19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Community Connect
Finding missing people with TB: what it will take to achieve the UN HLM targets
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Finding missing people with TB: what it will take to achieve the UN HLM targets
At the United Nations High-Level Meeting on Tuberculosis (UNHLM on TB) in September 2018, member states committed to finding, diagnosing, and treating 40 million people with TB between 2018 and 2022. According to the 2019 Global TB report, an estimated 10 million people fell ill with TB in 2018 and 7 million people were reached with TB care in 2018, up from 6.4 million in 2017. Nearly 75% of the 3 million ‘missing people with TB’ were estimated to be accessing care in the private sector. While this was a major milestone towards delivering on the political declaration on TB, progress has been severely derailed by the COVID-19 pandemic. Nearly all recent studies show sharp drop in TB notification globally, up to 70%. Most countries report that active case-finding has been completely halted and the focus during the pandemic has been on ensuring continuity of services for TB patients. However, without finding these missing people with TB, it is virtually impossible to achieve the HLM targets. Against this backdrop, this session will explore the challenges, opportunities and approaches, including new innovations for reaching the missing people with TB in the changed landscape. 

1. Dr Suvanand Sahu, Deputy Executive Director - Stop TB Partnership Secretariat
2. Dr Andy Eyo, Chief Executive Officer/Project Director - ECEWS UNOPS/TB REACH
3. Blessi Kumar, CEO - Global Coalition of TB Activists
4. Rachel Forse - Friends for International TB Relief (FIT)
5. Amir Khan, Epidemiologist and Social Entrepreneur - Interactive Research and Development (IRD)
6. Aaron Oxley, Executive Director - RESULTS UK
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SP-21-Engaging communities to address concurrent pandemics of TB and COVID-19
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SP-21-Engaging communities to address concurrent pandemics of TB and COVID-19
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This symposium will utilise a range of perspectives to explore the critical role of community engagement to address tuberculosis (TB) and COVID-19. We will hear front line field notes from a community health worker (CHW) in South Africa. We will learn from experiences of applying knowledge from TB to deliver testing and contact tracing for COVID-19 through non-profit organisations in Peru and the U.S. We will examine strategies for engaging with policy makers to support CHWs and reduce the dual stigma of these infections. Finally, we will discuss partnerships with the media to maximise the impact of public health messaging to communities.

15:00 - 15:05: Introduction

15:05 - 15:15: Field notes: a frontline community health worker perspective on responding to TB in the time of COVID-19Community health workers (CHWs) play a critical role in supporting person-centred care, raising tuberculosis (TB) awareness, providing TB information in local languages to communities, and reaching missing people with TB who are not accessing health services and linking them to the health system. Each person has a human right to health and CHWs play a critical role in transforming the TB response to be equitable, rights-based and people-centred. Yet, CHWs are not provided with platforms to inform the TB response despite being experts on the healthcare needs of communities. Ms. Muedi will discuss insights from frontline CHWs, including identified gaps in the training and personal protective equipment offered to CHWs caring for people with TB, and the role of CHWs in the response to COVID-19.  
Portia Muedi

15:15 - 15:25: Prioritising partnerships: mobilising community health workers to fight COVID-19 in PeruSocios En Salud (SES) has partnered with the United States Agency for International Development to support Peru’s healthcare system to care for patients with COVID-19. Dr. Lecca will discuss how SES activated a community health worker network to safely conduct outreach visits to identify families needing clinical and social support in Peru’s hardest hit regions of Lima as well as a medical call centre to conduct telehealth consultations. Dr. Lecca will discuss how SES applied its many years of experience mobilising CHWs to contact public health education and contact tracing for TB in order to train CHWs to safely provide community-based care and education.  
Leonid Lecca

15:25 - 15:35: Bending the curve: leveraging experiences from TB care to contain COVID-19 in MassachusettsPartners In Health (PIH) is a non-governmental organisation that has built long standing relationships with ministries of health and communities in the world’s poorest settings, with the goal of providing the highest standard of care to all. As such, they are well positioned to tackle COVID-19, which is having a disproportionate impact on communities already affected by poverty and poor healthcare. Dr. Seung will discuss how PIH developed an ambitious response that sought to bend, rather than merely flatten, the curve of COVID-19 in Massachusetts and other U.S. states by applying lessons learned from TB with respect to testing, contact tracing, and supported quarantine and isolation. He will discuss the challenges of implementing rapid testing and addressing the social and economic needs of underserved communities, including the use of food and cash assistance, as part of a comprehensive response.
KJ Seung

15:35 - 15:45: Engaging policy makers to protect community health workersMs. Schoeman will discuss insights gained from leading a Gates Foundation funded project to empower community health workers (CHWs) to motivate for and contribute to person-centred tuberculosis (TB) care, by providing training in advocacy, media and communications. In response to stigma being identified as a major barrier in the TB care cascade, she helped to facilitate CHWs in Hammanskraal, Gauteng province, to develop community-focused theatre plays to address stigma.  She will discuss the challenges of building and maintaining strong relationships locally, provincially and nationally in order to secure support for in-service TB training of CHWs and for an implementation plan to accompany the Ward Based Primary Health Care Outreach Team policy that was recently released by the department of health. Finally, she will examine how TB Proof was able to leverage its TB advocacy partnerships to advocate to the South African government to impose a lockdown and #Masks4All policy to disrupt COVID-19 transmission.

Ingrid Schoeman

15:45 - 15:55: Partnering with the media to deliver public health messages to communitiesGovernments in high tuberculosis (TB) incidence settings like India have consistently failed to invest adequately in health and ensure funding of basic programmes to test, trace and treat TB. Concurrently, stigma and mistrust of government health systems have fuelled longstanding challenges to engage communities to participate in TB screening and to complete treatment. The COVID-19 pandemic has exacerbated social inequities with lockdowns and mass unemployment that have a disproportionate effect on the poorest, particularly while investment in testing, tracing and isolation remains inadequate. Ms. Krishnan will discuss insights she has gained from interviews with people affected by TB and other key stakeholders in the context of the COVID-19 pandemic. She will provide suggestions as to how public health professionals can engage communities with more effective messaging and interventions that are responsive to their needs. She will also address perceived gaps in current TB advocacy, from her unique perspective as a journalist.
Vidya Krishnan

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

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TBS2A-TB infection and disease - the details: plenary session
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TBS2A-TB infection and disease - the details: plenary session
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Recent research has suggested that M. tuberculosis can present as more subtle states than just 'latent' infection and active disease. This has relevant diagnostic, preventive, therapeutic, transmission, modelling and economic analyses implications. This session is intended to discuss different implications of the spectrum of tuberculosis infection.

15:00 - 15:03: Introductory note


15:03 - 15:23: Subclinical TB in epidemiological models: What we know, what we don't, and what difference it makes

Emily Kendall

15:23 - 15:43: Bacterial and host determinants of cough aerosol culture-positivity in patients with drug-resistant or drug-susceptible TB

Grant Theron

15:43 - 16:03: Natural history of subclinical tuberculosis tracked by PET/CT and blood biomarkers

Anna Coussens

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


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SS2-COVID-19: different strokes
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SS2-COVID-19: different strokes
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While SARS-CoV2 has spread across the world, countries’ responses have varied around the globe. This session will focus on the different approaches and the impact of these strategies on country statistics and experiences. The discussion will include the reasons for different strategies (including lessons learned from other epidemics), the pros and cons of these approaches and the possible translational lessons for tackling other epidemics.

15:00 - 15:03: Introduction


15:03 - 15:13: Turkey: targeted mitigation

Kayihan Pala

15:13 - 15:23: Senegal: be prepared

Abdoulaye Bousso

15:23 - 15:33: South Africa: Early lockdown

Glenda Gray

15:33 - 15:43: Brazil: Missed opportunities

Guilherme Werneck

15:43 - 15:53: New Zealand: Elimination strategy

Ayesha Verrall

15:53 - 16:03: Australia: Adaptability

Jodie McVernon

16:03 - 16:13: A personal experience

Robin Gorna

16:13 - 16:28: Live Q&A and moderated discussion

Kayihan Pala
Abdoulaye Bousso
Glenda Gray
Guilherme Werneck
Jodie McVernon
Robin Gorna

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OA-18-(Im)possible mission: TB care in low-resourced settings
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OA-18-(Im)possible mission: TB care in low-resourced settings
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15:00 - 15:05: Introduction


15:05 - 15:13: OA-18-612-22-Enabling MPs to support and take ownership of India’s TB programme Localised review and troubleshooting mechanisms, with political will and ownership driving them forward, could be pivotal for the success of tuberculosis (TB) programmes. This pilot initiative showed that elected representatives (Members of Parliament), when provided with the right tools and information, are well placed to support TB elimination efforts. 

Indira Behara

15:13 - 15:21: OA-18-613-22-99DOTS for TB treatment supervision in Uganda: adherence rates and acceptability 99DOTS is a low-cost technology with the potential to improve tuberculosis (TB) treatment adherence and completion. We implemented 99DOTS at 18 health facilities in Uganda to evaluate treatment adherence, benefits and challenges of using it. Despite challenges of phone availability and software malfunctions, patients and providers found the technology acceptable and convenient.

Alex Kityamuwesi

15:21 - 15:29: OA-18-614-22-Determinants of delayed diagnosis and treatment of TB in high burden countries: a mixed methods systematic review and meta-analysis Delays in diagnosis and treatment vary across countries and little is known among countries bearing most of the global tuberculosis (TB) burden. Therefore, a systematic review and meta-analysis were undertaken to derive the determinants and duration of diagnosis and treatment delay of pulmonary TB in the high TB-burden countries.

Alvin Kuo Jing Teo

15:29 - 15:37: OA-18-615-22-The effect of depression, anxiety and other risk factors on adherence to anti-TB treatment in the Philippines It is important to know the effect of depression, anxiety, stigma, social/family support and nutrition on adherence. In the Philippines, there is limited published research on the barriers to adherence in tuberculosis (TB) patients. This study investigated the reasons for non-adherence among Filipino TB patients enrolled in public TB-DOTS centres. 

Hend Elsayed

15:37 - 15:45: OA-18-616-22-Impact of HIV 'test and treat' policy on the incidence of TB in HIV populations in East-Central Uganda This abstract demonstrates the impact of the test and treat early antiretroviral treatment initiation policy on the incidence of tuberculosis (TB) among HIV populations, in programme settings in sub-Saharan Africa. The risk of TB among people living with HIV significantly reduced with the test and treat policy. It adds programmatic evidence for the implementation of the policy.

Rodrigo Nyinoburyo

15:45 - 15:53: OA-18-617-22-Utility and benefits of TB molecular bacterial load assay to monitor TB therapy in a resource-limited, high burden setting Rapid and accurate tests are needed for monitoring tuberculosis (TB) therapy. We explored the utility and benefits of TB molecular bacterial load assay (TB-MBLA) for monitoring TB therapy. We found that the TB-MBLA test provides rapid and accurate results in time to inform clinical management of TB patients and that it can be applied in high burden settings.

Bariki Mtafya

15:53 - 16:01: OA-18-618-22-Using TB care process mapping to improve treatment retention and treatment success rate in low-income settings: experience from central Uganda According to the World Health Organization, tuberculosis (TB) treatment success rate (TSR) is below the 95% global target in many countries, including in Uganda. TB patient retention is a contributor to TSR. By early 2019, only 17% facilities were meeting the national retention target. A TB care process mapping intervention was implemented with improvements in retention and TSR.  

Herbert Kisamba

16:01 - 16:20: Q&A


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SP-20-Improving access to laboratory-based diagnosis for young children: recent advances using stool and urine as alternative sample types
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SP-20-Improving access to laboratory-based diagnosis for young children: recent advances using stool and urine as alternative sample types
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While clinical diagnosis remains valuable, improving access to laboratory-based diagnosis for children with presumptive tuberculosis (TB) is critical to increase diagnostic certainty and ensure timely initiation on effective treatment, even more so in settings with high transmission of drug-resistant TB. Laboratory-based diagnosis in children is hampered by challenges in obtaining adequate specimens and sub-optimal performance of existing tests on pauci-bacillary specimens. Recently the World Health Organization recommended stool as a useful specimen to diagnose pulmonary paediatric TB and urine-based LF-LAM for children living with HIV. This session will review the latest evidence on the role of those alternative sample types for childhood TB.  

15:00 - 15:05: Introduction

15:05 - 15:15: Closing the case detection gap in children with TB: WHO updatesOver 1.1 million children (aged under 15 years) were estimated to have fallen ill with tuberculosis (TB) in 2018 and over 200,000 of them died, the majority before their 5th birthday. The case detection gap was estimated at 54% and was highest (63%) in children under five, due to -among others - the paucibacillary nature of TB, the lack of a sensitive point-of-care test and the challenges in collecting a respiratory sample for bacteriological testing in young children. This presentation will set the scene covering the latest epidemiological data on TB children as well as progress towards the United Nations High-Level Meeting on TB targets for children. Updated World Health Organization policy recommendations, relevant to the diagnosis and management of TB in children, will be discussed.
Sabine Verkuijl

15:15 - 15:25: Utility of stool samples for microbiological confirmation of TB in childrenIn January 2020 the World Health Organization published a Rapid Communication on the use of molecular assays as initial tests for the diagnosis of tuberculosis (TB). The conclusions support the continued use of Xpert MTB/RIF and Xpert Ultra in children including stool samples. 
Following up on last year’s symposium, two parallel evaluations of centrifuge-free stool processing methods are underway, including the Stool Processing Kit (FIND), Simple One-Step (KNCV) and Sucrose Flotation (TB-Speed) methods, in combination with Xpert Ultra. 
The head-to-head comparison includes an assessment of the performance for TB detection as well as the ease of use of the three methods.
Pamela Nabeta

15:25 - 15:35: Update on simple one step stool testing method and practical guidance on the best placement of this test in the diagnostic algorithmTo assess the accuracy, feasibility and acceptability of the KNCV SOS stool method as compared to Xpert on a gastric aspirate or an induced sputum specimen, the SOS stool method is being implemented in parallel to the routine algorithm in Ethiopia and Indonesia. This will provide more precise accuracy estimates and valuable lessons for scale-up. Modelling studies are underway to provide more insights into the best placement of the method in the diagnostic algorithms. This presentation will outline key lessons learned to be addressed for scale-up of stool processing in countries and provide insights on how it can best be placed in the diagnostic algorithm for childhood tuberculosis.
Edine Tiemersma

15:35 - 15:45: Accuracy of a novel urine test, Fujifilm SILVAMP TB LAM, for the diagnosis of pulmonary TB in childrenAn accurate point-of-care test for tuberculosis (TB) in children remains an elusive goal. A novel urinary lipoarabinomannan (LAM) test, Fujifilm SILVAMP TB LAM (FujiLAM) showed superior sensitivity to Alere Determine TB LAM (AlereLAM) in HIV-infected adults. We compared the accuracy of FujiLAM and AlereLAM in children with suspected pulmonary TB presenting to hospital in Cape Town, South Africa. There were 204 children enrolled who had valid results from index and sputum tests. Using a microbiological reference standard, sensitivities of FujiLAM and AlereLAM were similar (42% and 50% respectively), but lower than Xpert MTB/RIF of sputum (74%).   However, specificity of FujiLAM was substantially higher than AlereLAM (92% vs. 66%), suggesting that non-specific detection accounted for the apparent higher sensitivity of AlereLAM. Sensitivity of FujiLAM was higher in HIV-infected and malnourished children. The high specificity of FujiLAM suggests utility as a ‘rule-in’ test for TB in children, particularly those who are HIV-infected.
Mark Nicol

15:45 - 15:55: Keynote : overview of where we are in childhood TB diagnosisThis presentation will discuss the role of the  sample types and tests recently recommended for tuberculosis (TB) diagnosis in the context of clinical and programmatic management of childhood TB and summarise remaining challenges to be addressed to close the gap in paediatric TB case finding
Ben Marais

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

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SP-23-Preventing TB in people with diabetes mellitus: where are we now and where are we going?
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SP-23-Preventing TB in people with diabetes mellitus: where are we now and where are we going?
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Diabetes mellitus (DM) increases susceptibility to tuberculosis (TB) infection and the risk of progression from latent infection to active disease. There is evidence that better DM control lowers the risk of TB and strong evidence that preventive therapy reduces the risk of TB in persons with latent TB infection. This symposium will bring together researchers and health professionals to discuss the risk of TB in persons with DM and their close contacts, as well as how to minimise the risk of progression from infection to active disease.  This approach is patient-centred and supports universal health coverage for TB care and achievement of the END TB targets.

16:30 - 16:35: Introduction

16:35 - 16:45: Risk of TB infection in healthcare workers in relation to blood glucose levels and vitamin D statusThe association between diabetes mellitus (DM) and tuberculosis (TB) has been known for many years but studies in the last 15 years highlighted that DM increases the risk of  TB and that patients with dual disease have worse TB treatment outcomes compared with those who have just TB alone. This was a cross-sectional study which sought to understand whether the association between vitamin D and TB risk is modified by fasting blood glucose (FBG) among adult healthcare professionals working in TB hospitals of Mongolia. Adult healthcare workers (doctors, nurses, laboratory staffs, etc) who work in the chosen sites will be recruited and assessed for TB infection using the QuantiFERON-TB Gold Plus (QFT-Plus) assay. Participants will undergo assessment of serum 25-hydroxyvitamin D (25(OH)D), FBG, and lifestyle characteristics.
Ganmaa Davaasambuu

16:45 - 16:55: Recurrence of TB in relation to blood glucose levels and vitamin D status in ChinaWe are following a cohort of 306 tuberculosis (TB) patients who were registered in six clinics and hospitals in Jilin, China, since 2015. Demographic information, TB characters, smoking status, blood glucose and vitamin D level was collected at baseline. TB recurrence information was collected after completion of their anti-TB treatment. Of the 306 patients, eight died during treatment and nine did not remain TB disease free for at least six months since end of the initial treatment. Therefore, 289 patients were qualified to be included in this study. There were 60 people who had at least one TB recurrence during the follow up years. Accumulate risk of recurrence was 20.76% (95% CI, 16.23-25.90%). In the multivariate analysis, risk of recurrence was strongly associated with being over 60 years (P=0.007), re-treatment (P<0.001), with treatment interruption (P=0.002) and smoking (P=0.036); but not significantly associated with their baseline diabetes status and vitamin D levels.
Yan Lin

16:55 - 17:05: Rifapentine-based short-course preventive therapy for diabetes mellitus patients with latent TB infectionBeginning in 2018, a pilot project for screening and treating latent TB infection (LTBI) in TB high-risk populations was launched by Taiwan CDC. In Taichung and Kaohsiung cities, people with poorly controlled diabetes mellitus (DM), defined as HbA1c ≥ 9% within one year, were chosen as the target population for intervention. Between April 2018 and August 2019, a total of 833 subjects were screened by DM specialists and 779 (93.5%) received LTBI testing by QuantiFERON, with a positive result in 200 (25.7%). After being evaluated by pulmonologists, two had active pulmonary TB and 49 declined preventive therapy. In the remaining 149 (female: 63), mean age was 65.2±8.9 and BMI 26.5±3.8. Of them, 45 and 104 received 9H and 3HP regimen, with 38 (84%) and 88 (85%) completing treatment, respectively. In the 3HP group, 7 (7%) suffered from systemic drug reactions. This pilot project demonstrates LTBI policy can be efficiently implemented under a collaborative framework.
Jann-Yuan Wang

17:05 - 17:15: Progression from latent TB infection to active TB disease and effectiveness of isoniazid chemoprophylaxis in persons living with diabetes: an individual participant meta-analysisGlobally, hundreds of millions of people are living with diabetes (PLWD) and are at increased risk of developing tuberculosis (TB). Drawing upon a multicohort collaboration of research groups, we aimed to explore two questions: i) is the increased risk of TB among PLWD predominantly due to increased risk of infection or disease progression? and ii) how effective is isoniazid in the prevention of TB among PLWD with Mycobacterium tuberculosis infection? The results of this work will be presented in this session showing that the increased risk of developing tuberculosis is due to an elevated risk of progression from M. tuberculosis infection to disease and that isoniazid preventive therapy is highly effective in preventing TB among PLWD. Taken together, these findings suggest that PLWD should be prioritised for preventive therapy.

Leonardo Martinez

17:15 - 17:25: Prevention of TB in diabetes (PROTID): a phase 3 randomised trialPROTID (www.protid-africa.com) is the first randomised controlled trial (RCT) globally to examine tuberculosis (TB) preventive treatment among people with diabetes mellitus (DM). (n=3000), comparing 3HP preventive therapy and placebo, with incident TB disease over two years as the primary endpoint. In parallel with the RCT, a cohort of 1000 people with DM, but without evidence of latent TB infection (LTBI) will be followed to confirm whether TB incidence in this group is indeed too low to warrant preventive treatment. PROTID will also evaluate optimal ways to screen people with DM for LTBI and TB; address gaps in prevention and therapeutic management of combined TB and DM; and estimate the population impact and cost-effectiveness of LTBI treatment in people living with DM on TB incidence and transmission.
Reinout van Crevel

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

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SP-25-It takes more than bandwidth - using the Extension for Community Healthcare Outcomes virtual community of practice model to build local health workforce capacity.
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SP-25-It takes more than bandwidth - using the Extension for Community Healthcare Outcomes virtual community of practice model to build local health workforce capacity.
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Countries with a high burden of tuberculosis (TB) are implementing the ECHO (Extension for Community Healthcare Outcomes) telementoring model — based on a combination of video conferencing, case-based learning, sharing of best practices and monitoring outcomes — to target communities where health disparities are the greatest. We will introduce participants to the basic principles of the ECHO virtual community of practice model that connects national and international experts with local TB practitioners, highlight innovative and sustainable examples of implementation in a variety of country contexts, and promote discussion around the challenges and opportunities for adapting the model to TB education and workforce development globally.

16:30 - 16:35: Introduction

16:35 - 16:45: National Initiative to Strengthen Collaboration between HIV-TB through e-learning (e-NISCHIT) in IndiaIn 2017, the national AIDS and TB programs introduced conceptual changes in TB guidelines, wherein TB treatment for PLHIV was shifted from TB to HIV clinics. Initial experience pointed towards a countrywide need for mentoring of HIV teams in clinical and programmatic management of TB. An HIV-TB ECHO program, e-NISCHIT, was started in 2018, in collaboration with Government of India, CDC, Share India and ECHO India. National Institute of TB is the hub for this program and state run HIV Clinics from two states each of North and South India (~100 clinics) were selected to be the initial spokes. This program has successfully conducted 52 sessions to date, enabling rapid percolation of TB/HIV guidelines and handholding of peripheral HIV teams to undertake optimal TB management. The GOI has recently extended this program to areas with high prevalence of both HIV and TB in India's northeast and plans to expand nationwide.
Upasna Agarwal

16:45 - 16:55: Ensuring quality TB and specialty care for underserved patientsDespite universal access to tuberculosis (TB) diagnosis and treatment in Georgia, TB services in rural and underserved areas of the country are still unevenly distributed; there is a lack of access to multi-disciplinary and specialty care, as well as to the latest updates and innovations in TB diagnosis, patient care and treatment. As a result, the majority of TB patients are referred to the central TB treatment facility to receive quality TB and specialty care. To overcome the challenges of delayed treatment initiation and minimize time and costs of patient travel to central facilities, Project TB-ECHO was implemented in late 2017 and fully functional since early 2018. Over 800 patient cases have been discussed since ECHO implementation which gives the country a hope to soon have a significant improvement in the number of lost to follow-up cases, increased treatment success and enhanced capacity of human resources on all country levels.
Mariana Buziashvilli

16:55 - 17:05: Building a Community of Practice for TB Program Managers - Utilizing the ECHO ModelThe National Tuberculosis Controllers Association (NTCA) is the premier organization in the United States representing tuberculosis (TB) public health programs; NTCA has evolved as a non-profit, professional member service organization and has over 600 members from every state, city, and territorial TB program. NTCA wanted to enhance networking and educational opportunities to meet the unique needs of TB program managers responsible for overall program administration. The NTCA launched its first Community of Practice session on July 11, 2019 with 56 participants from across the United States.  The initial sessions (296 participants) focused on writing and preparing the CDC TB Cooperative Agreement 2020 Notice of Funding Opportunity.  Series Two, (161 total participants) focused on writing the CDC Cooperative Agreement Five Year Progress Report. Series Three, (237 participants) focused on the maintenance of TB programmatic and clinical activities despite the pressing COVID-19 responsibilities added to TB programs.
Diana Fortune

17:05 - 17:15: Expansion of the Regional TB ECHO Program across Central AmericaThe CDC Central America Regional (CAR) Office provides technical assistance to Ministries of Health in the region through a PEPFAR funded TB/HIV program. In 2019, WHO reported 14,353 TB cases in CAR including 1123 cases ofTB/HIV in the region of seven countries. Some of the challenges faced to obtain TB epidemic control in rural areas are lack of resources, poor referral of patients for care and treatment, difficult to reach communities and lack of specialized trained physicians to treat TB. From 2018-2019, CDC CAR launched three TB ECHOs in Guatemala, Panama and Honduras. The TB ECHO program in Guatemala included a 6-month TB basics national certificate program and trained around 300 healthcare workers. In addition to the national programs, CDC CAR and its partner SE-COMISCA (Commission of Ministries of Health in the region) launched a regional program in May 2020 to discuss common challenges for all countries such as TB cases in immigrants, people living with HIV, diabetes and COVID-19.
Diana Patricia Forno

17:15 - 17:25: Advancing Prevention in Massachusetts, USA - Implementing the ECHO model to increase latent tuberculosis infection testing and treatment in primary careIn 2016, the US Preventive Services Task Force updated recommendations to support latent tuberculosis infection(LTBI) testing as a preventive strategy and recommended that primary care providers(PCPs) integrate LTBI management into their primary care practices. PCPs rarely receive sufficient LTBI training and feel uncomfortable prescribing rifampin and isoniazid. In 2019, the Massachusetts (MA) Department of Health partnered with the University of MA Project ECHO hub to design a LTBI ECHO. The course incorporates six virtual telementoring sessions for MA PCPs. A mixed-methods program evaluation was conducted. Pre- and post quantitative structured surveys were administered to LTBI ECHO course participants. Qualitative in-depth interviews were conducted with participants and content experts to assess resulting practice changes and recommendations. We found that our LTBI ECHO course increases PCPs knowledge and confidence and supports practice change. Health departments may find LTBI ECHO programs to be an effective intervention to train PCPs in LTBI management.  
Daria Szkwarko

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

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TBS2B-Bacterial metabolic activity and the host response in TB disease: oral abstract presentations
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TBS2B-Bacterial metabolic activity and the host response in TB disease: oral abstract presentations
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Recent research has suggested that M. tuberculosis can present as more subtle states than just 'latent' infection and active disease. This has relevant diagnostic, preventive, therapeutic, transmission, modelling and economic analyses implications. This session is intended to discuss different implications of the spectrum of tuberculosis infection.

16:30 - 16:32: Session introduction


16:32 - 16:40: TBS-OA-05-Transcriptomic profile of aerosolized Mycobacterium tuberculosis from patients during the early phase of drug-sensitive anti-tuberculosis treatment

Ambreen Shaikh

16:40 - 16:48: TBS-OA-06-Antigen-specific T cell activation distinguishes between recent and remote tuberculosis infection

Elisa Nemes

16:48 - 16:56: TBS-OA-07-Self-clearance of Mycobacterium tuberculosis infection: implications for lifetime risk and population at-risk of tuberculosis disease

Jon C. Emery

16:56 - 17:04: TBS-OA-08-Cough-independent production of metabolically active Mycobacterium tuberculosis in bioaerosol

Benjamin Patterson

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


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OA-21-Finding missing people with TB: targeted approaches
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OA-21-Finding missing people with TB: targeted approaches
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16:30 - 16:35: Introduction


16:35 - 16:43: OA-21-626-22-TB screening and treatment by neo-literate community volunteers among tribal populations in insurgency hit Swabhiman Anchal saved lives and livelihoods in Malkangiri district, Odisha Tuberculosis (TB) screening and treatment by neo/semi-literate community volunteers among tribal populations in insurgency hit Swabhiman Anchal (cut-off area) saved lives and livelihoods in Malkangiri district, Odisha. Engaging the community themselves and adapting out-of-box strategies brought a significant impact on the disease prevalence and mortality among such a community.

Gayadhar Mallick

16:43 - 16:51: OA-21-627-22-Investigating the feasibility of universal screenings and instituional treatment support of the homeless population through a mobile digital X-ray and CBNAAT algorithm in India A pilot study demonstrated the efficacy of a universal screening test, using a mobile digital X-ray and CBNAAT algorithm, and the high, untreated burden of tuberculosis (TB) among the homeless population in Delhi.  It also pointed to the importance of a diversity of treatment support mechanisms required for treatment completion.

Armaan Mullick Alkazi

16:51 - 16:59: OA-21-628-22-Risk factors associated with loss to follow-up among multidrug-resistant TB patients in Ukraine Risk factors associated with loss to follow-up (LTFU) among multidrug-resistant (MDR-TB) patients in Ukraine. Our data reinforced the concept that LTFU in MDR-TB is a serious public health problem and that adequate follow-up of treatment is necessary, along with the expansion of social support programmes for patients, in order to avoid unfavourable outcomes.

Olha Zaitseva

16:59 - 17:07: OA-21-629-22-Promoting a community-led, multisectoral and collaborative response to TB: learnings from India Globally, the tuberculosis (TB) response has remained largely biomedical, with minimal involvement of communities and other actors. An intervention to engage previously un-engaged stakeholders and to broaden the conversation around TB was implemented in India between 2016-2019 and affirmed that a multisectoral, community-led approach is essential to trigger collective action.

Anupama Srinivasan

17:07 - 17:15: OA-21-630-22-Towards a Nairobi TB free city: engaging city authorities towards the elimination of TB: the case of the Nairobi City County government Local city authorities play a critical role towards attainment of the End TB Strategy goals. However, their engagement has been challenging in many countries. This presentation outlines key steps towards successful engagement of city authorities in tuberculosis (TB) activities to ensure ownership and sustainability of efforts towards ending TB.

Ann Masese

17:15 - 17:23: OA-21-631-22-Maintaining TB care and management through community refills in a high HIV-TB-burden setting in the era of COVID-19 TB-HIV care was provided in the community due to COVID-19 measures, which limited the ability of patients to come to the clinic for routine care and drug refills. The community programme implementation alleviated travel challenges and led clinicians to also understand community influences in accessing to care.

Hloniphile Gama

17:23 - 17:31: OA-21-632-22-A WhatsApp-based interactive communication strategy to reduce initial loss to follow-up among presumptive TB patients in a high-incidence setting Delays and losses along the tuberculosis (TB) care cascade constitute important challenges for TB programmes. Mobile messaging services, such as WhatsApp, might help mitigate these challenges. We developed and piloted a WhatsApp-based interactive communication intervention to reduce initial loss to follow-up among individuals awaiting TB test results in a high-incidence setting.



Florian M. Marx

17:31 - 17:50: Q&A


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