19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 2
OA-23-TB: finding the missing millions
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OA-23-TB: finding the missing millions
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-23-640-23-Improving detection of persons with TB during national polio immunisation plus days and polio outbreak response activities in Kaduna State, Nigeria Nigeria remains among the high burden tuberculosis (TB), TB-HIV and drug-resistant TB countries. Leveraging on the polio immunisation plus days (NIPD), where virtually every household in the state is visited by the house-to-house vaccination teams, presents an avenue for identifying the missing or un-diagnosed people with TB in the community.

Dauda Samuel Hananiya

11:13 - 11:21: OA-23-641-23-Results of active case finding with, and without, the joined approaches of the seed-and-recruit model We have shown that roving, one-off active case finding, along with a joint seed-and-recruit model, can have a significant impact on the number of people receiving tuberculosis (TB) treatment, even in the context of a well-functioning TB programme with declining notifications. We are very happy with the success of both projects generating high additionality.

Monyrath Chry

11:21 - 11:29: OA-23-642-23-Missing no more: improved case detection of childhood TB through active case finding in hard-to-reach riverine communities in southern Nigeria We report the results of a focused, community-wide project intervention in hard-to-reach riverine communities in southern Nigeria, and the corresponding impact on childhood tuberculosis case notification within the intervention period. Our findings highlight enablers that can improve TB case finding in resource-constrained settings.

Ngozi Murphy-Okpala

11:29 - 11:37: OA-23-643-23-Thinking outside the (TB) box: intensified paediatric TB case finding in non-TB entry points in nine sub-Saharan countries Paediatric tuberculosis (TB) is under-diagnosed, highlighting a need for effective case finding. We introduced systematic TB screening using a child-adapted, symptom-based tool in waiting areas of non-TB entry points across nine countries. We found low numbers needed to screen in order to diagnose one case in outpatient departments, paediatric wards and nutrition services.

Shirin Kakayeva

11:37 - 11:45: OA-23-644-23-Implementing structured TB screening as part of routine child care services at orphanage homes in a Nigerian local government area Five large orphanage homes were engaged to include regular tuberculosis (TB) screening as part of their routine care package for the children. Over a nine-month period, TB cases were diagnosed among the children and their caregivers. We recommend that periodic evaluation for TB be considered for all such settings.

Ukamaka Onyima

11:45 - 11:53: OA-23-645-23-Data-driven TB active case finding in South Kivu, Democratic Republic of the Congo, leveraging innovative predictive and surveillance reporting software applications We designed and tested a two-step methodology for the systematic screening of tuberculosis (TB) for active case findings. This encompasses the development of an incidence-rates prediction map at a very granular level and the usage of the Mediscout© applications for individual risk assessment. The pilot test in South Kivu showed promising results.

Mauro Faccin

11:53 - 12:01: OA-23-646-23-Finding missing patients: yield of targeted universal testing for TB in high-risk groups presenting to 30 primary healthcare facilities in South Africa We report yield of a risk factor-based testing strategy in South Africa. To be tested, clinic attendees had ≥1 tuberculosis (TB) risk factor; HIV infection; recent contact with a TB patient or recent prior TB, irrespective of symptoms of TB. Participants provided a single specimen for Xpert Ultra and MGIT culture.

Rebecca Berhanu

12:01 - 12:20: Q&A


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Channel 5
SP-39-National TB prevalence surveys in Southern Africa: key results, lessons learned and programmatic implications
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SP-39-National TB prevalence surveys in Southern Africa: key results, lessons learned and programmatic implications
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Accurate measurement of the burden of disease through national tuberculosis (TB) prevalence surveys is part of the work of the World Health Organization's Global Task Force on TB Impact Measurement. Four such surveys were recently conducted in high TB-HIV burden countries in Southern Africa - Eswatini, Lesotho, Mozambique and South Africa. This symposium will present the key results, major lessons learnt and the programmatic implications, followed by how these survey results were used to re-estimate TB burden.

16:30 - 16:35: Introduction

16:35 - 16:45: The road to TB elimination in Eswatini: who are we missing and why?Eswatini, a high TB-HIV burden country, successfully conducted its first national tuberculosis (TB) prevalence survey in 2018. Results showed a significant number of TB cases were being missed with the current symptom screening strategy. Innovative approaches are needed to guide the strategic direction for TB elimination against the high background of HIV. This presentation will share the country’s experience and the policy/programmatic implications of the survey findings.
Welile Sikhondze

16:45 - 16:55: Lesotho national TB prevalence survey 2019: results, lessons learned and implications for the national TB programmeLesotho, a high TB-HIV burden country, conducted a national tuberculosis (TB) prevalence survey in 2019 that was led by University Research Company jointly with its partners NEXT2PEOPLE and AQUITY Innovations. The presentation will focus on the rationale for conducting the survey, methodology (including the use of Xpert Ultra – one of the first countries to do so), lessons learned during implementation, key results (that included a high burden among men compared with women, a burden that increased with age, and a very large TB-HIV co-infection rate) and implications for the national TB programme.
Bridget Maama Llang

16:55 - 17:05: The first national TB prevalence survey of Mozambique, 2018-2019: challenges and achievementsMozambique is on all three World Health Organization high burden lists for tuberculosis (TB), HIV-TB co-infection, and multi-drug resistant TB. The country conducted its first national TB prevalence survey to gain more insight in the country's TB epidemic and used the results to guide TB control in the country. This presentation will discuss the methodological approach, key findings and lessons learned including how to guide quality assurance in culture and manage discordant results between Xpert MTB/RIF and culture. It will also underline key operational and technical challenges faced during the field work. Finally, it will describe the impact of the survey results on the design of future strategies for TB control in Mozambique.
Ivan Manhiça

17:05 - 17:15: Insights into the TB epidemic of South Africa: findings from the first national TB prevalence survey, 2019The first ever national prevalence survey in South Africa was completed in 2019; a country with a high TB-HIV burden and where high levels of community transmission of tuberculosis (TB). Screen-positive survey participants ≥15 years were tested for TB by culture and Xpert MTB/RIF Ultra. Findings from the survey are that the country has a high burden of pulmonary TB, that there is a considerable gap in prevalence to notification, and that many prevalent TB cases were not reported by the routine surveillance system of the national TB programme. TB was not uniformly distributed across age groups, prevalence in men was 1.6 times than that of women, prevalent TB was often not symptomatic, and HIV infection was a major risk factor for symptomatic TB. Previous TB was common among survey participants, which showed the limitation of molecular-based tests in the absence of signs and symptoms. 
Lindiwe Mvusi

17:15 - 17:25: Estimating incidence from national prevalence survey results in Southern AfricaA presentation of statistical methods, key results and their limitations will be made, covering the following countries: Eswatini, Lesotho, Mozambique and South Africa.
Philippe Glaziou

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

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E-posters
EP37-Joining efforts for TB elimination: the role of the private sector
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EP37-Joining efforts for TB elimination: the role of the private sector
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP37-455-24-Is it worth investing additional resources to catalyse access to TB care in the private sector? An experience from southern IndiaOur study aims to assess the impact of additional project investments on access to TB care services, like microbiological confirmation of diagnosis, universal DST and linkage to government portals by notification, thereby enabling access to incentives etc. Our learning from southern India can be generalised for Indian context and holds high significance in resource-constraint settings.
Vaibhav Ghule

EP37-456-24-The importance of using systematic screening in high TB burden countries to improve case detection rates: a case from private clinical facilities in NigeriaSystematic screening is key to tuberculosis (TB) case detection in high TB burden countries like Nigeria. The United States Agency for International Development SHOPS Plus programme engaged private clinical facilities in Lagos and Kano States to increase case detection though screening and testing. We compared screening, testing and case finding rates between supported hospitals and nursing homes.
Flora Nwagagbo

EP37-458-24-Factors affecting Nigerian private health facilities' TB case finding performance: reviewing programme dataThe United States Agency for International Development's SHOPS Plus Nigeria programme has engaged over 500 private health facilities in Lagos and Kano States to increase case detection. SHOPS Plus assessed the performance of its networked clinical facilities, using service delivery data, so it could better target oversight and diagnostic resources.
Abdu Adamu

EP37-459-24-Improving quality of care in private sector patients: state of Uttar Pradesh, IndiaCase finding in the private sector has been a challenge which was successfully overcome by the Joint Effort for Elimination of Tuberculosis (JEET) project. However, providing quality of care to these diagnosed tuberculosis (TB) patients in the private sector was another area which the JEET team took up as a challenge and managed to improve through state government collaboration.
Bharati Kalottee

EP37-460-24-The experience of engaging private pharmacies in TB case detection in EthiopiaWe present an innovative experience of engaging private pharmacies and drug vendors in tuberculosis (TB) case detection in Ethiopia. By engaging 110 private pharmacies and drug vendors, we contributed to the detection of 699 additional TB cases (21%) compared with a 1% decline in the control zone. The approach should be expanded.
Samson Ogayse

EP37-461-24-The Global Fund public-private mix TB grant: impact in three southern states in NigeriaThe private sector constitutes a majority of the Nigerian healthcare system. However, only 2.5% of these facilities are formally engaged for tuberculosis services, contributing 11% to total case notification in the country. We present the preliminary findings on the impact of private sector engagement in three states of southern Nigeria.
Chukwuka Alphonsus

EP37-462-24-How frequently are TB care providers changed in the private sector in rural Bihar, India?Provider switching can impact patient care and result in a high-cost of care in the private sector. Understanding its nature and reasons are crucial to addressing it in the tuberculosis programmes engaging the private sector.
Smriti Ridhi

EP37-463-24-Initiation of preventive treatment among household contacts of TB patients registered at a private healthcare facility in Karachi, PakistanInvestigation for tuberculosis (TB) infection in household contacts of individuals with known TB, can lead to early diagnosis and prompt treatment initiation as well as helping to reduce the transmission cycle. In 2019, post-exposure treatment (PET) was initiated for household contacts at a specialised TB diagnostic and treatment centre in the private sector Karachi, Pakistan.
Wafa Jamal

EP37-464-24-Emerging trends in private sector notifications in India: experiences from the Joint Effort for Elimination of Tuberculosis projectThe abstract documents the experiences of implementing the Joint Effort for Elimination of Tuberculosis project (JEET) in geographies covered by FIND India and analyses trends over the years. Comparisons have been drawn with districts where JEET is not being implemented.
Aakshi Kalra

EP37-465-24-Establishment of TB Diagnostic Hubs in Selected Private LaboratoriesEstablishing TB diagnostic hubs in urban private facilities that are surrounded by a rich network of spokes reduces access barriers and hence provide a fertile ground for ACF interventions. Hub and spoke model coupled with a web-based system and a rider, minimizes the leakages in the care cascade. 
Drusilla Nyaboke

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E-posters
EP32-Quality improvement of the TB cascade of care
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EP32-Quality improvement of the TB cascade of care
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP32-404-24-Evaluation of TB active case finding cascade: results from a TB surge intervention in Akwa Ibom State, NigeriaActively finding tuberculosis through screening of all hospital attendees and instituting multiple testing options, will widen the chances of finding the missing cases within the health facility. Due to poor health-seeking behaviour and lack of awareness, most persons will not seek medical attention because of a cough.
Ifiok Ekanim

EP32-405-24-Pay for performance to optimise the TB care cascade and improve quality of services at high volume health facilities in KenyaThrough Global Fund support, Amref Health Africa - in collaboration with the national tuberculosis (TB) programme in Kenya - is implementing a pay for performance initiative in 197 high volume health facilities in 13 high TB burden counties. Facilities earn money for additional TB cases notified and quality of TB services offered. 
Anne Gorreti Munene

EP32-406-24-Cascade analysis for active TB case finding intervention in Nigeria: a tool for quality improvement and programme monitoringKNCV Nigeria constructed a cascade to assess clients’ retention across tuberculosis (TB) screening stages. Based on epidemiological data, we set targets for each stage and designed a template for weekly data monitoring and cascade analysis to measure gaps. We did root cause analysis and designed specific interventions to address identified gaps.
Ogoamaka Chukwuogo

EP32-407-24-Impact of TB cascade loss in a facility-based, intensified TB case finding intervention in Nasarawa State, NigeriaThe review of the impact of loss of patients in a cascade during facility-based screening activities has the potential to undermine efforts to find missing tuberculosis (TB) cases in Nigeria. This can lead to programmatic under-reporting and an increase in the spread of TB in communities
Daniel Egbule

EP32-408-24-Implementation and scale-up of TB Clinic-Laboratory Continuous Quality Improvement (TB CLICQI) in Nigeria: Lessons learntTuberculosis clinic/laboratory continuous quality improvement (TB CLICQI) was a proof of concept in Nigeria. It was piloted and implemented in Benue State and the outcome fueled the scale-up. This present study documents the impact and lessons learned during the scale-up at selected states and health facilities.
Laura Madukaji

EP32-409-24-Finding additional TB cases through symptom screening for diagnosis in high burden setting: cough of two weeks is not enoughSystematic screening for tuberculosis (TB) in health facility settings and among priority groups remains an important active case finding strategy in high TB burden countries. National TB programmes will benefit through more attention to accurate diagnosis and earlier start of treatment.
Chidubem Ogbudebe

EP32-410-24-Prevalence of Mycobacterium tuberculosis in sputum among adult clinic attendees compared with the surrounding community in rural South Africa: implications for finding the missing millionsThis analysis compares the findings of a tuberculosis prevalence survey, conducted within primary healthcare clinics, to a community-based survey during the same period. Characteristics of enrolled participants, as well as those with a sputum culture positive for Mycobacterium tuberculosis, are compared.
Indira Govender

EP32-411-24-A country tailored package approach to TB case finding: Challenge TB project experience across 23 countriesHierarchy of tuberculosis (TB) case finding interventions, based on yield, from strengthening healthcare facility TB screening (highest) to TB index case contact investigation (least) and the use of a package approach, driven by patient health-seeking behaviour, and pathway to accessing TB diagnosis and care.
Mustapha Gidado

EP32-412-24-Enhancing the performance of newly established TB services sites through the incorporation of structured demand creation activities in Nigeria: findings from a non-randomised intervention studyTuberculosis (TB) prevention is largely ensured by early case identification and treatment in Nigeria among the non-HIV infected populations. Enhancing the performance of newly established TB service sites, through the incorporation of structured demand creation activities, improves case detection and, thus, prevention of TB.
Aminu Babayi

EP32-413-24-Towards achieving UN General Assembly political declaration on HIV and AIDS: commitment on TB case finding among PLHIV, in IndiaThe study assesses the improvement in coverage of intensified case finding among persons living with HIV, in India, as a result of a collaborative, multipronged approach involving capacity building and periodic supervision of the activity.
Deepak Balasubramanian

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E-posters
EP30-Where are the undiagnosed TB cases?
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EP30-Where are the undiagnosed TB cases?
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP30-384-24-Active TB case finding targeted at high burden health facilities in Nigeria: results from a pilot interventionSystematic screening for tuberculosis (TB) in health facility settings and among priority groups remains an important active case finding strategy in high TB burden countries. National TB programmes will benefit through more attention to accurate diagnosis and earlier start of treatment.
Chidubem Ogbudebe

EP30-385-24-Improving TB case finding in hospital outpatient departments: lessons from a health system strengthening approachSystematic screening for tuberculosis (TB) in health facility settings and among priority groups remains an important active case finding strategy in high TB burden countries. National TB programmes will benefit through more attention to accurate diagnosis and earlier start of treatment.
Chidubem Ogbudebe

EP30-386-24-Achieving End TB Strategy: screening for TB in pregnant and non-pregnant women in reproductive age group. Findings from an observational study in Pune, IndiaReproductive age women face a higher risk of tuberculosis (TB) transmission, morbidity and mortality. But women’s access to healthcare is restricted. This study discusses prevalence of active/suspected and latent TB in pregnant and non-pregnant women screened for TB in a hospital in Pune, India. It also discusses he challenges faced for screening.
Mallika Alexander

EP30-387-24-Active case finding for TB among factory workers in Punjab, IndiaFactories are one of the key areas for tuberculosis (TB) prevention and control activities. However, an apprehension of losing employment continues to deter factory workers from participating in TB screening. In close co-ordination with factory owners, active case finding at factories can increase awareness and confidence among workers to seek care.
Prachi Shukla

EP30-388-24-TB treatment outcomes among patients identified through active case finding in a high-density, urban township in Lusaka, ZambiaActive case finding is gaining traction as a means to find missing TB cases in communities as we aim to achieve the End TB Strategy. It identifies individuals who otherwise would spread the disease and further fuel the epidemic. Ever wondered what happens to TB patients identified in this manner? 
Sulani Nyimbili

EP30-389-24-The yield of school-based active TB case finding in Oromia Region of EthiopiaIn the Oromia Region of Ethiopia, which has a high TB burden, school-based TB screening is an advantage. Additional TB cases can be identified in school settings and there is the added advantage of engaging school students in community and household presumptive TB referrals.

Bizuneh Alemu Fetenesa

EP30-390-24-Strengthening active TB case finding: results from using an active case finding toolkit at health facilities in UgandaWith one-quarter of estimated tuberculosis (TB) patients missed, the Ugandan Ministry of Health developed active case finding toolkits to improve the quality of TB screening, case detection and treatment at health facilities. Strengthening health worker capacity to implement the toolkit improved performance and should be scaled-up to address gaps in TB notification.
Aldomoro Burua

EP30-391-24-Active TB case finding among HIV key populations and their contacts: an effective intervention modelThe key populations (KPs) for HIV (MSM and FSW) and their close community (KPC) are at an increased risk of tuberculosis (TB). Active TB case finding activities from PSI TOP centres can detect additional TB cases among non PLHIV KPs and their contacts and percentage of TB cases were higher than KPs.
Nandi U

EP30-392-24-Integrating TB case finding into house-to-house polio vaccination campaigns: findings from the July 2019 supplemental immunisation activities in Anambra State, NigeriaWe leveraged the World Health Organization-supported community polio vaccination structure to integrate tuberculosis (TB) case finding into a house-to-house vaccination campaign. Presumptive and confirmed TB cases were reported through the process. Our report shows that the intervention was most productive in peri-urban slums, riverine and hard-to-reach areas. 
Chukwuebuka Ugwu

EP30-393-24-Intensified case finding among outpatients and their companions by using chest X-ray with artificial intelligence software for TB triaging in the PhilippinesThe companions of patients are not usually part of intensified case finding (ICF) for tuberculosis (TB). We included them in ICF in the Philippines by using chest X-ray with artificial intelligence software for TB triage, which resulted in a high TB case yield, from both patients and companions.
Nichel Marquez

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