19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 7
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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SP-03-When novel product bans are best: lessons learned and challenges faced in tackling tobacco in low-and middle-income countries.
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SP-03-When novel product bans are best: lessons learned and challenges faced in tackling tobacco in low-and middle-income countries.
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The debate on novel products (e-cigarettes and heated tobacco products) wages on. It has been both contentious and also somewhat myopic, focusing on electronic nicotine delivery systems (ENDS) potential utility — or lack thereof — as a harm reduction tool in developed countries. This session will expand the discussion, providing a much needed spotlight on low-and middle-income countries; many have decided that absent sufficient regulatory framework and new product sales bans are critical to tobacco control — and protecting youth. Experiences will be shared from India, Indonesia, Viet Nam and Mexico.

12:45 - 12:50: Introduction

12:50 - 13:03: Mexico: industry attempts to influence governmentSince its latest iteration, stemming from the 2003 patent, vaping has transformed from a hobbyist movement to a rapidly growing industry. Headed by the big tobacco companies, along with the new specialised companies and 'users' groups, this new industry is not shy about using all the tools developed by the tobacco companies to achieve a legal and social situation that favours their interests. A prolific marketing effort, legal trials, alliances with legislators, sponsored scientific articles, news and media inserts, and public attacks on those who do not share their position are just some of the methods used, magnified through the use of social networks. In Mexico these efforts has been stronger in the last two years, since the ban turned 10 years of being imposed, and the products of large tobacco companies (BAT's Vype and PMI's IQOS) have been illegally introduced to the Mexican market.
Inti Barrientos-Gutierrez

13:03 - 13:16: Reflections on the one year anniversary of the banIn September 2019, India announced a federal ban on the production, import and sale of e-cigarettes, noting that these products are harmful to health. This session will describe decisions and factors leading to the ban and outline any issues that emerged—either in support of, or in opposition to, the ban. It will also describe progress and challenges faced over the year-long period since the ban was announced and detail gaols for the next year.
Leimapokpam Swasticharan

13:16 - 13:29: Making the case: where sales bans are bestCatlin Rideout and Megan Quitkin are both deputy directors at The Union, which released its electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs) position paper in advance of World No Tobacco Day 2020. In this session, they will provide context for the 2020 position paper, explaining why The Union felt the need to outline the arguments towards bans. They will also provide specific context about low-and middle-income countries, explaining why the economic conditions and advanced tobacco epidemics in these countries necessitate banning ENDS as critical to child protection and ensuring no further escalation of the tobacco epidemic.
Ayu Swandewi Astuti

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OA-05-Innovative TB diagnostics
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OA-05-Innovative TB diagnostics
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12:30 - 12:35: Introduction


12:35 - 12:43: OA-05-529-21-Correlation of high-sensitivity C-reaction protein, Gene Xpert and urine LAM test for TB diagnosis in HIV-positive Kenyan patients within DREAM programme The objective of the present study is to improve tuberculosis (TB) diagnosis among HIV-positive patients using HS-CRR, LF-LAM test, 4SS and Gene Xpert. Five hundred and seventy eight Kenyan, TB-suspected patients were enrolled. Diagnosing TB infection in HIV-positive patients remains challenging, as concordance with clinical screening and different tests is suboptimal.

Fausto Ciccacci

12:43 - 12:51: OA-05-530-21-Purification of lipoarabinomannan from urine of patients with TB A multistep approach to extract urinary lipoarabinomannan (uLAM) from patients with tuberculosis (TB) and which can be scaled to use on large specimen volumes, was developed and assessed. The resulting uLAM will be used to support generation and screening of new uLAM antibodies that may increase the sensitivity of TB LAM assays.

Jason Cantera

12:51 - 12:59: OA-05-531-21-Sequence-specific hybridisation capture of urine cell-free DNA to diagnose pulmonary TB We have developed a highly-sensitive hybridisation capture assay for improved detection of TB-specific, cell-free DNA in urine. We present the results of clinical testing of our assay in urine from HIV-infected and HIV-uninfected adults with, and without, pulmonary tuberculosis in South Africa and in healthy controls in the United States. 

Amy Oreskovic

12:59 - 13:07: OA-05-532-21-Correlation between the metabolic urine profile using nuclear magnetic resonance spectrometer and the standardised case definitions for the diagnosis of childhood TB Surveillance during treatment is essential to monitor adherence and treatment response. In this proof of concept we identified a urine metabolic profiling, based on nuclear magnetic resonance of drug-sensitive pulmonary tuberculosis (TB) patients, that can identify individuals who have received treatment and changes over the course of TB treatment.

Patricia Comella-del-Barrio

13:07 - 13:15: OA-05-533-21-A novel urine method for the diagnosis of active pulmonary TB by immunoassay for the detection of ESAT-6 using hydrogel nanoparticles in HIV patients In HIV patients, tuberculosis (TB) diagnosis is difficult. A new test in urine - using hydrogel nanoparticles (NIPAm) with reactive blue - is proposed, allowing capture, preservation and concentrating ESAT-6. NIPAm are N-isopropylacrylamide copolymers, which capture and protect from enzymatic degradation. A new method for diagnosing active pulmonary TB was evaluated by immunoassay.

Raquel Mugruza

13:15 - 13:23: OA-05-534-21-Similarity algorithm for chest X-ray images: testing on large, annotated TB patient cohort and implementation of database search service We evaluated strategies for chest X-ray similarity calculation from radiomic features for application to the large, annotated image dataset in the NIAID Tuberculosis Portals (TBP). With increasingly large and well-annotated clinical image datasets, image retrieval through image similarity may help physicians identify similar patient cases with useful context for clinical care.

Conrad Shyu

13:23 - 13:31: OA-05-535-21-Diagnosis of TB through exhaled, volatile organic compounds using a real-time, high-pressure photon ionisation time-of-flight, mass spectrometry Early and accurate diagnosis and detection of tuberculosis (TB) is essential for achieving global TB control. More accurate, rapid and cost-effective screening tests are needed to improve case detection and treatment evaluation. Due to the non-invasive nature and the possibility to sample continuously, exhaled breath analysis has great clinical potential.

Liang Fu

13:31 - 13:50: Q&A


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SP-04-Advancing TB prevention in children during the COVID-19 pandemic
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SP-04-Advancing TB prevention in children during the COVID-19 pandemic
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If resources are diverted away from child and adolescent tuberculosis (TB) programmes in order to fight COVID-19, consequences in resource-limited settings could be devastating. TB prevention is more important than ever but better strategies need to be developed and applied to deliver proven interventions for child TB contact management (CCM), TB preventive treatment (TPT) and BCG vaccination to newborns in the context of COVID-19. We will engage stakeholders by discussing early experiences of globally adapting CCM, TPT and BCG delivery during the COVID-19 pandemic. Sharing experiences is essential to identifying feasible and safe strategies that assist in maintaining essential TB prevention services.

12:30 - 12:35: Introduction

12:35 - 12:45: Overview of TB prevention services in children and adolescentsIn this talk, we will present a policy overview and coverage of tuberculosis (TB) prevention services among eligible children and adolescents. We will share reports from regional and country colleagues as well as partner organisations on the effect of COVID-19 on TB prevention services.
Annemieke Brands

12:45 - 12:55: The effect of COVID-19 on childhood TB preventive treatment services in sub-Sahara Africa: experiences from CaP TB projectContact investigation and delivery of tuberculosis preventive treatment (TPT) are World Health Organization-recommended core components of childhood TB programming. Between Q4 2018 and Q1 2020, the CaP TB project has supported facility-based implementation of those interventions in purposely selected sites across nine African countries. As of March 2020, project countries have started enforcing measures aimed at controlling the COVID-19 pandemic, with repercussions on accessibility to health services that varied among countries. This presentation will discuss the effect of COVID-19 control measures and interventions on delivery and accessibility of contact investigations and TPT services, as documented by key patient level indicators collected through the project framework for monitoring and evaluation. It will also discuss the effectiveness and feasibility of mitigation measures introduced to ensure continuation of those essential TB prevention services in the context of the COVID-19 pandemic.
Martina Casenghi

12:55 - 13:05: Impact of COVID-19 on 3HP rollout: experiences from IMPAACT4TBProvision of tuberculosis preventive therapy to household child contacts and people living with HIV is a key component of the END TB strategy. The IMPAACT4TB project was scheduled to begin roll out of 3HP, a new short-course TB preventive therapy regimen, in 12 high burden countries in March 2020 as the COVID-19 pandemic was beginning to unfold. As countries developed their COVID-19 response, there have been large ramifications for healthcare delivery, including contact investigations and TB prevention services. We will discuss mitigation measures and alternative models of care that have been implemented to ensure these services have continued during the COVID-19 pandemic response.
Nicole Salazar-Austin

13:05 - 13:15: Flexible child contact management frameworkThe World Health Organization roadmap for childhood tuberculosis recommends an ‘integrated, family and community-centred strategy’. Yet, there is no clear guidance on how health systems can operationalise such a strategy. it is crucial to recognise that barriers that impede successful child contact management (CCM) vary from family to family, even within the same community. COVID-19 further complicates delivery of CCM during the pandemic and recovery periods. We propose a flexible CCM framework, which goes beyond standardised approaches. Suggestions will be provided on how health systems could support a framework that is customised for each child’s/family’s needs as well as their varied environments.
Yael Hirsch-Moverman

13:15 - 13:25: Responsible use of BCG in the context of COVID-19 pandemicBacille Calmette-Guérin (BCG) vaccines are live vaccines (different strains) that have been used to protect mainly young children against severe forms of tuberculosis (TB) in high TB burden settings for many years. Recent BCG stock-outs emphasised its importance when TB meningitis cases soared among unvaccinated children. BCG’s effect on the immune system is not fully understood, but it has an immune modulating effect, which extends its use beyond TB prevention, e.g. it has proven value in treating non-invasive bladder cancer. A recent ecological study showed an association between lower mortality in COVID-19 cases and BCG coverage. However, this does not prove causality. Clinical studies are now being done to determine whether BCG protects against COVID-19 and likely other respiratory infections. We will provide an update on this topic.
H. Simon Schaaf

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

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SP-05-Updating World Health Organization TB screening guidelines: evidence reviews of the yield, tools and costs of screening
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SP-05-Updating World Health Organization TB screening guidelines: evidence reviews of the yield, tools and costs of screening
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In order to achieve the targets for the World Health Organization's (WHO's) End TB strategy and for the United Nation's High-Level Meeting for diagnosing and treating people with tuberculosis (TB), there is an urgent need to deploy strategies to improve TB case detection. One such strategy is systematic screening for TB. To help facilitate implementation at the country level, the WHO is currently updating the guidelines on systematic screening for TB, for which systematic reviews have been conducted of the current landscape and yield of screening activities, the performance of screening tools, approaches for screening in children and the costs and cost-effectiveness of screening.

12:30 - 12:35: Introduction

12:35 - 12:45: Overview and systematic review of the number needed to screen for active TBOne of the pillars of the World Health Organization End TB strategy is to increase early diagnosis of tuberculosis (TB) through implementing systematic screening programmes for high-risk groups. Active case finding (ACF) is a useful tool for targeted screening and has been shown to reduce time to TB detection, TB incidence and mortality. This presentation will review results of a systematic review undertaken to evaluate and synthesise the existing body of evidence that has been collected about ACF to assess the number needed to screen (NNS) in order to detect one case of active TB. Specific outcomes assessed include 1) the average NNS in order to detect one case of active TB, 2) the average NNS for high-risk groups (including prisoners, pregnant women, persons with diabetes, drug users, healthcare workers and others, and 3) how different screening tools (including symptom screening, CXR, Xpert, and others) affect NNS.
Lelia Chaisson

12:45 - 12:55: Performance of symptoms and chest radiography as screening tools and choosing algorithms for screening for active TBThe accuracy of screening tools, in combination with confirmatory testing, determines the performance and yield of a screening programme and the burden on individuals and the health service. Symptom questioning and chest radiography (CXR) have been the most widely available screening tools used to date. We conducted a systematic review to assess the sensitivity and specificity of symptom screening and chest radiography for detecting bacteriologically-confirmed active pulmonary TB, assessing potential sources of heterogeneity. To inform disease control programmes about the choice of appropriate screening and diagnostic tools for tuberculosis (TB) screening, we compared the performance of a range of screening algorithms in decision analytical models, assessing the yield, number needed to screen (NNS), positive predictive value, and resource implications (cost per true case detected and individual screened) for different TB epidemiological and population settings.
Anja van’t Hoog

12:55 - 13:05: Computer aided detection solutions for pulmonary TB: what is their performance in screening and diagnostic triage settings?The tuberculosis (TB) field welcomed several computer aided detection (CAD) products that provide an automated, standardised interpretation of a digital chest X-ray (CXR). CADs generate an abnormality score that can be used to identify individuals requiring further diagnostic testing.
FIND established an archive of CXRs from various data sources with representation of different geographical origin, high and low TB risk groups from screening and triage settings. The archive, housed at an offline facility, contains images that were not used for training of any of the CADs and is used to assess the accuracy of CAD4TB (Delft Imaging), Lunit Insight CXR (Lunit Insight) and qXR (Qure.ai) for their ability to detecting pulmonary abnormalities suggestive of TB compared against a microbiological, human radiologist and composite reference standard.
In this talk, accuracy is presented for each CAD and the consequences for their use as screening or triage tool will be discussed.
Sandra Kik

13:05 - 13:15: Screening tests for active pulmonary TB in children: systematic reviewCase finding is a crucial step in the cascade of care for patients with tuberculosis (TB). However, in many children the disease is never diagnosed. National and international recommendations for child health generally lack guidance on systematic screening strategies for TB. This presentation will share findings from a recently conducted systematic review and meta-analysis assessing the accuracy of several screening strategies for child TB, including various symptoms and symptom combinations, chest radiography, Xpert MTB/RIF, Xpert Ultra, and combinations of these tests. This review focuses on screening of children and adolescents up to 19 years old in high-risk groups - including contacts of persons with TB, children living with HIV and children with pneumonia. Implications of these findings will be discussed.
Bryan Vonasek

13:15 - 13:25: Costs and cost-effectiveness of TB screening: systematic reviewThe presentation will include key results from a systematic review of the published literature on economic evaluations for tuberculosis (TB) screening, including active and intensified case finding with a particular focus on the following tools: symptom screens (prolonged cough and any symptom), chest X-ray (CXR) and CXR using automated detection such as CAD4TB, and GeneXpert MTB/RIF and Xpert Ultra. We included studies that compared these TB screening approaches to standard case detection and looked at study outcomes, including numbers of cases detected and impact on TB epidemiology in a community. We will present current economic evidence and key costs, cost-effectiveness results and discuss affordability of these screening approaches. We will also present results among high-risk populations, such as people living with HIV, migrants, prisoners and people with diabetes.
Hannah Alsdurf

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

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SP-06-The people-centred framework for national and subnational TB planning and programming: early adopters share lessons learned and experiences
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SP-06-The people-centred framework for national and subnational TB planning and programming: early adopters share lessons learned and experiences
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In the era of the End TB Strategy, the Sustainable Development Goals, and recent COVID-19 pandemic, national tuberculosis (TB) programmes are under increasing pressure to balance demands for ambitious programme targets with limited/diminishing resources. The resulting requirement for prioritisation and 'hard choices' threatens to curtail effective TB programming. Rwanda, Uganda and Ethiopia, early adopter countries, share their experiences applying the people-centred framework in their latest NSP development. The people-centred framework was designed to help countries to better streamline and utilise increasingly available evidence/data for decision making along the care continuum (including utilisation of mathematical impact and cost-effectiveness modelling), and facilitate evidence-based, optimised, people-centred responsive and resilient strategic planning and programming.

12:30 - 12:35: Introduction

12:35 - 12:47: Introduction to the people-centred framework for TB planning and programmingThe people-centred framework (PCF) for tuberculosis (TB) programming encourages us to rethink our approach to analysis, planning, implementation and evaluation of TB programmes. The presentation will introduce the philosophy, concept, approach, elements and some initial experiences (when and how to employ it). A future is envisioned in which evidence is reviewed and analysed in a patient-centred manner. Priority gaps are identified and closed ensuring access for all to high-quality services for prevention, diagnosis, treatment and care of TB, including post-treatment follow-up care. Data consolidation along the TB care continuum, impact optimisation of interventions, subnational validation and health service delivery optimisation form the four cornerstones of the PCF-based national strategic plan (NSP) 2.0. PCF will help countries to decide how best to allocate resources and use pre-populated data and automated data visualisations to continuously and critically assess the performance of TB-NSP implementation.
Emmy van der Grinten

12:47 - 12:59: Using the people-centred framework for national strategic plan development while on lockdown due to COVID-19The COVID-19 pandemic and lockdown to mitigate spread impacted the finalisation of the national strategic plan (NSP) and development of the NSP-based TB & HIV combined Global Fund funding request. Under unprecedented circumstances, how did Rwanda manage to adopt the people-centred framework (PCF), data consolidation and visualisation along the care continuum and TIME modelling, to support prioritisation and optimisation, before the lockdown? And also a patient pathway analysis to assess the alignment of care-seeking and service availability, with distant support from consultants due to international travel restrictions? Plus the intervention package scenarios to compare budget to best impact and the GFFR development, with a mix of in-country and distant TA? Patrick Migambi will share challenges, experiences, creative solutions and lessons learned.
Patrick Migambi

12:59 - 13:11: Developing an evidence-informed national strategic plan using epidemiological, people-centred and systems-related dataUganda is one of the early adopter and approach shaper countries for the people-centred framework for tuberculosis (TB) programming. The development of the Uganda national TB strategic plan (2020/21-2024/5) employed a patient-centred approach and was informed by the evidence gathered through a data consolidation process along the TB care continuum. The process included a patient pathway analysis (PPA) that was carried out to assess the alignment between country-level service provision and initial care-seeking by the population. Data was consolidated into an excel tool with automated data visualisations based on key performance indicators that provided evidence on epidemiology, people and systems. The evidence generated provided a basis for problem identification, prioritisation, root cause analysis, intervention identification and optimisation. 
Stavia Turyahabwe

13:11 - 13:23: Developing an optimised national strategic plan using TIME Impact & TIME EconomicsEthiopia, under the now ending national tuberculosis strategic plan, has made significant strides to achieve the End TB goals. By the end of 2018, 96% of public hospitals and health centres; 71% of private hospitals; 6.5% of private specialised clinics; and 22% of private medium clinics were providing TB diagnostic and/or treatment services. However, the country still remains among the top 30 high TB, TB-HIV and multidrug-resistant TB burden countries, and over a third of estimated 165,000 TB cases were missed in 2018. The country’s TB programme had about 60% funding gap in 2018. In an effort to address the remaining challenges, we analysed policy, programmatic and implementation gaps and did root cause analyses using the people-centred framework (PCF). We combined our in-house modelling capacity with support form external consultants to develop an optimised national strategic plan. We share our experience with the PCF approach with particular focus on TIME Impact and TIME Economics modelling.
Taye Letta

13:23 - 13:50: Q&A session

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SP-07-Towards new TB vaccines: progress and considerations for introduction
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SP-07-Towards new TB vaccines: progress and considerations for introduction
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The World Health Organization End TB strategy aims to end the tuberculosis (TB) epidemic by 2035. A new TB vaccine that is safe, affordable and effective in providing protection against all forms of TB in adolescents and adults is critical for rapidly reducing disease incidence and mortality. There are currently promising candidates in the clinical pipeline. However, accelerating progress requires a globally coordinated plan to efficiently streamline the complex approaches to testing and the introduction of new vaccines. This symposium aims to discuss current evidence around the full benefits new vaccines offer, as well as venues needed to accelerate development and to facilitate programmatic implementation.

12:30 - 12:35: Introduction

12:35 - 12:47: World Health Organization preferred product characteristics for preventive and therapeutic vaccinesThis presentation outlines the World Health Organization's (WHO’s) preferred and minimal product characteristics (PPCs) for both preventive and therapeutic vaccines. These PPCs intend to articulate attributes of products, that are suitable for end users, to scientists, funding agencies and industry groups developing TB vaccine candidates intended for WHO pre-qualification and policy recommendations
Ann Ginsberg

12:47 - 12:59: The clinical development pipeline of new TB vaccinesThis presentation will summarise the progress in the clinical development pipeline of new tuberculosis (TB) vaccines and the prospect for their availability and use in countries that need them most. Considering that vaccines potentially offer a novel approach to combat emergence and transmission of anti-TB resistance, this session will also seek to inform the debate on the use of new vaccines in settings with high level of resistance.
Dereck Tait

12:59 - 13:11: A global roadmap for the research and development of new TB vaccinesThis presentation will share findings from the development of a global roadmap for the research and development of new tuberculosis (TB) vaccines, which was launched in 2020. The roadmap articulates elements of need across the clinical development, delivery and implementation of new TB vaccines in the form of research questions, as well as capacity needs with an end-to-end perspective. Crosscutting challenges and opportunities at the scientific, financial, policy, regulatory, manufacturing and access interface will be discussed in this presentation.
Frank Cobelens

13:11 - 13:23: Assessing the full value of new TB vaccines for decision-makingThe introduction of a new vaccine into national immunisation programmes often involves a trade off with investing in other vaccines or alternative strategies. As such, countries need broader information for assessing the comparative health and economic impact of new vaccines before implementation. I will share an update on progress in a project designed to assess the potential health and economic impact of new tuberculosis (TB) vaccines, using various vaccine characteristics and implementation scenarios. The intended goal is to proactively prepare evidence necessary for decision-making by countries, partners and institutions involved in new TB vaccine development and implementation.
Richard White

13:23 - 13:50: Q&A session

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P1-Prevention supports cure
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P1-Prevention supports cure
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Historically TB services and approaches have focused on finding and treating people who have active TB disease, who may be at risk of transmitting TB to their immediate contacts and community. However, there are tools that have been available to TB programmes for a number of decades that can prevent TB disease – TB vaccine and TB preventative therapies. Yet, despite these preventative tools, 10 million people a year still develop TB disease.
This plenary will discuss how TB prevention tools continue to improve and how to ensure that as new tools are developed the appropriate health system strengthening and policies on Universal Health care can be undertaken so they are implemented without compromising the treatment and care of TB disease.

14:00 - 14:03: Session introduction


14:03 - 14:18: P1A-Vaccines: 100 years since BCG - where are we now?

Helen McShane

14:18 - 14:33: PL1B-Lessons for TB preventive therapy implementation

Rovina Ruslami

14:33 - 14:48: PL1C-The truth about being TB Proof

Arne von Delft

14:48 - 14:58: PL1D-Moderated discussion

Helen McShane
Rovina Ruslami
Arne von Delft

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OA-06-Different approaches to improve treatment and care
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15:00 - 15:05: Introduction


15:05 - 15:13: OA-06-536-21-Community health workers augment the cascade of TB detection to care in urban slums of two metro cities in India The Tuberculosis Health Action Learning Initiative (THALI) recruited community health workers, in urban slums in two metro cities in India, to augment tuberculosis (TB) detection to care cascade. Their performance and TB treatment outcomes improve over time. It will be important to examine the cost per-TB case detected and successfully treated.

RAJARAM Potty

15:13 - 15:21: OA-06-537-21-Improving isoniazid preventive therapy coverage among children aged 0-14 years living with HIV through designating special clinic days: case of Kapelebyong Health Centre IV Isoniazid preventive therapy demonstrated efficacy of over 60% in preventing active tuberculosis (TB) among people with latent TB infection. However, uptake is low. People of all ages living with HIV, who attend the clinic at the same time, limits opportunities for special care, emphasising the need for age-sensitive HIV clinics to address unique challenges. 

Pius Ongareno

15:21 - 15:29: OA-06-538-21-Using market-based e-pharmacies for delivering free TB drugs to patients treated in the private sector: lessons learned from a pilot in Madhya Pradesh, India This innovative demonstration model of engaging e-pharmacy companies for door step delivery of national TB elimination programme-supplied anti-TB drugs, diagnostic services and treatment adherence support, to patients treated in the private sector.

Varsha Rai

15:29 - 15:37: OA-06-539-21-The potential of mHealth to improve TB awareness and case detection in Tanzania Provide support to the Tanzania National Tuberculosis and Leprosy Program (NTLP)  through the implementation of mHealth technologies to increase case detection and enhance TB knowledge among the general public in Tanzania.

Eunice Moturi

15:37 - 15:45: OA-06-540-21-Identifying subpopulations at high-risk for severe adherence challenges in the treatment of multi- and extensively drug-resistant TB and HIV In generalised epidemics of drug-resistant tuberculosis (DR-TB) and HIV, identifying high-risk subpopulations is critically important to improve treatment outcomes and prevent amplification of resistance. We hypothesised that an electronic dose-monitoring device could empirically identify adherence-challenged patients and that a mixed methods approach would characterise treatment challenges.

Jennifer Zelnick

15:45 - 16:20: Q&A


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OA-07-Moving away from isoniazid for TB preventive treatment
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OA-07-Moving away from isoniazid for TB preventive treatment
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15:00 - 15:05: Introduction


15:05 - 15:13: OA-07-542-21-Safety of high-dose rifamycin for active and latent TB: a systematic review and meta-analysis There is an increasing interest in using rifamycins at higher doses to treat tuberculosis (TB). We performed a systematic review and meta-analysis to examine the safety and efficacy of rifamycin therapy for all patients with TB, by reviewing trials that compared daily administered, high-dose rifamycins to standard-dose rifamycins.

Omri A Arbiv

15:13 - 15:21: OA-07-543-21-Rifampicin maximum, early bactericidal activity not reached at 50 mg/kg The PanACEA HIGHRIF1 trial has recently evaluated the pharmacokinetics (PK) and early bactericidal activity (EBA) of rifampicin at 50 mg/kg. Our analysis focused on defining if earlier developed rifampicin PK and PK-pharmacodynamics models are applicable at a 50 mg/kg dose and if a maximal EBA is reached at 50 mg/kg rifampicin.

Budi O Susanto

15:21 - 15:29: OA-07-544-21-Treatment outcomes of people living with HIV on TB preventive therapy in Lusaka, Zambia Tuberculosis preventive therapy (TPT) has been proven to reduce incidence of TB among people living with HIV (PLHIV). The reduction in TB incidence is more significant in patients who complete a course of TPT compared to those who do not. Improving uptake of TPT among PLHIV is urgently required to reduce the TB burden.

Eugenia Mwamba

15:29 - 15:37: OA-07-545-21-A randomised controlled trial comparing two rifapentine-based short-course regimens for latent TB infection: 1HP vs 3HP 3HP is an attractive regimen for latent tuberculosis infection treatment. However, it is flawed in its systemic drug reactions. By reducing unit drug dosage, 1HP has been shown to have a favourable safety profile in HIV populations. The unanswered questions are the extrapolation of results to non-HIV population and direct comparison with 3HP regimen.

Jann-Yuan Wang

15:37 - 15:45: OA-07-546-21-Preparing for a short-course treatment regimen to prevent TB: catalysing procurement and policy to scale-up 3HP Unitaid funded the IMPAACT4TB project to scale-up 3HP in 12 countries. Work includes updating tuberculosis preventive therapy clinical guidelines, determining the scale of 3HP rollout per country, global 3HP price negotiations, support of generic manufacturers, and discussions with donors and governments to purchase 3HP.

Karin Turner

15:45 - 15:53: OA-07-547-21-Latent TB infection testing and treatment using shortened treatment regimen for contacts and secondary school children in Do Son district, Hai Phong, Viet Nam In 2019, Friends for International TB Relief, together with the Hai Phong TB Programme, implemented a community-wide, mobile screening campaign with integrated tuberculosis (TB) and latent TB infection (LTBI) testing and treatment. We describe the results of the LTBI testing and treatment activities, from screening to treatment completion.

Thuy Thu Thi Dong

15:53 - 16:01: OA-07-548-21-Impact of age on completion rate and systemic drug reaction of rifapentine-based weekly therapy for latent TB infection Under proper medical support and programmatic follow-up, 3HP can be of widespread use among populations of all ages, including the elders. Caution should be given for the high risk of systemic drug reaction in the middle-age population.

Hung-Ling Huang

16:01 - 16:20: Q&A


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