19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 5
OA-08-The Union student late-breaker session on lung health
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OA-08-The Union student late-breaker session on lung health
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This session is sponsored by the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA).


15:00 - 15:05: Introduction


15:05 - 15:15: LB-2092-21-Utility of previously identified host immunological biomarkers in the diagnosis of TB and monitoring therapy response in high- and low- endemic countries To assess their potential global relevance, candidate tuberculosis (TB) biomarkers require validation in different geographical settings. We evaluated the utility of selected biomarkers in participants recruited from low- and high-TB endemic regions and identified promising biosignatures. Our data highlights the importance of the use of harmonised designs in multicentered studies.

Bih H. Chendi

15:15 - 15:25: LB-1968-21-Characterisation of clinical subtypes of antiretroviral therapy-associated tuberculous meningitis using host transcriptomic analysis Tuberculosis meningitis (TBM) patients are at high risk of IRIS-related (immune reconstitution inflammatory syndrome) mortality, but there is limited data on unmasking IRIS in TBM. We sequenced CSF RNA to describe the host immune response, alongside clinical characteristics, of Ugandan patients presenting with TBM after initiation of antiretrovirals, to determine features of unmasking IRIS.

Carson M Quinn

15:25 - 15:35: LB-2082-21-Assessment of whole genome sequencing technology applied to drug-resistant TB diagnosis In the last decades, whole genome sequencing has become a promising tool in the diagnosis of drug-resistant tuberculosis, evincing the limitations of the phenotypic drug-susceptibility testing. We have evaluated the reliability of its resistance profile prediction in a local study based on a low burden setting of Spain.

Ana María García Marín

15:35 - 15:45: LB-2115-21-Personalised adherence management in TB: using artificial intelligence to schedule targeted interventions We designed an artificial intelligence-based intervention decision support system for community health workers managing tuberculosis medication adherence. The assistant learns to make intervention recommendations, subject to available resources, based on individual patient responsiveness to interventions over time.

Jackson A. Killian

15:45 - 15:55: LB-2119-21-Tale of the tape: use of mid-upper arm circumference to identify increased probability of paediatric TB treatment failure and mortality in a low-resource setting Mid-upper arm circumference (MUAC) independently identifies paediatric tuberculosis (TB) cases that are more likely to later experience TB treatment failure or mortality. Thus, in resource-limited settings, a simple tape measure may aid clinicians in targeting young children in need of more intensive monitoring and clinical care.

Daniel Van Aartsen

15:55 - 16:05: LB-2047-21-Impact of COVID-19 pandemic on latent and active TB treatment registrations in Montreal, Canada: a retrospective study at the Montreal Chest Institute Since the declaration of a global pandemic in March 2020, COVID-19 has disrupted the delivery of tuberculosis (TB) services worldwide. We assessed the effect of COVID-19 on the number of people registered for latent or active TB treatment in Montreal, the city with the highest COVID-19 burden in Canada.

Mariane Saroufim

16:05 - 16:20: Q&A


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Channel 4
SP-08-Incarceration for drug use and TB among people who use drugs: time to break the cycle
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SP-08-Incarceration for drug use and TB among people who use drugs: time to break the cycle
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The interactive panel discussion in this session aims to highlight the impact of over incarceration on the United Nation's High-Level Meeting tuberculosis (TB) targets and the urgent need to reform drug policies as an effective approach in fighting COVID-19, TB and HIV.  It will bring together high-level policy makers, correctional medical doctors, civil society and drug policy makers to identify the influence of the criminalisation of drug use and possession on TB infection rates, to discuss the latest advances in drug policy and to explore how the response to TB can mobilise for drug policy reform.

15:00 - 15:05: Introduction

15:05 - 15:15: Incarceration, drug policies and TB in Tanzania and across Africa: reflections by the community of people who use drugsIn her presentation, Happy will reflect on the impact of incarceration and drug policies on tuberculosis (TB) in Tanzania and across Africa, particularly among women who use drugs. She will also share information about the situation with TB and multidrug-resistant TB, including among the key populations in Tanzania. She will share what concerns her most and what gives her hope for the way forward.
Happy Assan

15:15 - 15:25: The heavy toll of drug policies on TB: prison health and human rightsColleen Daniels will present an overview and discussion on how prisons are a highly ineffective way to deal with people who use drugs. With incarceration rates increasing every year, bad living conditions in prisons, exacerbated by poor access to healthcare, jeopardises the fight against communicable diseases, particularly tuberculosis (TB).  The presentation will discuss how mass incarceration, overcrowded prisons, and human rights violations contribute to fueling TB. These issues are compounded in countries that have high rates of incarceration for drug-related offences and in settings where there is no continuity of treatment for people entering and leaving the prison system. With a global prison population of 11 million people that keeps increasing every year, many prisons in the world are overcrowded due to the incarceration of people for drug-related offences, over 80% of them are in prisons for non violent offences.  In some countries, over 50% of the prison population are held under drug-related offences, while among female inmates this proportion is higher and up to 80% in some countries.  This presentation will outline the need to reform drug policy as an effective approach to fight TB and HIV.
Colleen Daniels

15:25 - 15:35: Reflections and suggestions for the way forward from people who use drugs in AsiaTuberculosis (TB) is one of the fastest growing epidemics among prison populations and one of the main causes of death, particularly in low- and middle-income countries. Yatie Jonet will share cross-Asia perspectives of people, who use drugs, on the influence of criminalisation on health, with a focus on TB. She will share powerful stories about experiences of people who use drugs with incarceration, getting infected in prison and lacking treatment in prison as well as positive stories on access to treatment in prison. She will share suggestions on the way forward from people who use drugs, focusing on the needs of women who use drugs. She will share what concerns her most and what gives her hope for the way forward.
Yatie Jonet

15:35 - 15:45: COVID-19, TB, harm reduction and prisons: challenges and opportunitiesLee will reflect on his personal journey of being the lawyer and the doctor. He will also share information about the situation with tuberculosis (TB) and multidrug-resistant TB, including among the key populations in the Philippines. Prisons and other closed settings are high risk environments for communicable diseases such as HIV, hepatitis C and TB as well as COVID-19. This presentations will draw on experiences in the Philippines. It will discuss that prisons, drug use and HIV are all independent risk factors for the development of TB and amplify each other into synergistic comorbid phenomena.  In the current context, COVID-19 also puts detained people and prison staff at extremely high risk, on top of these existing health threats. Yet the COVID-19 pandemic has also prompted countries to release people who were incarcerated for non-violent offences, including people who use drugs. This approach should urgently be adopted in other countries too and, critically, it opens up a debate about whether people who use drugs have rightly been detained in the first place.
Lee Yarcia

15:45 - 15:55: Vision, evidence and roadmap for the way forwardProfessor Michel Kazatchkine will discuss that punitive approaches to drug use and repressive drug policies have been hindering the results of the investments made in the fight against communicable diseases, particularly tuberculosis (TB). Health outcomes are exacerbated by overcrowding and unhealthy conditions, particularly in Eastern Europe and Central Asia. Michel will discuss how United Nations bodies and other regional human rights monitors could be better at monitoring and reporting on the issue of TB in prisons. Building on data related to incarceration around the world, this presentation will reflect that political will and partnerships - including with the medical, scientific communities, decision makers, parliamentarians and city mayors - are the main driver for drug policy reform and effective response to TB and co-infection. Mobilisation of the community working on addressing TB is key for scale-up of harm reduction services and drug policy reforms. It will discuss that further progressing drug policy reform across countries is key for the effective response to TB The presentation will discuss the impact of over incarceration on the achievement of the UN High-Level Meeting on TB targets, discuss solutions, suggest a way forward as well as reflecting on the presentations made.
Michel Kazatchkine

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

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Channel 6
SP-09-Ending TB in vulnerable populations through operational research, capacity building and evidence-informed decision making in Eastern Europe and Central Asia (Find-Treat-All).
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SP-09-Ending TB in vulnerable populations through operational research, capacity building and evidence-informed decision making in Eastern Europe and Central Asia (Find-Treat-All).
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The objective is to present new evidence on optimised case finding, use of digital technology for TB diagnosis and care, and adjunctive interventions in complex cases for key populations in Eastern Europe and Central Asia (EECA). The evidence was generated from EECA researchers under the Structured Operational Research and Training Initiative (SORT IT), which is a global partnership coordinated by the TDR, The Special Programme for Research and Training in Tropical Diseases. The specific SORT IT programme that led to this symposium was implemented by Tuberculosis Research and Prevention Center, Armenia, the Alliance for Public Health, Ukraine, The Union and TDR.

15:00 - 15:05: Introduction

15:05 - 15:15: Breaking the one size fits all paradigm: introduction of optimised case finding of TB among key populations in UkraineMissed tuberculosis (TB) cases are disproportionally concentrated among vulnerable populations that often cannot access health systems. These include socially marginalised individuals (people who inject drugs, displaced, homeless, Roma and former prisoners). Based on experience from an optimised case finding (OCF) strategy, which has been effective in HIV detection among key populations, the Alliance for Public Health in Ukraine has adapted a similar strategy for active TB case finding among vulnerable groups. The OCF strategy empowers index TB cases to refer up to eight close contacts within their social network for TB investigations, in contrast to the usual contact tracing strategy limited to household contacts. Study sites were TB clinics in four regions of Ukraine. Four thousand eight hundred contacts of 600 index TB patients, registered between July 2018 and March 2020, were assessed with respect to numbers of TB contacts referred for investigations, the numbers diagnosed and treated for TB, and the numbers needed to screen.
Liliia Masyuk
Olga Denisiuk

15:15 - 15:25: Scale-up and impact of an electronic medical record system (Open MRS) and GxAlert on diagnosis of TB and linkage to treatment in TajikistanThe advent of the automated Xpert MTB/RIF assay has so far failed to speed up time between diagnosis and treatment of tuberculosis (TB), mainly because of the need for personnel and paper-based interfaces to link results with TB registers. GxAlert is an electronic data monitoring system that automatically connects Xpert instruments to the network and mobile channels to communicate assay results. This should lead to patients being diagnosed and initiated on treatment more quickly. Tajikistan started scaling up GeneXpert instruments in 2014. From 2017 these instruments were connected to GxAlert. During this period, the country scaled-up a new Open MRS medical information system allowing more reliable recording and reporting of TB control efforts. This study presents the scale-up and national coverage of GeneXpert / GxAlert and Open MRS in Tajikistan, between 2014 and 2019, and the impact of this on TB diagnosis and timely linkages between diagnosis and treatment.
Shodmon Khushvakhtov

15:25 - 15:35: Outcomes of video observed TB treatment for drug-susceptible TB in the Republic of MoldovaAsynchronous video observed treatment (aVOT) has been proposed as an alternative method of ensuring medication adherence in tuberculosis (TB) patients, compared with directly observed therapy (DOT). The current study used 2016-2017 secondary data from the randomised clinical trial (RCT) piloted aVOT strategy, in Chisinau, and data from the national TB register. From 647 TB patients included in the study, 169 were from the RCT group (83 – in aVOT and 86 – in DOT) and 478 – DOT in practical conditions (control group). Based on the suggestions of the parent study aVOT may be an acceptable approach to treatment monitoring. Our supplementary results show that aVOT was superior to DOT in terms of treatment outcomes as well; aVOT was associated with short- and long-term TB treatment favourable outcomes. aVOT, as a new patient-centred approach improving treatment adherence and outcomes, might be recommended as an alternative to DOT strategy in the Republic of Moldova.
Svetlana Doltu

15:35 - 15:45: People who inject drugs in Ukraine: comparative analysis of TB treatment outcomes in relation to opioid substitution therapyPeople who use injectable drugs (PWID), who are often socially marginalised and have limited access to health services, are at high risk of being infected with Mycobacterium tuberculosis and developing tuberculosis (TB). Many PWID are also infected with HIV and hepatitis C. Opioid substitution therapy (OST – using methadone or buprenorphine) is one of the pillars of harm reduction strategies for PWID and should be an integral part of TB care. In Ukraine, the Alliance for Public Health coordinates TB and HIV prevention and care services for PWID and has integrated a model of 'OST with TB care at the same facility'. Between July 2017 and July 2019, there were 200 PWID diagnosed with TB in five large regions of Ukraine. The current study documented numbers on OST, socio-demographic and clinical characteristics of those on and off OST and treatment outcomes in relation to OST, HIV status and hepatitis C.
Tetiana Fomenko

15:45 - 15:55: The effect of psychotherapy/psychiatric support for alcohol use disorder for multidrug-resistant TB in Zhytomyr, UkraineUkraine is among the high burden countries for multidrug/rifampicin-resistant tuberculosis (MDR-TB/RR-TB). The country ranks in the top ten for years lost due to disability and premature mortality as a result of alcohol abuse, and TB control efforts are often adversely affected by alcohol use disorder (AUD). Mental health interventions can be effective in reducing alcohol use and together with psychosocial support, these may improve patients’ adherence to TB treatment and result in more favorable TB treatment outcomes. Of 73 patients with RR-TB in Zhytomyr region, Ukraine, 33 were screened positive for AUD and eligible for mental health interventions: 22 received this support and 11 declined. This study compared the two groups with respect to socio-demographic and clinical characteristics, measures of depression, adherence to TB medications and interim/final TB treatment outcomes. The study also assessed why some patients declined to be helped.
Vitalii Plokhykh

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

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Channel 1
SS1-Sars-CoV2 - the hope for a vaccine
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SS1-Sars-CoV2 - the hope for a vaccine
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Since the SARS-CoV-2 virus was identified in December 2019, over 37 million people have been infected, and over 1 million deaths have been reported worldwide. Our hopes have been largely focused on the development of a preventative vaccine. But data suggests that immunity may be short lived following infection raises many questions and possible challenges for vaccine development.

15:00 - 15:05: Session introduction


15:05 - 15:20: COVID19 - Public health and scientific challenges

Anthony Fauci

15:20 - 15:30: The COVID19 vaccine portfolio

Vasee Moorthy

15:30 - 15:40: How do we ensure equitable global access to COVID-19 vaccines?

Suerie Moon

15:40 - 15:50: Vaccine hesitancy: until we understand public opinion, we cannot hope to change it

Jeffrey Lazarus

15:50 - 16:00: Going from efficacy trials to public health intervention

Kate O'Brien

16:00 - 16:25: Live Q&A and moderated discussion

Vasee Moorthy
Kate O'Brien
Suerie Moon
Jeffrey Lazarus

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Channel 7
TBS1A-Role of innate and adaptive immunity in TB and evaluation of immune correlates in pre-clinical and clinical studies: plenary session
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TBS1A-Role of innate and adaptive immunity in TB and evaluation of immune correlates in pre-clinical and clinical studies: plenary session
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In this session recent insights into the host immune response to M. tuberculosis infection will be discussed. The results from a first tuberculosis (TB) biomarker guided clinical trial will be reported and discussed in the context of TB risk and targeted interventions. The role of innate trained immunity will next be reviewed and discussed, including in the context of BCG vaccination. The emerging role of antibodies in TB will be reviewed as well. The three keynote presentations will be followed by the selected abstract presentations and close with an open panel discussion.


15:00 - 15:03: Introductory note

Tom H. M. Ottenhoff

15:03 - 15:23: TB biomarkers and first results of the CORTIS trial

Thomas Scriba

15:23 - 15:43: BCG vaccination, trained immunity, TB and COVID-19

Reinout van Crevel

15:43 - 16:03: Antibodies as a bridge between the innate and adaptive immune system

Galit Alter

16:03 - 16:22: Live Q&A


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Community Connect
Activating a Human Rights Based Tuberculosis Response
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Activating a Human Rights Based Tuberculosis Response
This session takes place on Zoom.us

Panel session: This session will be a follow up to the Human Rights based Response to TB Workshop conducted last year during the Union conference. The session will include presentation and discussion on how to bring a change at the policy level in adopting the HR policy and guidelines at country level. This will be followed by Q and A.

1. Moderator - Blessina Kumar, CEO, Global Coalition of TB Activists
2. Prof. Brian Citro, Assistant Professor, Northwestern Pritzker School of Law
3. Allan Maleche, ED, KELIN
4. Priyam Cherian, Legal Officer, Lawyers Collective
5. Nyokabi Njogu, Advocate, High Court of Kenya
6. Jeffry Acaba, Community representative, APCASO
7. Ani Hernasari, Community representative, POP TB Indonesia
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TBS1B-Role of innate and adaptive immunity in TB and evaluation of immune correlates in pre-clinical and clinical studies: oral abstract presentations
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TBS1B-Role of innate and adaptive immunity in TB and evaluation of immune correlates in pre-clinical and clinical studies: oral abstract presentations
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In this session recent insights into the host immune response to M. tuberculosis infection will be discussed. The results from a first tuberculosis (TB) biomarker guided clinical trial will be reported and discussed in the context of TB risk and targeted interventions. The role of innate trained immunity will next be reviewed and discussed, including in the context of BCG vaccination. The emerging role of antibodies in TB will be reviewed as well. The three keynote presentations will be followed by the selected abstract presentations and close with an open panel discussion.

16:30 - 16:32: Session introduction


16:32 - 16:40: TBS-OA-01-Inflammatory markers in the cerebrospinal fluid linked to mortality in tuberculous meningitis

Valerie A.C.M. Koeken

16:40 - 16:48: TBS-OA-02-Vaccination with intravenous BCG protects SIV+ macaques from tuberculosis.

Erica Larson

16:48 - 16:56: TBS-OA-03-A pilot study on plasma metabolomic characterization of patents with MDR-TB

Qi Tan

16:56 - 17:04: TBS-OA-04-A 22-gene transcriptomic model predicting individual therapy durations in multidrug-resistant tuberculosis

Jan Heyckendorf

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


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OA-09-What person-centred care really means
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OA-09-What person-centred care really means
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16:30 - 16:35: Introduction


16:35 - 16:43: OA-09-550-21-Using the patient pathway analysis method to align care-seeking and service delivery in development of a person-centred, national strategic plan The patient pathway analysis uses data to identify a mismatch between tuberculosis (TB) healthcare-seeking and service delivery. Fifty eight percent of the population initially sought care in private facilities, of which only 2% were equipped with diagnostic capacity for TB, emphasising the need to engage private sector facilities in TB control.

Moses Arinaitwe

16:43 - 16:51: OA-09-551-21-A 360 degree view of TB-related stigma in Uganda: findings from a mixed methods study involving perceptions from patients, providers and communities Stigma is a key driver that hinders tuberculosis (TB) control programmes by negatively affecting delay in care-seeking and treatment adherence. A mixed methods assessment was conducted to understand perceptions and knowledge of TB-related stigma among TB providers, patients and community members, to inform  TB programme strengthening efforts in Uganda.

Nikki Davis

16:51 - 16:59: OA-09-552-21-Support for integrating TB preventive treatment into community antiretroviral refill groups among people on antiretroviral treatment in Zimbabwe Zimbabwe's 2018 tuberculosis (TB) incidence - 210/100,000 - is among the highest globally. However, only 11% of people living with HIV (PLHIV) and newly enrolled in care, were on TB preventive treatment (TPT) in 2017. Community antiretroviral refill groups can be an efficient way to scale-up TPT in PLHIV in Zimbabwe. 

Jennifer M. Zech

16:59 - 17:07: OA-09-553-21-Integrating mental health services into TB care: Gujarat, India Mental health interventions to treat depression among tuberculosis (TB) patients were integrated into routine TB workflows. Healthcare workers, trained in psychotherapeutic counselling, screened for depression symptoms, administered 4-6 sessions with patients and measured reduction in depression symptoms with each session.

Sirisha Papineni

17:07 - 17:15: OA-09-554-21-Journey patterns and models of care observed in patients receiving drug-resistant TB treatment in South Africa This analysis uses spatio-temporal mapping of patient care journeys in South Africa to describe diverse patterns - ranging from highly centralised to highly decentralised - and uses these to provide structure to illustrate existing models of care. Five dominant geospatial movement patterns of patient journeys, and the associated care models, are described. 

Lindy Dickson-Hall

17:15 - 17:23: OA-09-555-21-Implementation of a supportive care package to strengthen drug-resistant TB patients' adherence to treatment in Xi'an, China Implementation of a comprehensive, supportive care package to strengthen treatment enrollment, retention and treatment adherence to among drug-resistant tuberculosis patients managed by Xi’an City Chest Hospital, western China

Ali Zhao

17:23 - 17:50: Q&A


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SP-10-High-dose rifapentine with or without moxifloxacin for shortening treatment of TB: TB Trials Consortium study 31/ACTG A5349 phase III clinical trial results
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SP-10-High-dose rifapentine with or without moxifloxacin for shortening treatment of TB: TB Trials Consortium study 31/ACTG A5349 phase III clinical trial results
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Study 31/A5349 is a phase III randomised controlled non-inferiority trial to evaluate the efficacy and safety of two, four-month regimens with high-dose rifapentine with or without moxifloxacin for the treatment of drug-sensitive tuberculosis (TB). The trial is a collaboration between the TB Trials Consortium (TBTC) and the Adult AIDS Clinical Trials Group (ACTG).  In this symposium, we will present the trial design and results of the primary 12-month analysis. In addition, presentations will discuss safety of the short regimens, selected secondary and sensitivity analyses, local medical and community perspectives, plus lessons learned and next steps.

16:30 - 16:35: Introduction

16:35 - 16:45: The design and primary efficacy results of Study 31/A5349In this talk the design and the efficacy results for Study 31/A5349, a randomised, open-label, controlled phase 3 trial, will be presented. The trial’s primary efficacy endpoint is tuberculosis (TB) disease-free survival at 12 months after study treatment assignment. A total of 2,516 participants, from 33 sites in 13 countries, were enrolled. The proportion of participants, who are culture-negative at eight weeks, and time to stable sputum culture conversion (on solid and liquid media) will also be reported.
Susan Dorman

16:45 - 16:55: Safety of high-dose rifapentine regimensThis talk will review safety data of the two high-dose rifapentine regimens. The proportion of participants with grade 3 or higher adverse events during study drug treatment will be described. Rates of discontinuation of assigned treatment for a reason other than microbiological ineligibility, will be reported. All-cause mortality, including all deaths from any cause during treatment or follow-up up, will be described with primary cause of death reported by the regimen. The presentation will also include suggestions for safety monitoring and patient management for the short regimen in programmatic settings.
Ekaterina Kurbatova

16:55 - 17:05: Secondary efficacy and safety analyses of short regimen performance by disease phenotypes and patient subgroupsKnown risk factors for relapse and treatment failure include extensive cavitation, higher smear grade, low BMI and a compromised immune system because of HIV infection or uncontrolled diabetes. This talk will review results of secondary analyses that further explore the efficacy and safety of the short regimens, highlighting particular groups of patients that experienced the most benefit.
Payam Nahid

17:05 - 17:15: Perspectives on shortened TB regimens: local medical and community viewsThis talk will focus on local medical and community perspectives considering the promise, value-add and possible challenges and solutions to implementation of short tuberculosis regimens. These will be considered in a specific country setting, contextualising the findings.
Grace Muzanye

17:15 - 17:25: Lessons learned and next stepsThis talk will discuss lessons about inclusion of adolescents and HIV-positive individuals with CD4 count threshold of 100 cell/mm3, adherence, regional differences, a novel 'possible poor treatment response' process for endpoint ascertainment, and the value of standardised laboratory techniques. Relevant future actions will be considered.
Richard Chaisson

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

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SP-11-Treating mild asthma: a paradigm shift
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SP-11-Treating mild asthma: a paradigm shift
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Management of mild asthma has for a long time been unsatisfactory and the treatment of mild asthma has not been tested in clinical trials. The use/overuse of short-acting beta-2 agonist (SABA) alone in patients treated as mild asthmatics has become a concern and the association with severe adverse events has become clear. Access adherence with regular inhaled corticosteroid (ICS) treatment is a major issue in this population. The rationale efficacy of treatment with as needed ICS and rapid acting bronchodilator will be discussed in this session.

Learning Objectives:

Review concerns associated with the use of rescue SABA in the absence of maintenance treatment.

Discuss the merits of as-needed ICS treatment strategies in mild asthma in adults and children.

16:30 - 16:35: Introduction

16:35 - 16:47: GINA 2019: a fundamental change in asthma managementNew recommendations about the treatment of mild asthma, published by the Global Initiative for Asthma (GINA) in early 2019, have been described as the most fundamental change in asthma management in 30 years. These recommendations represented the culmination of a decade-long campaign by GINA to develop new strategies for mild asthma with the aim of reducing asthma morbidity and mortality, particularly in low-resource countries. They were prompted by concerns about the risks and consequences of treating mild asthma with short-acting beta2-agonists alone. This presentation will describe the background to the changes, the evidence obtained from large, new clinical trials and observational studies which provided the basis for the new GINA recommendations, the issues and priorities that were taken into account, and the global challenges and evidence gaps that remain.
Helen Reddel

16:47 - 16:59: As-needed use of ICS and SABA in separate inhalers? Applicability to childrenOne of the more frequent issues in difficult asthma in children is adherence. Using inhalers only when they are needed could be a good way to improve adherence and control. This presentation would update the evidence on the efficacy of treating asthma in children using as needed combination of short-acting beta-2 agonists and corticosteroids combined in the same inhaler, as compared to the standard approach in GINA guidelines. If this is approach is safe and effective in children, as well as being more affordable, it should be seriously considered.

Luis Garcia-Marcos

16:59 - 17:11: Combination inhaler (ICS/ formoterol) applicability to children: a low- resource setting perspective.Asthma in children is increasing in prevalence in children in low- and middle-income countries. Risk factors for this increase and poor asthma control in this population are poorly studied. One of the critical gaps in asthma treatment is access to affordable and safe medication delivered via an appropriate delivery system. The current Global Initiative for Asthma recommendations encourage the use of combination therapy to improve asthma control, but this may not be possible in settings where there is poor access to spacer delivery systems and unaffordability of drugs. Motivation for one drug device to manage asthma is an attractive option in this setting where there is an overuse of short-acting beta-agonist, together with interventions and advocacy, to improve access to asthma treatment and this may be a solution to this issue in low-income settings.
Refiloe Masekela

17:11 - 17:23: Obtaining optimal control of asthma in resource-limited settings: theory and practiceThe management of asthma requires medicines relaxing airway smooth muscles and reducing airway inflammation. Rapid-acting b2 agonist does not effectively address the underlying problem of airway inflammation. Excess use of inhaled bronchodilators alone for symptom relief may result in a delay in seeking health care. Inhaled corticosteroid (ICS) is critical in the treatment of airway inflammation but is underused. A substantial proportion of patients with persistent asthma in resource-limited settings have no access to affordable ICS for long-term treatment. Studies have shown that the use of both ICS and rapid-acting b-agonist as needed for symptom relief might be a better option.
Chen-Yuan Chiang

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

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