
Isabella Gomes

EP06-158-21-Lessons from a data quality assessment of TB notifications in Zambia: the case of under notification in a national TB programmeNational tuberculosis (TB) programmes should conduct periodic data quality assessments (DQAs) to validate notifications data. Findings will be very useful in designing future programming and implementation. The findings underscore the urgent need to strengthen the linkage to care. National TB programmes could potentially increase the TB treatment coverage by restoring data management systems.
Patrick Lungu

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E-posters
EP01-Resisting the resistance
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EP01-Resisting the resistance
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP01-100-21-Pharmacokinetics of anti-TB drugs in multidrug-resistant TB patients in IndiaA pharmacokinetic (PK) study of drugs used to treat multidrug-resistant (MDR) tuberculosis (TB) was undertaken in 350 adult MDR-TB patients treated according to the prevailing guidelines in India. Factors influencing drug PK and end of intensive phase status were also determined. Results of this study will be discussed.
Agibothu Kupparam Hemanth Kumar

EP01-101-21-Multidrug-resistant TB and its determinants of health service, community and social context in the state of São Paulo, BrazilThis study presents the social determinants of health in relation to the occurrence of multidrug-resistant tuberculosis, key information for disease control in regions with great social inequity. We emphasise the importance of socioeconomic, demographic and health system structure conditions for the spread of the disease.
Ricardo Arcêncio

EP01-102-21-Decentralised care for rifampicin-resistant TB in Western Cape, South Africa: a laboratory cohort studySouth Africa implemented a policy to decentralise rifampicin-resistant tuberculosis (RR-TB) care in 2011. We used laboratory data from the Western Cape province to assess patterns of RR-TB care and identify changes in hospitalisation rates, length of hospital stay and travel burden from 2012-2014. We compared Cape Town with more rural districts.
Helen Jenkins

EP01-103-21-Effectiveness, safety and feasibility of nine-month treatment regimen for rifampin-resistant TB in the PhilippinesThe short nine-month multidrug-resistant tuberculosis regimen had a high treatment success rate (74 percent) with a favourable safety profile in a prospective single-arm study conducted in the Philippines during 07/2015-12/2016. Nine-month treatment regimen operational research had a major impact on building national capacity and infrastructure for programmatic adoption of the new regimen in country.
Vivian Lofranco

EP01-104-21-Characterising multidrug-resistant tuberculosis transmission in rural KwaZulu-Natal: a prospective cohort studyThis study combined whole genome sequencing of 129 Mycobacterium tuberculosis (Mtb) isolates with demographic data from patients with multidrug-resistant TB in KwaZulu-Natal, South Africa. Transmission clusters based on genomic differences were identified. Relationships between demographic characteristics, Mtb lineage, rpoB mutation and transmission clustering were examined, aiming to elucidate drivers of Mtb transmission.
Cassandra Fairhead

EP01-105-21-Effectiveness and safety of use of bedaquiline and delamanid in combination for drug-resistant extrapulmonary TB in Mumbai, IndiaMédecins Sans Frontières has been providing treatment, including bedaquiline and/or delamanid, to patients with drug-resistant tuberculosis (TB) in Mumbai since 2015. Cases are referred with complex resistance profiles and extensive treatment history. This study aims to describe the effectiveness and safety of use of bedaquiline and delamanid for drug-resistant extrapulmonary TB.
Himani Mongia

EP01-106-21-Eliciting patient preferences for different attributes of a community-based model for management of multidrug-resistant TB in Uganda: a discrete choice experimentThe advent of all-oral regimens for the management of multidrug- resistant tuberculosis makes the implementation of home-based treatment a possibility for this group of patients. However, to be successful, options for home-based care should take into consideration patient preferences for different aspects of care.    
Stella Zawedde-Muyanja

EP01-107-21-Treatment of multidrug-resistant TB with modified shorter all-oral treatment regimen: Belarus operational research studyIn October 2018, Belarus started to use mSTR for multidrug-resistant tuberculosis under operational research conditions. By 1st May 2020, 415 patients were included in the study and, of them, 114 had final treatment outcomes with encouraging results (89% of treatment success).
Alena Skrahina

EP01-108-21-Patient’s perspective on drug-resistant TB medication: does it matter? Putting research into action to develop information, education and communication materialA qualitative study of drug-resistant tuberculosis (DR-TB) treatment from the perspective and experience of patient, family, healthcare worker and psychologist in six health facilities within three districts of Indonesia as a basis for developing DR-TB information, education and communication material based on the Health Belief Model and Transtheoretical Model.
Ferdiana Yunita

EP01-109-21-The role of clinical healthcare champions in driving drug-resistant TB policy implementation in South AfricaIn South Africa, champions have emerged as a driving force behind the implementation of decentralised management of drug-resistant tuberculosis (DR-TB). This study explored the typology of champions in the decentralisation of DR-TB management, strategies that champions used to implement policy and the contextual factors that enabled or hindered their agency.
Sacha Le Roux

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E-posters
EP09-Improved acceptability of TB regimens needed
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EP09-Improved acceptability of TB regimens needed
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP09-176-21-Risk factors for cycloserine neurotoxicity in patients treated for multidrug-resistant TBCycloserine has been re-classified as a category B drug by the World Health Organization. The neurotoxicity associated with cylcoserine has limited its use in treatment programmes. We systemically collected neurotoxicity data in patients in Cape Town treated with cycloserine, dosed as terizidone, for multidrug-resistant TB. We then evaluated factors, including cycloserine AUC, with neurotoxicity.
Richard Court

EP09-177-21-Hearing loss on second line injectable therapy for rifampin-resistant TB in a retrospective cohort in Worcester, South AfricaSecond line injectables (SLIs) remain a part of the drug-resistant TB regimen in many settings globally, even with SLI-induced ototoxicity rates remaining high. In this South African rifampin-resistant TB cohort, regimen adjustments due to hearing loss were common, further emphasising the need for access to SLI-sparing regimens.
Tara C Bouton

EP09-178-21-Treatment outcome of shorter regimen for multidrug-resistant TB in Pakistan 2018The National Tuberculosis (TB) Programme in Pakistan recommended a shorter regimen of nine-11 months in January 2018 under programmatic settings in all PMDT sites of the country. We compared treatment outcome of patients who were put on the shorter regimen, with those who were eligible for the shorter regimen but who were put on the longer one.
Abdul Ghafoor

EP09-179-21-From pilot to nationwide scale-up of shorter treatment regimen for drug-resistant TB treatment: lessons from NigeriaFollowing the adoption and rapid scale-up of GeneXpert as a primary tuberculosis (TB) diagnostic tool, limited bed spaces resulted in the challenge of a huge number of diagnosed drug-resistant TB (DR-TB) patients on treatment waiting lists. The CTB project facilitated nationwide scale-up of STR and NDs, including establishing aDSM for newly diagnosed DR-TB patients.
Sani Useni

EP09-180-21-Preferences for shorter regimens and child-friendly formulations for TB preventive treatment among families affected by TB in Lima, PeruFocus group discussions with families affected by tuberculosis (TB) in Lima, Peru, explored preferences for TB preventive treatment regimens, for both adult and child contacts, and sought to understand the drivers behind these preferences.
Courtney Yuen

EP09-182-21-Safety and efficacy of allogeneic γδ T cells for multidrug-resistant TB: an interim analysis of a prospective single centre, open labeled, non-randomised, controlled matched trialAnti-tuberculosis (TB) drugs for multidrug-resistant (MDR-TB) and rifampicin-resistant TB (RR-TB) currently encounter many obstacles and host-directed therapy approaches are now a focus for use as adjunct treatment options for shortening duration, limiting immunopathology, and improving outcomes. The safety and efficacy of γδT cells have been studied in our pilot trial, which is the first one worldwide.
Liang Fu

EP09-183-21-Interim outcomes of bedaquiline-containing regimen for the treatment of MDR/XDR-TB — a prospective cohort study from Hunan, ChinaChina introduced bedaquiline relatively late and little data exists on its use outside clinical trials. We conducted  a prospective cohort study to evaluate the effectiveness and safety of bedaquiline-containing regimen for 24 weeks intensive treatment of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis (MDR/XDR-TB) in Hunan province, China.
li shi

EP09-184-21-Treatment interruption patterns among patients on bedaquiline- containing regimen under programmatic conditionsThis was an observational study, including 275 consecutively enrolled tuberculosis (TB) patients, who received a bedaquiline-containing regimen under the national TB programme in India. The study analysed the reasons for interruptions of treatment and loss to follow-up and their effect on interim treatment outcomes during the first six months of treatment.
Rupak Singla

EP09-185-21-Incidence rate of linezolid adverse events among Myanmar adult MDR/RR-TB patients on individualised longer drug-resistant TB regimensLinezolid, a Group A drug, has evidences for significant treatment success but it also has common, serious adverse events such as myelosuppression and peripheral neuropathy. The study determined the incidence rate of linezolid adverse events and characterised the safety of linezolid among Myanmar adult multidrug-resistant and rifampicin-resistant tuberculosis (TB) patients who were on individualised, longer drug-resistant TB regimens.
Thandar Hmun

EP09-186-21-Real-time payment of Nikshay Poshan Yojana under direct benefit transfer scheme improved overall notification, treatment adherence and outcome of TB and DR-TB patients in Odisha, IndiaReal-time payment of Nikshay Poshan Yojana under a direct benefit transfer scheme improved the overall notification, treatment adherence and outcome of tuberculosis (TB) and drug-resistant TB patients in Odisha, India. The National TB Programme performance rank in the Odisha state went up from 27th to 15th during 2019.
Gayadhar Mallick

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Community Connect
Start, Stop and Continue: what needs to change so that communities are better supported to lead the charge on TB and co-morbidities during COVID-19
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Start, Stop and Continue: what needs to change so that communities are better supported to lead the charge on TB and co-morbidities during COVID-19
Available in English and French
This session takes place on Zoom.us

This practical and interactive debate will discuss solutions to how governments, the UN system and donors could work closer with community -led organisations and groups so that communities are better supported to lead the charge on TB and co-morbidities in the time of COVID-19. Session participants will discuss practical recommendations on what needs to start, stop and continue to make this happen.

Chair: 
Dr Khuat Thi Hai Oanh, Executive Director, NGO ‘SCDI, Vietnam, Southern Civil Society Organisations Alternate, Civil Society Engagement Mechanism for UHC2030 

Speakers: 
1. Ashim Chowla Chief Executive , Alliance India HIV/AIDS Alliance 
2. Dr Coulibaly OFFIA Madiarra, Executive Director of Alliance Cote D'Ivoire 
3. Andrey Klepikov, Executive Director, Alliance for Public Health, Ukraine 
4. Zahedul Islam
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SP-02-Tests for the detection of TB infection - tuberculin skin test vs interferon-gamma release assays
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SP-02-Tests for the detection of TB infection - tuberculin skin test vs interferon-gamma release assays
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There is no gold standard method for diagnosing tuberculosis (TB) infection. The World Health Organization (WHO) currently recommends a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA) to test for TB infection to identify candidates for TB preventive treatment. This session reviews current WHO guidelines on who to test and critically reviews the related programmatic and implementation considerations. The pros and cons of current TB infection tests are discussed, including issues of supply. Finally, status of development and potential advantages and disadvantage of future tests for TB infection are addressed.

11:00 - 11:05: Introduction

11:05 - 11:15: Evidence and policy recommendations for testing for TB infection before TB preventive treatmentTuberculosis preventive treatment (TPT) should be selectively targeted to population groups at highest risk of progression to active disease. World Health Organization (WHO) guidelines strongly recommend TPT for adults and adolescents living with HIV and for children aged < 5 years who are household contacts of people with bacteriologically-confirmed pulmonary TB, if active TB is excluded. These groups should be given TPT even if TB infection testing is unavailable. However, for household contacts aged ˃= 5 years, confirmation of TB infection using IGRA or TST before starting TPT is desirable. Finally, systematic testing for TB infection and TPT is recommended for people who are initiating anti-tumor necrosis factor treatment, receiving dialysis, preparing for an organ or haematological transplant, or who have silicosis. It may also be done for prisoners, health workers, immigrants from countries with a high TB burden, homeless people and people who use drugs. In this presentation the WHO recommendations and underlying evidence are discussed.
Yohhei Hamada

11:15 - 11:25: Who to test: programmatic and implementation considerationsPartly as a result of testing availability and limitations in their accuracy, tuberculosis (TB) infection tests are not required prior to start of TB preventive therapy (TPT) in priority risk groups: people living with HIV (PLHIV) and household contacts aged less than 5 years. For other at-risk populations (household contacts 5 years and older and other high-risk groups), TB infection tests are generally recommended to identify those who would benefit most from treatment and to avoid unnecessary medication. However, implementation of TB infection tests is fraught with difficulties ranging from high cost, cold chain requirements (TST), short supply of quality-assured TST, to inadequate laboratory setup in undertaking high volumes of IGRA testing in decentralised settings where people need them. In this session the pros and cons of the requirement to test household contacts and HIV negative individuals before starting TPT are discussed, including risk-benefit considerations and programmatic implications.
Dick Menzies

11:25 - 11:35: TST vs IGRACurrently available tests for tuberculosis infection have major limitations. They have poor predictive value for development of active TB and do not indicate whether treatment of TB infection has been successful, which means that most people who have successfully completed what is considered an adequate course of preventive treatment will usually continue to have a positive test. IGRA needs sophisticated laboratory infrastructure and technical expertise as well as expensive equipment. TST is considered less resource intensive than IGRA but it requires a cold chain, two healthcare visits and needs training for intradermal injection and reading and interpretation and its quality control is a challenge. In the following presentations we present the true differences in the performance of these tests, but also the different roles these tests have in different settings.
Daniela Cirillo

11:35 - 11:45: Supplies of TST/IGRAGovernments and donors should invest and build health system capacity (human resources, logistics and supply chain and monitoring and evaluation) for TST and/or IGRA to avoid unnecessary TB preventive therapy, related harms and to improve acceptance. For TST this requires ensuring the availability and supply of tuberculin in cold chain as well as syringes, needles and consumables. IGRA tests have many infrastructural requirements (e.g. capacity of the laboratory system to conduct IGRA, including phlebotomy, processing of blood specimen, incubation and enzyme-linked immunsorbent assay (ELISA) reading) and are costly (unit test costs as well as need for laboratory infrastructure and laboratory personnel), making routine programmatic use in most low-and middle-income countries challenging. Supply of appropriate reagents and testing tubes for IGRA need to be ensured. However, having this capacity in place will also enable rapid adoption of any new TB infection test endorsed for programmatic use in future.
Brenda Waning

11:45 - 11:55: Future tests for TB infectionNew versions of TST and IGRA are expected to be launched in the immediate future, all using recombinant ESAT6-CFP10 antigens (C-Tb (Serum Institute of India, India), Diaskin Test (Generium, Russian Federation) and ESAT6-CFP10 test (Anhui Zhifei Longcom, China)) as well as point of care IGRA tests (Quantiferon Access and Standard E and F TB-feron tests from SD biosensor and the Advansure TB-IGRA test from LG Chem). Qiagen and SD Biosensor have both developed a simplified version of the IGRA that can be operated in peripheral facilities without laboratory infrastructures. These tests offer an incremental gain in ease of use or cost, or other operational aspects, but are not expected to provide major advantages in diagnostic test accuracy or predictive ability. In this presentation the status of development of new tests is presented, potential advantages and disadvantage of future tests for tuberculosis infection are discussed and remaining gaps are identified.
Morten Ruhwald

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

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OA-03-Optimising lung health beyond TB
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OA-03-Optimising lung health beyond TB
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-03-514-21-Clinical predictors of outpatient child pneumonia mortality and development of a severity of illness score for outpatient care in rural Bangladesh – a multisite study Identifying children at higher risk of pneumonia mortality during outpatient care may improve outcomes. We explored clinical predictors of child pneumonia mortality and developed a predictive model applicable to outpatient care in rural Bangladesh.

Eric D McCollum

11:13 - 11:21: OA-03-515-21-Pneumococcal serotype epidemiology in Botswana following the introduction of 13-valent pneumococcal conjugate vaccine We endeavoured to describe temporal trends in pneumococcal serotype colonisation among children in Botswana following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV-13). Understanding how the introduction of PCV-13 affects pneumococcal serotype epidemiology is essential to optimising the next generation of pneumococcal vaccines and reducing childhood mortality.

Sweta M. Patel

11:21 - 11:29: OA-03-516-21-Mycobacteria and other acid fast organism among presumptive pulmonary TB patients in Kaduna state, Nigeria Tuberculosis is a leading public health problem in Nigeria. Hence, there is a need for continuous characterisation of mycobacteria in order to obtain current data that will aid ongoing diagnosis and treatment. The aim of this study was to phenotypically characterise mycobacteria isolates recovered from patients with smear-positive samples.

Isiyaku Ahmadu

11:29 - 11:37: OA-03-517-21-A novel quantitative tool for rapid monitoring of Mycobacterium abscessus pulmonary disease treatment response Mycobacterium abscessus is the most common, rapid growing, non-tuberculous mycobacteria (NTM) causing NTM pulmonary disease (PD). A quantitative treatment monitoring tool has been developed to follow M. abscessus PD treatment response. This treatment monitoring tool does not require sample decontamination, with results available on the same day.

Daniela Alferes de Lima

11:37 - 11:45: OA-03-518-21-How does exposure to fine particulate matter in Malawi vary by gender, exposure source and cooking characteristics? Fine grain data from an ethnography-linked exposure study In low-income settings such as Malawi, continued use of biomass fuels for cooking causes frequent exposure to high levels of air pollution, strongly associated with a range of cardiorespiratory pathologies. We use personal exposure monitoring to describe differential PM2.5 exposures in this setting by gender, exposure source and cooking features.

Sepeedeh Saleh

11:45 - 11:53: OA-03-519-21-Pulmonary function testing and predictive equations in a healthy adult population in Mbeya, Tanzania Despite the increasing importance of spirometry in research projects as well as in clinical medicine, there is a lack of lung function reference values available for the African population. We conducted a cross-sectional study with 343 adults, in Mbeya, Tanzania, to obtain local predictive equations and compared them to GLI.

Rebekka Wenzel

11:53 - 12:01: OA-03-520-21-Availability of diagnostic services and essential medicines for non-communicable respiratory diseases in African countries The study aimed to explore the availability of diagnostic spirometry and essential medicines for asthma and COPD in African countries. Data was collected by a questionnaire given to attendees at PATS MECOR and IMPALA meeting. Primary data on availability was gathered and reasons behind the challenges of non-availability were explored.

Catherine Plum

12:01 - 12:09: OA-03-521-21-Chronic lung diseases remain under-prioritised in Africa despite their growing burden: findings from a lung health policy analysis Despite the growing burden of chronic lung diseases (CLDs) in Africa, investment in research, policy and programmes is lacking. Understanding regional and national-level lung health policy environments (via policy desk review and key informant interviews) is critical to inform generation, and effective, uptake of relevant and responsive lung health research.

Emma Heneine

12:09 - 12:20: Q&A


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OA-02-Finding a needle in the haystack: where are children with TB?
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OA-02-Finding a needle in the haystack: where are children with TB?
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-02-507-21-Barriers to contact investigation among children: experience from Lagos, Nigeria The study explored the barriers to effective contact investigation among children from the health workers' perspective and found the need to address stigma, while also supporting health workers financially, to conduct contact investigation of index tuberculosis cases.

Oluremilekun Kusimo

11:13 - 11:21: OA-02-508-21-Low-level care facilities as entry points for peadiatric TB screening and case finding: a stepped-wedge randomised controlled study Using a stepped-wedge, randomised controlled study design, we enrolled children under five years, who had presumed TB, in health facilities in Cameroon and Kenya. We demonstrate high proportions of children diagnosed with presumptive and confirmed TB at lower-level care facilities, suggesting the utility of decentralised active case finding.

Rose Otieno-Masaba

11:21 - 11:29: OA-02-509-21-A simple clinical score for predicting active TB when same day microbiological testing is unavailable We developed and validated a simple clinical risk score for tuberculosis (TB) diagnosis among adults presenting to primary healthcare in sub-Saharan Africa. The score (ranging from 1-10) requires only readily accessible information in resource-limited settings. We identify score cutoffs where TB diagnosis has a high benefit-risk ratio when same day microbiological testing is unavailable.

Yeonsoo Baik

11:29 - 11:37: OA-02-510-21-Key clinical features among children under five with a presumptive or confirmed TB diagnosis in sub-Saharan Africa We described the clinical presentation of 203 children, aged under five, with a presumptive or confirmed tuberculosis (TB) diagnosis. Cough and fever were the most common symptoms overall. Adenitis, oedema and acute malnutrition were more frequent in children diagnosed with TB. Assessing malnutrition status should be a key component of paediatric TB screening.

Lise Denoeud-Ndam

11:37 - 11:45: OA-02-511-21-Using a mobile application to improve presumptive TB identification in children in western Kenya Tuberculosis (TB) is under-recognised in children globally. To evaluate the role of mobile health technology in facilitating paediatric TB screening, we implemented a presumptive paediatric TB mobile application in a rural hospital in western Kenya. Following roll-out, there was an increase in the proportion of children identified in presumptive TB registers.

Dylan Peterson

11:45 - 11:53: OA-02-512-21-Protecting our children from active TB disease: expanding TB preventive therapy in nine sub-Saharan countries Using a pre- and post-intervention design, we demonstrate a significant increase in the initiation of tuberculosis preventive therapy (TPT), following the introduction of intensified household contact investigation and linkage to care for children eligible for TPT, in routine clinical settings across nine sub-Saharan countries.

Jean-Francois Lemaire

11:53 - 12:01: OA-02-513-21-Challenges and solutions in the recruitment of children to a multidrug-resistant TB prevention trial: early experiences from TB-CHAMP TB-CHAMP is a randomised, placebo-controlled trial to assess the efficacy of fluoroquinolone preventive therapy in young children exposed to an adult with multidrug-resistant tuberculosis. Recruitment to randomised clinical trials can be challenging and lessons learned from TB CHAMP will be relevant to other current, and future, research efforts.

Susan Purchase

12:01 - 12:20: Q&A


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SP-01-Strengthening evidence on optimal treatments for multidrug-resistant TB: approaches to studying timing and duration.
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query_builder 11:00 - 12:20 | Event time (GMT+2)
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place Online Session/Virtual
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mic English
SP-01-Strengthening evidence on optimal treatments for multidrug-resistant TB: approaches to studying timing and duration.
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Treatment for multidrug-resistant tuberculosis (MDR-TB) is characterised by prolonged duration and frequent toxicity. While injectable-free and shortened regimens represent enormous improvements, critical knowledge gaps remain about optimal treatment for MDR-TB. Among them are the comparative effectiveness of all-oral shortened regimens; the exposure-toxicity relationship in dynamic multidrug regimens; the optimal duration of treatment and of individual drugs and the choice and timing of endpoints used for each. This symposium will highlight challenges in the study of these questions, both in the clinical trial and observational study settings, and will offer practical approaches for improving valid inference.

11:00 - 11:05: Introduction

11:05 - 11:15: Follow-up duration in study of treatment of different durations: bias and implicationsA major concern about shortened regimens is possible increased recurrence (relapse and reinfection) after treatment completion. Documented, systematic post-treatment follow-up is critical to accurately assess efficacy of shortened regimens compared to longer control regimens.  Failure to systematically follow patients in observational or experimental studies can result in underestimated recurrence after shortened regimens. Follow-up time for equivalent durations after treatment completion (e.g. six months after a nine-month regimen and after an 18-month control) can result in the same overestimate, which can bias the effect estimate. For that reason, guidance recommends defining total follow-up duration from the point of randomisation, e.g. 24 months after randomisation. Effectively, this results in 15 months post-treatment follow-up for a nine-month regimen and six months for an 18-month regimen. This could overestimate recurrence in shortened regimens relative to controls and lead to bias. This talk will explore these biases and their implications for guidelines and programmatic decision making.
Gerry Davies

11:15 - 11:25: Short, long, or somewhere in between? Designing clinical trials to identify the optimal duration of therapyClinical development of new regimens for the treatment of tuberculosis (TB) involves not only the selection of the right drugs and doses, but also a choice of the optimal duration of therapy that maximises efficacy, while not exposing patients to a longer duration of potentially toxic drugs than necessary. Different approaches have been considered to generate evidence to support this choice with varying success. bedaquiline and delamanid have been evaluated in clinical trials and approved for the treatment of TB, but we are still learning the optimal duration of each. In this presentation, I will talk about the latest clinical trial designs that are being applied in drug-susceptible TB and drug-resistant TB randomised trials to efficiently identify optimal durations of new regimens. I will talk about the duration-randomised design which involves modelling of the duration-response relationship, proving a case study of how this has been applied in a planned TB trial.
Patrick Phillips

11:25 - 11:35: Does prolonged use of bedaquiline improve treatment outcomes? An application of methods to study optimal treatment duration using observational dataIn observational research, a common approach to studying the effect of treatment duration entails categorising patients according to the duration of their regimen (e.g. <15 months; 15-20 months, >20 months) and comparing the frequency of treatment success in patients with longer and shorter regimens. Results derived from this approach may be biased in favour of longer treatment because patients who survive longer can receive longer treatment. On the other hand, results may be biased against longer treatment if patients receive longer treatments due to a slower treatment response or treatment-emergent toxicities that then limit subsequent treatment options. To overcome these potential biases, we employ an alternative approach that emulates a randomised trial in which each individual is randomly assigned to a treatment duration. We provide an illustrative example in which we compare the effects of bedaquiline for 24 weeks, 48 weeks or the entire duration of treatment on end-of-treatment outcomes.
Molly Franke

11:35 - 11:45: Methodological challenges in analysis and reporting of sputum culture conversion endpoints in observational treatment cohortsIn observational multidrug-resistant tuberculosis treatment cohorts, time-to-sputum culture conversion (SCC) or SCC at specified time-points since treatment initiation (e.g. six months), are commonly used as interim endpoints for end-of-treatment outcome. While World Health Organization definitions for SCC exist, there is substantial heterogeneity in how these definitions are operationalised given varying data collection practices, monitoring schedules and laboratory procedures across cohorts. We will discuss the potential for selection bias due to the use of prolonged periods to establish patients’ baseline culture in SCC cohorts. We will describe the current state defining baseline sputum culture in the literature and recommend best practices for avoiding or resolving this bias.
Carly Rodriguez

11:45 - 11:55: How best to analyse and report adverse events occurring during multidrug-resistant TB treatment?Is the new regimen safe? This is a priority question in the evaluation of new multidrug-resistant TB regimens. Adverse events reporting is critical to evaluate regimen safety. However, drawing conclusions from observational adverse event data is challenging in the context of dynamic regimens. Important considerations include causality attribution in the context of regimens with multiple drug stops and stops; determining the dates of event onset and drug exposure; and adverse event recurrences. In this talk, we will detail methodological challenges to the analyses and reporting of adverse event data and provide illustrative examples using data from the End TB observational study. 
Mathieu Bastard

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

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Channel 6
OA-04-A holistic approach: experiences from Europe
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query_builder 11:00 - 12:20 | Event time (GMT+2)
query_builder - | Your time (GMT)
place Online Session/Virtual
card_travel Oral Abstract session
mic English
OA-04-A holistic approach: experiences from Europe
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-04-522-21-“You have to adjust your whole life.” Interconnected, dynamic influences on adherence to treatment for TB among adults in three UK cities Non-adherence to tuberculosis (TB) treatment has significant implications for individual patients and for efforts to end TB. A better understanding of how factors affecting the non/adherence intersect can guide development of patient-centred, cost-effective measures to improve treatment taking. We report on in-depth interviews with individuals on TB treatment in the United Kingdom.

Aaron S Karat

11:13 - 11:21: OA-04-523-21-Doubling TB preventive treatment enrolment rates among people living with HIV in Ukraine Under the United States Agency for International Development funded Challenge TB (CTB) mechanism, PATH used a data-driven, evidence-grounded advocacy approach to shift the management of tuberculosis (TB) preventive treatment (TPT) services for people living with HIV (PLHIV), in Donetsk Oblast, from TB doctors to HIV specialists. This shift led to a doubling of PLHIV initiated on TPT.

Olga Pavlova

11:21 - 11:29: OA-04-524-21-Providing incentives and enablers to support people suffering with TB completing their treatment in Belgium: a successful approach In Belgium, tuberculosis (TB) treatment completion remains challenging, especially among the most vulnerable groups, such as the homeless or people living in irregular situations. Since 2015, a joint project between the Belgium TB Programme and non-governmental organisation, has looked to provide incentives and enablers, including shelters, to improve treatment outcomes.

Lilas Weber

11:29 - 11:37: OA-04-525-21-Video observed treatment for TB patients in Belarus In Belarus, with the Global Fund’s support, a pilot video-observed treatment (VOT) project was expanded across the country in October 2016. VOT for tuberculosis patients in Belarus, used at programmatic level, demonstrates high levels of patient acceptability and excellent treatment outcomes.

Alena Skrahina

11:37 - 11:45: OA-04-526-21-ART prescription by TB doctors in Odeska oblast, Ukraine: successful model of integration of services for patients with TB-HIV co-infection In Ukraine, only HIV specialists are permitted to prescribe antiretroviral treatment (ART), which leads to delayed initiation and low ART coverage among tuberculosis (TB) patients. The United States Agency for International Development funds the Challenge TB Project and its support has enabled TB doctors to prescribe ART. This resulted in a significant increase of ART coverage and reduction of ART initiation delays.

Olga Pavlova

11:45 - 11:53: OA-04-527-21-Results of pilot of integrated diagnosis of TB and hepatitis C among HIV-positive incarcerated individuals using GeneXpert in Dnipropetrovska oblast of Ukraine Usage of GeneXpert opportunities as an integrated patient-oriented approach for TB and hepatitis C virus diagnosis, and HIV viral load determination, among detainees and prisoners in Dnipro Penal Institution №4, in Ukraine, greatly reduces turnaround times and improves efficiencies while also increasing access to services for prisoners and detainees.

Svitlana Leontieva

11:53 - 12:01: OA-04-528-21-COVID-19-TB and multidrug-resistant TB co-infection in Belarus Belarus, a high burden multidrug-resistant TB country, had a total of 22,973 confirmed COVID-19 cases on May 10th. Measures to monitor COVID-19-TB patients prospectively, in the countrywide cohort, were developed. Our data will help create a global database for the subsequent generation of evidence-based recommendations to combat both infections. 

Alena Skrahina

12:01 - 12:20: Q&A


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