19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 2
SP-04-Advancing TB prevention in children during the COVID-19 pandemic
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query_builder 12:30 - 13:50 | Event time (GMT+2)
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SP-04-Advancing TB prevention in children during the COVID-19 pandemic
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If resources are diverted away from child and adolescent tuberculosis (TB) programmes in order to fight COVID-19, consequences in resource-limited settings could be devastating. TB prevention is more important than ever but better strategies need to be developed and applied to deliver proven interventions for child TB contact management (CCM), TB preventive treatment (TPT) and BCG vaccination to newborns in the context of COVID-19. We will engage stakeholders by discussing early experiences of globally adapting CCM, TPT and BCG delivery during the COVID-19 pandemic. Sharing experiences is essential to identifying feasible and safe strategies that assist in maintaining essential TB prevention services.

12:30 - 12:35: Introduction

12:35 - 12:45: Overview of TB prevention services in children and adolescentsIn this talk, we will present a policy overview and coverage of tuberculosis (TB) prevention services among eligible children and adolescents. We will share reports from regional and country colleagues as well as partner organisations on the effect of COVID-19 on TB prevention services.
Annemieke Brands

12:45 - 12:55: The effect of COVID-19 on childhood TB preventive treatment services in sub-Sahara Africa: experiences from CaP TB projectContact investigation and delivery of tuberculosis preventive treatment (TPT) are World Health Organization-recommended core components of childhood TB programming. Between Q4 2018 and Q1 2020, the CaP TB project has supported facility-based implementation of those interventions in purposely selected sites across nine African countries. As of March 2020, project countries have started enforcing measures aimed at controlling the COVID-19 pandemic, with repercussions on accessibility to health services that varied among countries. This presentation will discuss the effect of COVID-19 control measures and interventions on delivery and accessibility of contact investigations and TPT services, as documented by key patient level indicators collected through the project framework for monitoring and evaluation. It will also discuss the effectiveness and feasibility of mitigation measures introduced to ensure continuation of those essential TB prevention services in the context of the COVID-19 pandemic.
Martina Casenghi

12:55 - 13:05: Impact of COVID-19 on 3HP rollout: experiences from IMPAACT4TBProvision of tuberculosis preventive therapy to household child contacts and people living with HIV is a key component of the END TB strategy. The IMPAACT4TB project was scheduled to begin roll out of 3HP, a new short-course TB preventive therapy regimen, in 12 high burden countries in March 2020 as the COVID-19 pandemic was beginning to unfold. As countries developed their COVID-19 response, there have been large ramifications for healthcare delivery, including contact investigations and TB prevention services. We will discuss mitigation measures and alternative models of care that have been implemented to ensure these services have continued during the COVID-19 pandemic response.
Nicole Salazar-Austin

13:05 - 13:15: Flexible child contact management frameworkThe World Health Organization roadmap for childhood tuberculosis recommends an ‘integrated, family and community-centred strategy’. Yet, there is no clear guidance on how health systems can operationalise such a strategy. it is crucial to recognise that barriers that impede successful child contact management (CCM) vary from family to family, even within the same community. COVID-19 further complicates delivery of CCM during the pandemic and recovery periods. We propose a flexible CCM framework, which goes beyond standardised approaches. Suggestions will be provided on how health systems could support a framework that is customised for each child’s/family’s needs as well as their varied environments.
Yael Hirsch-Moverman

13:15 - 13:25: Responsible use of BCG in the context of COVID-19 pandemicBacille Calmette-Guérin (BCG) vaccines are live vaccines (different strains) that have been used to protect mainly young children against severe forms of tuberculosis (TB) in high TB burden settings for many years. Recent BCG stock-outs emphasised its importance when TB meningitis cases soared among unvaccinated children. BCG’s effect on the immune system is not fully understood, but it has an immune modulating effect, which extends its use beyond TB prevention, e.g. it has proven value in treating non-invasive bladder cancer. A recent ecological study showed an association between lower mortality in COVID-19 cases and BCG coverage. However, this does not prove causality. Clinical studies are now being done to determine whether BCG protects against COVID-19 and likely other respiratory infections. We will provide an update on this topic.
H. Simon Schaaf

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

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Channel 5
SP-29-TB in pregnancy: what’s new in prevention and treatment?
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SP-29-TB in pregnancy: what’s new in prevention and treatment?
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Diagnosing, preventing and treating tuberculosis (TB) disease is essential to reduce poor maternal and infant outcomes known to be associated with TB during pregnancy. In this session, speakers will discuss current challenges in TB prevention, use of new short course TB prevention regimens during pregnancy, and long-term outcomes of bedaquiline for pregnant women with multidrug-resistant TB. The session will conclude with a discussion on innovative methods to study TB in pregnancy.

11:00 - 11:05: Introduction

11:05 - 11:17: Controversies of TB prevention during pregnancyPregnant and postpartum women are at an increased risk of contracting tuberculosis (TB) disease, particularly in the context of HIV-co-infection. Morbidity is often severe, with adverse maternal, pregnancy and infant outcomes. TB preventive therapy (TPT) is effective in preventing TB disease in women living with HIV, but there are concerns about the risks and benefits to both mother and foetus of TPT during pregnancy. Regimen choice, and the optimal timing and duration of therapy to maximise benefits and safety, are also unclear. Decisions may be context-specific depending on TB and HIV prevalence and national screening, diagnostic and treatment practices. Current evidence and outcomes of TPT in pregnancy and the postpartum period are summarised and the challenges discussed.
Emma Kalk

11:17 - 11:29: 3HP, a new option for TB prevention during pregnancy?Pregnancy increases the risk of progressing from latent tuberculosis infection (LTBI) to active TB. A recent randomised controlled trial reported increased risk of adverse pregnancy outcomes in women with HIV, who initiated isoniazid preventive therapy during pregnancy, versus in the postpartum period. These results have left national and international programmes at a loss for what to recommend for TB prevention in pregnant women at high risk of developing active TB. IMPAACT 2001 was a multisite Phase I/II study evaluating the pharmacokinetics and safety of 3HP among pregnant women with, or without, HIV. In this talk, the results of this important study and its implications for antenatal policies will be presented.
Jyoti Mathad

11:29 - 11:41: The short bedaquiline regimen in pregnant women with rifampicin-resistant TB: treatment, pregnancy and infant outcomesThe South African Medical Research Council (MRC) studies an ongoing cohort of pregnant women with rifampicin-resistant tuberculosis (RR-TB). We previously reported maternal treatment, pregnancy and infant outcomes in the first 108 women enrolled, comparing outcomes in the injectable versus bedaquiline-containing regimens. We now report maternal treatment, pregnancy and infant outcomes at six months in 18 women treated with the short (nine–12 month) bedaquiline regimen. Sixteen (89%) of the women were co-infected with HIV and on antiretroviral treatment, the median age was 28.5 years. Thirteen (72%) have successfully completed treatment. Of 16 babies born, 4 (25%) were premature and 5 (31%) low birth weight(<2500g). There were no foetal or neonatal deaths. Eleven babies have been clinically assessed at six weeks, all are thriving (following the normal growth trajectory) and achieving their developmental milestones timeously. Pregnant women treated with the short bedaquiline regimen have similar treatment outcomes to non-pregnant adults. All who have delivered have healthy babies.
Marian Loveday

11:41 - 11:53: Innovative research study designs on TB in pregnancy: challenges and solutionsThe risk of developing tuberculosis (TB) for a woman is highest during pregnancy and the early postpartum period. Unlike non-pregnant adults, we have a poor grasp of best practices for screening, diagnosing and preventing TB in pregnant women. Pregnant women need to be followed from pregnancy through delivery and postpartum to understand the immunological dynamics during this period. A significant challenge is enrolling and retaining pregnant and postpartum women. Since 2016, we have conducted an observational cohort study of HIV-infected and –uninfected pregnant women with latent TB infection (PRACHITi) to improve our understanding of the intersection of TB and pregnancy immunology. In this talk, the results of PRACHITi will be presented as well as strategies employed to maintain >90% retention rate for 12 months postpartum.
Mallika Alexander

11:53 - 12:20: Q&A session

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Channel 3
SP-43-COVID-19 in pregnant women
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SP-43-COVID-19 in pregnant women
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Immunologic and physiologic changes occur rapidly in pregnancy and may impact pathogenesis, clinical presentation and transmission of SARS-CoV-2, complicating management and leading to poor maternal-foetal outcomes in some cases. Recent reports of asymptomatic women admitted for delivery services have led some settings to initiate universal screening. This symposium will feature emerging research on the immunology of COVID-19 in pregnancy and the differences in clinical presentation and management - including treatment options, policies for safe pregnancy and potential research priorities - which will improve our understanding of this devastating pandemic in all populations.

12:30 - 12:35: Introduction

12:35 - 12:45: Pathogenesis and immunology of COVID-19 in pregnant womenThe Washington State COVID-19 in Pregnancy Collaborative was established to identify known pregnant COVID-19 cases from 16 major tertiary referral centres and community hospitals representing >40% of the ~86,000 annual deliveries in Washington State. In order to improve our understanding of how SARS-CoV-2, the virus that causes COVID-19 impacts the health of pregnant women and their newborns, a multipronged approach is needed, including population-based efforts to describe pregnancy outcomes among women with COVID-19, as well as detailed immunologic studies including placental innate immune responses to SARS-CoV-2. We will discuss the pathogenesis and immunology of COVID-19 in pregnancy, including lessons learned from other emerging infectious diseases.
Kristina Adams Waldorf

12:45 - 12:55: Pregnancy and postpartum outcomes of COVID-19 in New York City: a multicentre prospective cohort studyOver 700,000 confirmed cases of SARS-CoV-2 and 20,000 deaths from COVID-19 have occurred in New York City, making it the epicentre of the infection with fatalities topping that of many European countries. Early in the pandemic, pregnant women were noted to be asymptomatic carriers of SARS-CoV-2, and New York rapidly instated a universal screening programme. In this talk, the findings from this prospective cohort will be discussed, including maternal presentation, obstetric and neonatal outcomes, and placental pathology associated with COVID-19 infection. We will also discuss the evolution of maternal symptoms throughout the course of labour and the postpartum period, with implications for postpartum care.
Malavika Prabhu

12:55 - 13:05: Use of remdesivir for moderate to severe COVID-19 in pregnancyRemdesivir is one of the promising treatments being investigated for the treatment of COVID-19. Gilead, the manufacturer of remdesivir, allowed compassionate use of remdesivir for pregnant women with moderate to severe COVID-19. In this talk, they will present the experience of 86 pregnant women, who received compassionate-use remdesivir, including baseline demographic and clinical characteristics, their time to recovery and time to discharge. For women who delivered, birth outcomes and postpartum complications will be characterised. This data will be important groundwork for future clinical trials that include pregnant women.
Moupali Das

13:05 - 13:15: Crowd-sourcing knowledge for COVID-19 in pregnancy with the World Health Organization registry: potential for maternal TB and beyond?To understand how SARS-CoV-2 infection during pregnancy impacts COVID and pregnancy and postpartum outcomes, the World Health Organization (WHO) has developed a standardised clinical registration platform with a specific module targeting pregnant women. Further, a standardised research protocol has been designed. The protocol allows each site to adapt, based on resource availability and local circumstances, and provides the option to focus on national analyses or participate in pooling. Knowledge of tuberculosis (TB) in pregnancy is still scarce. This presentation will discuss possibilities to build on experiences through different methods related to SARS-CoV-2 and possible implication to TB.
Anna Thorson

13:15 - 13:50: Q&A session

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Channel 3
OA-41-TB detection and treatment in mothers and children
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OA-41-TB detection and treatment in mothers and children
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15:00 - 15:05: Introduction


15:05 - 15:13: OA-41-747-24-Increasing active TB case detection rate among children in nine sub-Saharan countries: the CaP-TB Intervention We demonstrate that a comprehensive intervention, which includes paediatric-specific, systematic symptom screening of children in waiting areas of various health facility entry points, increased access to Xpert MTB/RIF testing. It also intensified household contact investigation and significantly improves, both case detection and bacteriological confirmation, for paediatric TB.

Jean-Francois Lemaire

15:13 - 15:21: OA-41-749-24-Role of urban DOTS approach on TB case finding among infertile women in Kabul: a document review Infertility is one of the serious problems for women in Afghanistan that led to mental disorders, in house conflicts, even separation and divorce. The aim of this assessment was to evaluate the outcomes of genital tuberculosis treatment along with anti-infertility treatment on fertility status of women in Kabul city.

Lutfullah Manzoor

15:21 - 15:29: OA-41-750-24-Systematic review of symptom-based screening and added value of chest radiography in screening paediatric contacts for TB in high- incidence countries We conducted a systematic review assessing the concordance between chest radiography and symptom screening to rule out tuberculosis (TB) in household child contacts in high-incidence countries. Results from six articles included in the review suggested that symptom-based screening alone was effective in classifying children unlikely to have TB.

Anca Vasiliu

15:29 - 15:37: OA-41-751-24-A systematic review of Xpert MTB/RIF and Xpert Ultra diagnostic accuracy for detection of active pulmonary TB and rifampicin resistance in children We will discuss results from a systematic review of the diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for the diagnosis of Mycobacterium tuberculosis and rifampicin resistance in children using multiple diagnostic specimen types (sputum, gastric aspiration, nasopharyngeal aspiration and stool).

Alexander Kay

15:37 - 15:45: OA-41-752-24-Population pharmacokinetics and potential, new optimised, fixed-dose combinations of rifampicin, isoniazid, and pyrazinamide in paediatric patients with TB In 2010, the World Health Orgaization revised the recommended paediatric doses of first line anti-tuberculosis (TB) drugs. We measured rifampicin, isoniazid and pyrazinamide plasma concentrations in 179 HIV-infected and uninfected children aged 0.2-12 years-old. Using model-based estimates of exposure, we suggest a new fixed-dose combination formulation, with revised weight-bands to improve exposures.

Roeland Wasmann

15:45 - 15:53: OA-41-753-24-Pregnancy and birth outcomes in multidrug-resistant TB patients treated with regimens including new and re-purposed drugs We report on incidence of pregnancy, birth and treatment outcomes among multidrug-resistant tuberculosis (TB) patients routinely initiated on treatment regimens containing bedaquiline, delamanid and re-purposed drugs in Pakistan.  Data was collected as a part of the End TB observational study.

Saman Ahmed

15:53 - 16:12: Q&A


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