19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 2
OA-02-Finding a needle in the haystack: where are children with TB?
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OA-02-Finding a needle in the haystack: where are children with TB?
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-02-507-21-Barriers to contact investigation among children: experience from Lagos, Nigeria The study explored the barriers to effective contact investigation among children from the health workers' perspective and found the need to address stigma, while also supporting health workers financially, to conduct contact investigation of index tuberculosis cases.

Oluremilekun Kusimo

11:13 - 11:21: OA-02-508-21-Low-level care facilities as entry points for peadiatric TB screening and case finding: a stepped-wedge randomised controlled study Using a stepped-wedge, randomised controlled study design, we enrolled children under five years, who had presumed TB, in health facilities in Cameroon and Kenya. We demonstrate high proportions of children diagnosed with presumptive and confirmed TB at lower-level care facilities, suggesting the utility of decentralised active case finding.

Rose Otieno-Masaba

11:21 - 11:29: OA-02-509-21-A simple clinical score for predicting active TB when same day microbiological testing is unavailable We developed and validated a simple clinical risk score for tuberculosis (TB) diagnosis among adults presenting to primary healthcare in sub-Saharan Africa. The score (ranging from 1-10) requires only readily accessible information in resource-limited settings. We identify score cutoffs where TB diagnosis has a high benefit-risk ratio when same day microbiological testing is unavailable.

Yeonsoo Baik

11:29 - 11:37: OA-02-510-21-Key clinical features among children under five with a presumptive or confirmed TB diagnosis in sub-Saharan Africa We described the clinical presentation of 203 children, aged under five, with a presumptive or confirmed tuberculosis (TB) diagnosis. Cough and fever were the most common symptoms overall. Adenitis, oedema and acute malnutrition were more frequent in children diagnosed with TB. Assessing malnutrition status should be a key component of paediatric TB screening.

Lise Denoeud-Ndam

11:37 - 11:45: OA-02-511-21-Using a mobile application to improve presumptive TB identification in children in western Kenya Tuberculosis (TB) is under-recognised in children globally. To evaluate the role of mobile health technology in facilitating paediatric TB screening, we implemented a presumptive paediatric TB mobile application in a rural hospital in western Kenya. Following roll-out, there was an increase in the proportion of children identified in presumptive TB registers.

Dylan Peterson

11:45 - 11:53: OA-02-512-21-Protecting our children from active TB disease: expanding TB preventive therapy in nine sub-Saharan countries Using a pre- and post-intervention design, we demonstrate a significant increase in the initiation of tuberculosis preventive therapy (TPT), following the introduction of intensified household contact investigation and linkage to care for children eligible for TPT, in routine clinical settings across nine sub-Saharan countries.

Jean-Francois Lemaire

11:53 - 12:01: OA-02-513-21-Challenges and solutions in the recruitment of children to a multidrug-resistant TB prevention trial: early experiences from TB-CHAMP TB-CHAMP is a randomised, placebo-controlled trial to assess the efficacy of fluoroquinolone preventive therapy in young children exposed to an adult with multidrug-resistant tuberculosis. Recruitment to randomised clinical trials can be challenging and lessons learned from TB CHAMP will be relevant to other current, and future, research efforts.

Susan Purchase

12:01 - 12:20: Q&A


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Channel 3
OA-07-Moving away from isoniazid for TB preventive treatment
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OA-07-Moving away from isoniazid for TB preventive treatment
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15:00 - 15:05: Introduction


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

Omri A Arbiv

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

Budi O Susanto

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

Eugenia Mwamba

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

Jann-Yuan Wang

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

Karin Turner

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

Thuy Thu Thi Dong

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

Hung-Ling Huang

16:01 - 16:20: Q&A


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Channel 5
OA-15-TB preventive therapy: we need to do better
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OA-15-TB preventive therapy: we need to do better
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12:30 - 12:35: Introduction


12:35 - 12:43: OA-15-592-22-Reaching at-risk groups with TB preventive therapy: building on commitments made at the United Nations High Level Meeting By September 2018, Uganda's tuberculosis preventive therapy (TPT) coverage was very low. Following high-level leadership and stakeholder engagement, procurement of commodities and the establishment of a strong accountability mechanism for TPT results, the country has surpassed its United Nations High-Level Meeting TPT enrollment target for people living with HIV, with a 90% completion rate. 

Stavia Turyahabwe

12:43 - 12:51: OA-15-594-22-Uptake of isoniazid preventive therapy among newly diagnosed people living with HIV initiating antiretroviral therapy in South Africa: a post-hoc analysis of a cluster randomised trial Fourteen clinics were randomised to standard of care or Quantiferon-gold in-tube test for diagnosis of TB infection in newly diagnosed people living with HIV in North West, South Africa. We present a post-hoc analysis of isoniazid preventive therapy uptake among participants who initiated antiretroviral treatment within 30 days of study enrolment.

Kate Shearer

12:51 - 12:59: OA-15-595-22-Systems approach to improve TB preventive therapy outcomes among people living with HIV in resource-limited settings: experiences from East-Central Uganda Tuberculosis preventive therapy outcomes have been suboptimal, especially in sub-Saharan Africa, due to a combination of health system and patient-level barriers. A health system approach to address logistical, health workforce, service delivery barriers and patient level- barriers, using the quality improvement methodology, is critical in ensuring good completion rates.

Rodrigo Nyinoburyo

12:59 - 13:07: OA-15-596-22-Increasing access to TB preventive treatment for children under-five in Democratic Republic of Congo: preliminary results We documented lessons learned from the implementation of household contact investigation of children 0-14 years old, in collaboration with a local civil society organisation, in 21 health facilities in Kinshasa, Democratic Republic of Congo (DRC)

VICKY ILUNGA

13:07 - 13:15: OA-15-597-22-Interferon-gamma cytokine concentration levels as a biomarker for recent infection with Mycobacterium tuberculosis in an African community setting Tuberculosis preventive therapy is prioritised for latently infected groups at high risk for active disease. In a cohort study design, we determined that concentrations of interferon-gamma could serve as a biomarker to discriminate individuals that are recently infected with Mycobacterium tuberculosis from remotely infected persons with similar TST reading.

Samuel Kirimunda

13:15 - 13:42: Q&A


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Channel 3
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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OA-28-New and old tests for latent TB infection
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OA-28-New and old tests for latent TB infection
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15:00 - 15:05: Introduction


15:05 - 15:13: OA-28-673-23-Systematic review on the diagnostic performance of specific skin test for latent TB infection compared to interferon-gamma release assays and tuberculin skin tests We systematically reviewed the performance of newer skin tests - C-Tb, Diaskintest and ESAT6-CFP10 - for latent tuberculosis infection including 31 previous studies in the data synthesis. Test performance was comparable to the tuberculin skin test and interferon-gamma release assays. Prospective head-to-head diagnostic accuracy studies and longitudinal evaluations are needed.

Maria Krutikov

15:13 - 15:21: OA-28-674-23-An evaluation of community-based TB infection testing using the QuantiFERON-TB Gold Plus assay and preventive treatment linkage in Ho Chi Minh City, Viet Nam Friends for International TB Relief (FIT) piloted the integration of tuberculosis (TB) infection testing using 5,000 QuantiFERON-TB Gold Plus assays at mobile chest X-ray screening events in Ho Chi Minh City, Viet Nam. This analysis examines testing yields, TB preventive treatment linkage using nine months of isoniazid, and treatment outcomes.

Nga Thuy Thi Nguyen

15:21 - 15:29: OA-28-675-23-The magnitude of interferon-gamma release assay response among children with household contact in a high burden setting is associated with TB exposure and active disease The magnitude of IFNy response in children with tuberculosis (TB) household contact correlated with the degree of Mycobacterium tuberculosis (M.tb) exposure using QFT-GIT and T-SPOT.TB. Among contacts ≥2 years, QFT-GIT IFNy levels were significantly higher in children with TB disease compared to children with M.tb infection.

Lena Ronge

15:29 - 15:37: OA-28-676-23-Correlation between monocyte to lymphocyte ratio and tuberculin skin test positivity among antiretroviral treatment-naïve adults Tuberculin skin test (TST) is known to be a barrier to isoniazid preventive therapy implementation. Therefore, alternative tests to assess tuberculosis (TB) risk, such as peripheral blood monocyte to lymphocyte ratio (MLR), have been explored. This study documents the correlation between TST positivity and peripheral MLR in people living with HIV.

Eva Van Ginderdeuren

15:37 - 15:45: OA-28-677-23-Novel strategies for tuberculin skin testing at primary care clinics: an economic evaluation A self-reading, fast-tracking and task-shifting model - combining patient empowerment and differentiated care models - proved to be an innovative, reliable and cost saving approach to tuberculin skin test-guided screening for tuberculosis (TB) preventive therapy in both high and low TB prevalence settings.

Eva Van Ginderdeuren

15:45 - 15:53: OA-28-678-23-TB screening in healthcare workers in Mozambique: where are we? Healthcare workers are a high risk group for tuberculosis (TB) infection. Knowing the burden of TB in this group, it is important to design better strategies towards control and elimination of the disease in this population. Infection control practices are necessary in this population.

Pereira Zindoga

15:53 - 16:01: OA-28-679-23-Identification of barriers and facilitators of TB contact investigation in Cali, Colombia Through a cross-sectional, qualitative study combining human-centred design, social science methods and a knowledge-growing strategy, we conducted different activities with stakeholders to examine their perceptions and lived experiences and, finally, identify barriers to, and facilitators, of tuberculosis (TB) contact investigation in Cali, the third largest Colombian city.

Juan Jiménez-Garcia

16:01 - 16:20: Q&A


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SP-44-Self-clearance of Mycobacterium tuberculosis infection: needs and consequences
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SP-44-Self-clearance of Mycobacterium tuberculosis infection: needs and consequences
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While there is growing acknowledgement that a Mycobacterium tuberculosis (M.tb) infection is not lifelong, the consequences for tuberculosis (TB) epidemiology and prevention efforts remain unclear. In this symposium we describe how self-clearance affects the TB prevention of progression through the denominator, that is how many people carry a viable infection as well as the numerator, and does this change how many episodes of TB should we expect from distal M.tb infections? In addition, presenters will cover the need for, and progress towards, testing for self-clearance, as well as the impact on TB vaccine research and preventive therapy programmes.

12:30 - 12:35: Introduction

12:35 - 12:45: Self-clearance and the denominator: who is still at risk and what does that mean?The presentation will provide definitions around self-clearance of M. tuberculosis (M.tb) infection and distal progression to disease, and summarise historical and current evidence for self-clearance. Using those observations, the consequences for the reservoir of viable M.tb infections will be discussed, both in likely overall size and distribution across countries and age groups. Finally, the implications of this change in the denominator i.e. the population at risk of distal progression, will be discussed.
Rein Houben

12:45 - 12:55: Self-clearance and the numerator: evidence for disease from distal M. tuberculosis infectionsThe presentation will evaluate the evidence for disease from a distal M. tuberculosis infection, which has been a source for debate in recent years. Empirical and modelling evidence will be considered.
Katie Dale

12:55 - 13:05: Testing for self-clearance: needs and progressOur understanding of M. tuberculosis (M.tb) self-clearance is greatly limited by our current diagnostic tests, which cannot distinguish between those with ongoing viable M.tb infection, and those who have cleared it but remain immunologically sensitised to M.tb. This presentation will consider the limitations of current tests for M.tb infection and discuss the need, potential applications and impact of a test of M.tb clearance. Novel approaches, including transcriptomics, for evaluating M.tb clearance will be presented.
Claire Broderick

13:05 - 13:15: TB vaccines and self-clearance: consequences for development and researchIf M.tuberculosis (M.tb) infection is not lifelong, this has consequences for how TB natural history of M.tb infection is conceptualised.
One immediate question is how self-clearance might affect natural protection against reinfection, and what this might mean for the potential impact of new TB vaccines. In this session I will discuss this issue and what it might mean for TB vaccine development.
Richard White

13:15 - 13:25: Preventive therapy and self-clearance: consequences for current and future programmesIt is widely recognised that if tuberculosis (TB) is to be ended by 2050, disease arising from the reservoir of existing M.tuberculosis infections needs to be addressed, potentially through some future programme of mass preventive therapy. Current preventive therapy programmes focus on established high risk groups and have struggled to expand and retain individuals entering the preventive therapy care pathway. This presentation will focus on whether, and how, current or future preventive therapies programmes should be adjusted in light of the possibility of a large proportion of previously infected individuals self-clearing.
Dick Menzies

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

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