Sessions

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Addressing comorbidities is a core component of patient-centred care within the End TB Strategy. Diabetes is associated with a two to three-fold risk of TB. TB can temporarily cause impaired glucose tolerance and a person with TB is significantly more at risk of dying or relapsing if they also have diabetes - all important reasons for collaborative action as outlined in The Union and World Health Organization 2011 Collaborative Framework for Care and Control of TB and Diabetes. This symposium will present evidence on the global uptake of collaborative action on TB and diabetes and share barriers, enablers, plans and opportunities for scale-up.

16:30 - 16:35: Introduction

16:35 - 16:45: Global status on uptake of the Union/World Health Organization Collaborative Framework for the Management of Tuberculosis and DiabetesThe Union/World Health Organization (WHO) Collaborative Framework for the Management of Tuberculosis and Diabetes was published in 2011. While we have seen impressive scale-up of collaborative action on HIV-associated tuberculosis (TB) globally during this period, uptake and scale-up of collaborative TB and diabetes activities appears to have been limited and difficult to gauge. This presentation will introduce the symposium and provide an overview of findings from a policy review conducted by WHO to assess uptake by high burden TB countries of the collaborative framework for the management of tuberculosis and diabetes and outline plans to promote further scale-up.
Annabel Baddeley

16:45 - 16:55: Addressing comorbidities as part of high impact TB interventions in Global Fund funding requests and grantsThe presentation will share opportunities from the Global Fund to address comorbidity as one of the high impact interventions – this includes the Global Fund strategy and policy on supporting comorbidity, integrated services and promotion of innovations. Further opportunities are available through catalytic funding to support innovative interventions to find missing people with tuberculosis/drug-resistant tuberculosis (TB), including among high risk groups such as people with diabetes. Additional resources to address TB and comorbidity could be leveraged through existing country grants (savings and reprogramming), portfolio optimisation and new grants.
Mohammed Yassin

16:55 - 17:05: Challenges, enablers and plans for scaling up integrated action on TB and diabetes: lessons from PakistanThe dual burden of diabetes and tuberculosis (TB) is a serious and growing challenge for the poorly resourced health system of Pakistan, which ranks 5th among the high TB burden countries. The number of diabetics are estimated to rise to 13.9 million by 2020 in Pakistan, increasing country ranking to 4th in the world. This presentation will give an overview of studies that have been conducted to pilot bi-directional screening for diabetes in TB clinics and for TB in diabetes clinics. It will also discuss the challenges and barriers to integration at all levels of the health system and how the country plans to ensure integrated and structured bi-directional screening, referral, case management and follow-up is scaled up from 2020-2023.
Aurangzaib Quadir Baloch

17:05 - 17:15: Experience of initiating TB preventive treatment among people with diabetes in BrazilThe national tuberculosis (TB) programme of Brazil has recently been introducing a policy on TB prevention among people with diabetes. This presentation will give an overview of the epidemiology of TB and diabetes in Brazil, common aspects and areas for synergy between the two programmes, Brazil’s experience of introducing programmatic management of latent TB infection as well as preliminary results of TB preventive treatment in people affected by diabetes.
Denise Arakaki-Sanchez

17:15 - 17:25: Introducing diabetes into TB-HIV collaboration: opportunities and plans for addressing multimorbidity in ZimbabweZimbabwe is one of the high tuberculosis (TB) burden countries with more than half of people with TB co-infected with HIV. In 2017, the prevalence of diabetes among adults in Zimbabwe is estimated to be 1.8% and over 75.0% of those with diabetes had never been diagnosed. This presentation will give an overview of the epidemiological background and the steps taken to assess feasibility of implementation and to scale-up collaborative action on TB and diabetes in Zimbabwe.  It will further discuss the challenges, enablers, opportunities and plans for national scale-up of integrated TB, diabetes and HIV care.
Charles Sandy

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

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There has been a great deal of discussion about the potential relationship between COVID-19 and tobacco use. The underlying logic of a smoking-COVID-19 relationship is that smoking is an established risk factor for respiratory infections because it undermines the immunological response that a person can otherwise mount against a viral infection. Furthermore, there is a very strong relationship between smoking and non-communicable diseases that has emerged as a risk factor for COVID-19 severity and death. Studies from China show that the odds of progression towards serious illness are 14 times higher among people with a history of smoking.

16:30 - 16:35: Introduction

16:35 - 16:47: COVID-19, non-communicable diseases and impact on young peopleYoung people, especially those living with non-communicable diseases (NCDs) and its associated risk factors are vulnerable and susceptible to developing COVID-19 and its complications. This includes incomplete treatment regimens and restricted access to public health services for chronic conditions in times of lockdown and social distancing. Not to forget the major impact on mental health of young people. On the other hand, young people are also critical in promoting preventive messages for risk mitigation, disseminating information to their families, peer groups and community during this global crisis. Therefore, meaningful involvement of young people during the time of pandemic, as well as prevention of NCDs, is significant to the preparedness efforts, for not only the current, but also future public health crises.
Ishu Kataria

16:47 - 16:59: COVID-19 and lung healthCurrently evidence is lacking on how underlying lung disease will affect the severity and outcomes of COVID-19.  The longer term impact of COVID-19 on lung health is unknown but with large numbers of people requiring high flow oxygen and/or ventilation there are concerns regarding residual lung damage in COVID-19 survivors. The data on these areas will be reviewed as well as discussing what services need to be planned for COVID-19 survivors.
Grania Brigden

16:59 - 17:11: Deadly partners: COVID-19 and tobaccoTobacco smoking appears to be an important and entirely avoidable risk factor for a poorer prognosis in COVID-19. COVID-19 has not only severely constrained health systems, but also could have a cascading impact on the progress that countries were making towards different goals and targets of the United Nations Sustainable Development Goals (SDGs). With the looming danger of economic recession, it becomes even more vital to avert the huge financial cost of tobacco use to the global economy. The urgency to prioritise stronger action on comprehensive tobacco control is mandatory for optimal response to contain the COVID-19 pandemic.
Tara Singh Bam

17:11 - 17:23: Responding COVID-19 and non-communicable disease risk factorsTobacco causes eight million deaths every year and is a known risk factor for severe disease and death from many respiratory infections. Emerging evidence has suggested that smoking increases the risk of severe COVID-19 outcomes as well as the risk of death from COVID-19. However, in the absence of robust population studies to date, the association between smoking and infection with SARS CoV2 and between smoking and hospitalisation has not been reliably quantified.  This presentation will review the evidence on smoking and COVID-19 and will position the findings within the context of the wider literature and body of evidence. It will also look at risk communication of the findings on tobacco use and COVID-19 in the overall context of harms from tobacco use that are well established.
Hebe Gouda

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

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The World Health Organization, in collaboration with the European Respiratory Society, formulated a framework towards the elimination of TB in 33 counties with currently low TB incidence, to be achieved by 2050. The symposium provides the stage for a pro/con discussion on the feasibility of this framework. It addresses the current state of affairs around some of the key priorities stated in the framework as being instrumental to reach TB elimination in low-incidence counties. These include the care for vulnerable groups, dealing with cross-border health seeking and investments in research and new tools for diagnosis and prevention.

16:30 - 16:35: Introduction

16:35 - 16:45: Mission possible: TB elimination in EuropeThe European Union (EU) and European Economic Area (EEA) observes a decline in tuberculosis (TB) notification rate of about 5% per year. This is not enough to reach TB elimination or a reduction of the TB incidence rate of 80% by 2030 (SDG target).  The too slow decrease of TB incidence is partly due to the increasing percentage of TB cases in migrants; in many EU/EEA countries with a low TB notification rate, >75% of TB cases are among migrants. Cases in migrants need to be diagnosed and treated but may be hard to prevent if infection occurred outside of the EU/EEA. Therefore, elimination can be better defined as no local transmission as measured by whole genome sequencing. By using whole genome sequencing data (EU/EEA wide and from selected countries) the potential for TB elimination will be presented and challenges identified.
Marieke van der Werf

16:45 - 16:55: Mission impossible: TB elimination in EuropeProjecting the incidence data of tuberculosis (TB) from the past decade into the future, suggests that elimination of TB in the European Union/European Economic Area (EU/EEA) might be achieved by 2035. However, in a globalised world, elimination of TB in the EU/EEA appears unlikely and even if this unlikely scenario were to happen, the elimination of TB in Europe would still be far out of reach. Only a small fraction of patients with TB in Europe live in the EU/EEA. Some countries in central and eastern Europe still have a high incidence of TB and central/eastern Europe is one of the hotspots of multidrug-resistant/rifampicin-resistant TB globally. The obstacles on the way to elimination are in all areas: prevention, diagnosis and treatment. Without a vaccine that protects contacts of patients with TB from the development of TB, elimination of TB will not be achieved, neither in Europe nor anywhere else.
Christoph Lange

16:55 - 17:05: Translational research and new tools in the pipeline to eliminate TB in low burden countriesTuberculosis (TB) elimination in low burden countries requires a comprehensive effort with existing and new tools. This presentation will familiarise the audience on recent diagnostic innovations in the pipeline to improve active case finding, infection detection and prediction of risk.
Morten Ruhwald

17:05 - 17:15: Access to care for vulnerable populations in EuropeTuberculosis (TB) burden in Europe is particularly high among vulnerable population groups. These groups also have an increased risk of inadequate access to diagnosis and treatment results. This is why access to healthcare for vulnerable groups, including migrants, is both important for individual care of patients and to ensure a reduction of transmission that would be necessary for TB elimination in Europe. Here, we will discuss 1) current evidence on access of care for vulnerable population groups in Europe; 2) evidence on strategies and policies effective at increasing access to care and lowering transmission of TB, and 3) some considerations on ethics, equity and legal issues in the design of these policies
Berit Lange

17:15 - 17:25: Research collaborations informing TB control strategies in Europe: TBnet and ERS-CRC approachTBnet has performed a large number of clinical and operational studies in the field of tuberculosis (TB). The consortium is supported by the European Respiratory Society, through a clinical research collaboration. The activities provided insight in - amongst others - the unequal distributions across Europe in terms of infection control facilities, the staff available, and inpatient vs. outpatient management of TB, the inclusion of 'hard to reach' groups, the cost and availability of molecular diagnostic tests for multidrug-resistant TB, the availability, cost and stability of drug supply, the adverse effects of new drugs, and the confounding effect of relapse on treatment outcomes.  
Graham Bothamley

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


17:20 - 17:45: Panel discussion

Thomas Scriba
Reinout van Crevel
Galit Alter
Ann Ginsberg

17:45 - 18:05: Live Q&A

Thomas Scriba
Reinout van Crevel
Galit Alter
Ann Ginsberg

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Using existing and emerging digital technology to enhance virtual, remote and supportive patient care and management during and beyond COVID-19

Please note that the number of participants is limited to 50 for this session.

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Organised by: The United States Agency for International Development / Infectious Disease Detection and Surveillance (IDDS) project

The tuberculosis (TB) diagnostic network assessment is an innovative, holistic and comprehensive way to assess a country's dedicated TB diagnostic network. It's a country driven activity which involves local and external TB experts. This joint activity assesses the functionality of a country's TB diagnostic, in line with the national strategic plan and the End TB strategy. This assessment and review will help the country to identify key gaps and recommendations as well as help to strengthen a comprehensive TB diagnostic network with strong underlying health systems. 

Target audience 1: Doctors, Nurses, Lab technicians
Target audience 2: Clinicians, TB programme managers, activists
Target audience 3: TB project managers, NGOs



18:15 - 18:20: Introduction


18:20 - 18:35: Improving TB diagnostic access by the TB diagnostic network assessment model The Tuberculosis (TB ) diagnostic network assessment (DNA) is a country driven process that assesses the functionality of the national TB diagnostic network and system. It helps in determining the system’s capacity to meet the needs of the country’s national TB strategic plan (NSP) for achieving the goals outlined in the End TB strategy. The TB DNA reviews, holistically, the diagnostic network and current practices and algorithms; identifies challenges that prevent the diagnostic network from performing efficiently and effectively and proposes evidence-based interventions to improve the overall ability of the diagnostic network to meet the goals and targets of the NSP.

Amy Piatek

18:35 - 18:50: The TB diagnostic network assessment tool presentation The use of an assessment tool, with semi-quantitative scoring, for the country to identify the stage of various aspects of the diagnostic network and to describe current capabilities and identify key areas for improvement. Verification of the self-assessed staging, using a set of standardised tools and checklists, and including site visits to a selection of sites. Conducted by an experienced group of international laboratory experts with support from in-country lab and TB experts.

Thomas Shinnick

18:50 - 19:05: TB diagnostic network assessment: data and spatial analysis The spatial TB diagnostic network analysis will be used to inform tuberculosis diagnostic network assessment (TB DNA) planning on a selection of regions to be assessed during the in-country visit  - brief the TB DNA teams about TB diagnostic network situation (coverage, access and effectiveness) prior to/at the beginning of the assessment visit; inform conclusions and support the development of recommendations by the TB DNA team during the assessment visit; develop baseline network scenarios, which can be refined during the TB DNA in-country visit, based on findings and assumptions for additional diagnostic instruments, relocated instruments, altered specimen referral linkages or other.

Manuela Rehr

19:05 - 19:20: Infectious Disease Detection and Surveillance project support to countries on the TB diagnostic network assessment The Infectious Disease Detection and Surveillance (IDDS) project is currently working closely with countries’ national tuberculosis (TB) control programmes to reinforce TB and drug-resistant TB diagnostics for all eligible patients. The TB diagnostic network assessment (TB DNA) has already been conducted in India, Uganda and Zimbabwe. The upcoming countries for 2020 are Tanzania, Viet Nam and Bangladesh. We are also working with relevant stakeholders to conduct this assessment in Mozambique and Burma. The support from IDDS is based on the respect of human rights and that access to all these diagnostic technologies should be available, regardless of a population’s income or cultural, racial, gender, religious or ethnic inclination.

Inoussa Zabsonre

19:20 - 19:45: Q&A session

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Organised by: Cepheid

The overall objective of the session will support the audience to gain deeper insights on latest innovations in TB diagnostics. 
The panelists will walk through novel technologies to improve drug-susceptibility testing, host response concepts as well as clinical insights to leverage available diagnostic tools.
* CE-IVD. In Vitro Diagnostic Medical Device. Product not available in the United States.

18:15 - 18:25: Introduction


18:25 - 18:45: Behind the scenes – Innovations in TB diagnostics Dr. Gnanashanmugam will share insights about the innovation behind the Xpert® MTB/XDR assay* and Cepheid’s technology.

Devasena Gnanashanmugam

18:45 - 19:05: Evaluation of Xpert® MTB/XDR* and possibilities of integration into the National diagnostic algorithm – the South African perspective Dr. Omar will present the first clinical evaluation of the recently launched Xpert® MTB/XDR* assay in South Africa.
* CE-IVD. In Vitro Diagnostic Medical Device. Product not available in the United States.

Shaheed Vally Omar

19:05 - 19:25: Demonstrating the power of heterogeneity: from discovery to point-of-care using public data for tuberculosis diagnosis Dr. Khatri will speak about host response gene signatures in Tuberculosis and share further insights.

Purvesh Khatri

19:25 - 19:45: Using available TB diagnostics to Guide Patient Management – A Clinical Perspective Prof. Kon will share his experience as a clinical expert in how to leverage diagnostic tools for patient management.  
 

Onn Min Kon

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Session Organised by: German Central Committee against Tuberculosis (DZK)

„History of The Union”
The centennial of The Union is a good opportunity to look back on some aspects of its long history. Since it is not possible in the allotted time to recognize all other important organizations worldwide, which are linked to The Union including their African, Asian-Pacific and South American Regions, the session has to concentrate on a few others. It is moderated by Dean Schraufnagel, former member of the Board of Directors of The Union and Past President of the ATS.
Since the Centennial of The Union coincides with the 125th anniversary of the German Central Committee against Tuberculosis (DZK), this year's Robert Koch Lecture provides a good opportunity for Robert Loddenkemper, Past President of DZK, of the Europe Region of The Union and of the ERS, to underline the close relationship of the DZK with The Union. The Robert Koch Lecture was initiated by Rudolf Ferlinz, Secretary General of DZK and President of the Union, at the 1994 World Conference in Mainz/Germany. Since 1994 six Robert Koch Lectures have been given by prominent TB experts at The Union World Conferences.
The roots of the Union are going back to the International TB Congress in Berlin 1902, where an "International Central Bureau for the Fight against Tuberculosis" was established, which can be seen as predecessor of The Union. It had the headquarters in Berlin, and Gotthold Pannwitz, Secretary General of DZK, took over the management of the bureau and of the international monthly journal "Tuberculosis". In 1895, Pannwitz was also the main initiator of the foundation of the “German Central Committee for the Establishment of Sanatoria”, one of the oldest national TB organizations worldwide. In 1905 the name of the Committee was changed to “…for the Fight against Tuberculosis". Out of this reason Robert Koch, being critical of the sanatorium movement, finally accepted to join the Committee.
Periodic international conferences systematically addressing clinical, research, and sociological aspects of TB were held until the outbreak of World War I in 1914. After the war, in 1920, a conference on TB was convened in Paris, at which the International Union Against Tuberculosis (IUAT) was founded. Until 1939, ten international conferences followed, the 11th Conference was planned to take place in Berlin in September 1939, but had to be cancelled because WW II was started by Germany on 1ST September. When the Nazis came into power in January 1933, a very dark chapter in TB control started under the general health-related motto “Public interest comes ahead of self-interest”. The horrible consequences for TB patients are described in detail. In June 1940, after the occupation of Paris, the Nazis closed the IUAT Office, which was reopened again after the war, in 1946.
During World War II, TB mortality had increased steeply in many belligerent and non-belligerent countries. This induced a broad international cooperation. Mario Raviglione, year-long former Director of the Global TB Programme at the WHO, describes in the second lecture, how the WHO was officially established by the UN in 1948, when malaria, TB, and venereal diseases were declared as the “3 main scourges demanding prior and special attention”. Just from the beginning, the Executive Committee established for TB a close relationship with the IUAT, the beginning of a very fruitful cooperation. In the mid-1960s, the Tuberculosis Surveillance Research Unit (TSRU) with The Union and the WHO as important members was initiated by KNCV. The results of the annual meetings were published in several guidelines/reports on Drug Resistance, which are now incorporated into the annual Global TB Reports of the WHO.  With the advent of HIV in the mid-1990s, the collaboration was intensified. The concept on DOTS, developed by Karel Styblo, Executive Director of The Union, was promoted by the WHO as a new strategy for TB control. There were many other fields of close cooperation, amongst them the World TB Day initiated in 1982 by The Union and later recognized officially as an annual event by the WHO.
Philip Hopewell, former President of the North American Region of The Union and of the ATS, describes in the third lecture the long and close relationship of the North American organizations from Canada und USA with The Union. The North American Region of The Union was founded in 1990. North American organizations with “informal” but influential relationships with The Union are United States Agency for International Development (USAID), the US Centers for Disease Control and Prevention (CDC), many academic institutions in US and Canada and NGOs (FHI 360, MSH, PATH). Lobbying effort for funding of global TB control were initiated by ALA/ATS in 1992. ALA/ATS convened advisory groups including the Union and the Tuberculosis Coalition for Technical Assistance (TBCTA), which was founded in 2000 at the request of USAID and original partners (The Union, WHO, CDC, KNCV, ALA/ATS). Between 2000-2019 USAID alone funded more than 900 Million USD for TB control.
In the last lecture, Giovanni Battista Migliori, Past President of the Europe Region of The Union, former ERS Secretary General and at present Chair of the Global TB Network and one of the two Chief Editors of the IJTLD, describes mainly the many activities in Europe during the last thirty years. The Europe Region of The Union was founded only in 2002 with the particular aim to increase the collaboration between Western and Eastern Europe, the latter with its high TB incidences and frequent drug resistances (MDR-TB). European organizations, which had been active already before, are WHO-Europe, KNCV, The Union and the ERS. All supported the two-yearly conferences of the Europe Region in Budapest, Bucharest, Moscow, Riga, Dubrovnik, London and Bratislava. KNCV organizes since 1990 the Wolfheze Workshops, at which experts from low incidence countries developed basic TB principles and documents allowing Europe to equip itself with surveillance, policies and guidelines for TB control and elimination. In other initiatives the Europe Region collaborates closely with ERS, WHO-Europe, ECDC, EU and many national respiratory societies, also on topics like prevention of smoking and non-communicable diseases.

18:15 - 18:19: Introduction


18:19 - 18:42: Robert Koch lecture: the history of the German Central Committee against Tuberculosis and its close relationship with The Union

Robert Loddenkemper

18:42 - 19:01: The World Health Organization and its close relationship with The Union

Mario Raviglione

19:01 - 19:20: North American organisations and their close relationship with The Union

Philip Hopewell

19:20 - 19:39: European organisations and their close relationship with The Union

Giovanni Battista Migliori

19:39 - 19:43: Closing remarks

This session takes place on Zoom.us

SeeChange works in close partnership with local communities and their organizations, such as Ilisaqsivik in Clyde River, Nunavut (ilisaqsivik.ca). 'Flattening the curve' of the COVID-19 pandemic in a particular setting requires the community to be front and centre in the development and implementation of essential activities. SeeChange and Ilisaqsivik have developed a practical tool called the 'CommunityFirst COVID-19 Roadmap' to assist communities in their planning and response to the threat of COVID-19 (www.communityfirstcovid19.org). This Roadmap offers a step-by-step guide for communities to create a plan to Organize, Prepare, Respond, and (just as importantly) Recover from COVID-19. During this webinar, utilization of the Roadmap tool will be described in detail by the Community Readiness Coordinator at SeeChange, with support from the Medical Director.

Jessica Farber, Community Readiness Coordinator, SeeChange Initiative 
Peter Saranchuk, Medical Director, SeeChange Initiative

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BCG protection against COVID-19

Please note that the number of participants is limited to 50 for this session.