19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 5
SP-17-Detecting TB among people living with HIV: updated options with updated guidance
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query_builder 11:00 - 12:20 | Event time (GMT+2)
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SP-17-Detecting TB among people living with HIV: updated options with updated guidance
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The World Health Organization (WHO) and the Stop TB Partnership’s Global Laboratory Initiative recently updated policies, recommendations and resources for tuberculosis (TB) diagnostic testing for persons living with HIV (PLHIV). Implementation of WHO endorsed rapid molecular diagnostic assays and a urine based, rapid lateral flow assay must now shift to optimally detect TB among PLHIV. Expansion of TB diagnostic landscapes across test types, locations and sub-populations increases opportunity for patients and complexity for TB programmes. In this session, speakers will share their expertise and experience with the updates and directly interact with participants through audience polling and remote question and answer tools.

11:05 - 11:15: The TB-HIV testing landscape: World Health Organization policy updatesIn 2018, an estimated 0.86 million (8.6%) of the 10.0 million people who developed tuberculosis (TB) worldwide were HIV-positive. Traditional diagnostic methods often are less sensitive in HIV-positive TB patients, as these patients often have paucibacillary forms of TB. Unlike traditional diagnostic methods, urinary LAM assays demonstrate improved sensitivity for the diagnosis of TB among this group of patients. In May 2019 the World Health Organization (WHO) convened a Guideline Development Group (GDG) meeting, where the evidence on use of commercially available urinary LAM test were evaluated. The outcome was extending WHO recommendations on use of the test to broader groups of people living with HIV (PLHIV). Conventional NAAT tests are recommended for PLHIV as well. In December 2019 WHO convened a GDG meeting, where the evidence on use of several NAATs was evaluated and recommendations updated. Xpert MTB/RIF, Xpert Ultra, Truenat MTB, MTB Plus, MTB-RIF Dx were recommended for broader patients groups, including PLHIV.
Alexei Korobitsyn

11:15 - 11:25: How? Practical global laboratory initiative resources to support updated WHO TB-HIV testing guidanceOn behalf of the Stop TB partnership’s Global Laboratory Initiative (GLI), Dr Heather Alexander will review GLI resources to support countries to review, implement and ensure quality for TB-HIV diagnostic testing strategies, policies, algorithms and networks. Highlights will include presentation of the GLI TB diagnostics implementation manual, the revised TB model algorithm for persons living with HIV and the practical guide for TB LAM implementation. Polling with be used throughout the presentation to review anonymous audience familiarity with up-to-date TB-HIV testing concepts and resources, and provide real-time feedback to GLI on themes of interest for further support. Participant responses may be used to guide live GLI website review of materials and resources for audience familiarity and quick reference.
Heather Alexander

11:25 - 11:35: Xpert MTB/RIF Ultra and LF-LAM: lessons learned from South AfricaSouth Africa is an early adopter of new tuberculosis (TB) tools. Two such diagnostics implemented are the Xpert MTB/RIF Ultra and the LF-LAM. Whilst the improved sensitivity of the Xpert MTB/RIF Ultra allows detection of more cases, a challenge emerged in managing a ‘trace’ result especially in light of the high proportion of previously treated TB in the country. Using the preliminary findings of the national TB prevalence survey an algorithm, addressing the management of Xpert Ultra ‘trace’ results, was developed and will be shared.
The LF-LAM testing algorithm for people living with HIV was developed in 2018 through National TB Think, taking into account clinical considerations. Training was initiated nationwide, for a roll out as a point of care diagnostic, and introduced in a phased approach. Several challenges have hampered implementation: kit availability, recording of results, competency in performing the test, task shifting etc. A hybrid model is now considered.
Farzana Ismail

11:35 - 11:45: Molbio Diagnostics Truenat™ MTB, MTB Plus and MTB-RIF: lessons Learned from IndiaMolbio Diagnostics (India) has developed chip-based RT-PCR assays for detection of tuberculosis (TB) i.e. Truenat™ MTB and the MTB-RIF Dx reflex assay for detection of RIF resistance. Basis interim data from a FIND coordinated multicentric, prospective field evaluation study, the performance of Truenat MTB, MTB Plus and MTB-RIF Dx assays showed comparable accuracy with Xpert MTB/RIF and Xpert MTB/RIF Ultra for TB detection and for sequential rifampicin resistance detection (WHO 2020). Truenat has been approved for use by India’s National TB Elimination Programme (NTEP) as a potential replacement for the smear microscopy test. There are currently 300+ Truenat platforms in India with a majority of them in the southern state of Andhra Pradesh. The Government of India is in the process of adding another ~1500 Truenat machines within the NTEP. The presentation will focus on the initial learnings from implementation that can be leveraged for a successful national, and potentially international, scale-up.
Sanjay Sarin

11:45 - 11:55: Challenges with maintaining quality of TB Xpert results in a low-resource countryAs tuberculosis (TB) diagnostic networks expand in test scope across far-reaching geography and across tiers of the laboratory network, additional resources are needed to ensure that accurate, reliable and timely test results are produced. Since 2011, the TB Xpert diagnostic network has expanded significantly in Uganda to include 250 testing sites that have evolved from use of the Xpert MTB/RIF assay to the more sensitive, Xpert MTB/RIF Ultra. Quality assurance efforts have had to similarly expand to support training at the site, and above site, levels of production and use of quality management system documentation, conductance of internal and external quality assurance activities, and that all efforts are matched with appropriate monitoring, evaluation and corrective action, as needed. In a resource-limited setting, these dual expansions challenge the health system and programme and require innovative approaches for support.
Moses Joloba

11:55 - 12:20: Q&A session

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Channel 7
SP-18-The work of the WHO European Laboratory Initiative on TB, HIV and viral hepatitis
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SP-18-The work of the WHO European Laboratory Initiative on TB, HIV and viral hepatitis
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This session describes activities of the World Health Organization (WHO) European Laboratory Initiative (ELI) with emphasis on development of integrative capacity to diagnose multiple diseases including, most recently, SARS-CoV-2. The ELI has developed and implemented policy statements for diagnostic and therapeutic integration, diagnostic algorithms, biosafety training, electronic external quality assurance dashboards for drug-resistant tuberculosis (TB), online training courses for the use and interpretation of WHO recommended rapid molecular techniques, and determined European laboratory readiness for the diagnosis of resistance to the drugs within the new multidrug-resistant TB treatment regimens, removal of western blot testing for HIV, and building behavioural science approaches into guidance strategies.

11:00 - 11:05: Introduction

11:05 - 11:15: European Laboratory Initiative (ELI) on TB, HIV and viral Hepatitis: supporting countries of the WHO European Region on integrated laboratory capacity building strategiesThe WHO European Region established the European Laboratory Initiative in 2012, in collaboration with the Global Laboratory Initiative, to strengthen laboratory capacities for accurate diagnosis and early detection of TB and drug resistant TB in the WHO European Region.
In 2018, ELI’s mission was expanded to upscale the detection of TB/HIV coinfection, HIV and viral hepatitis, with the ultimate objective of strengthening and making more efficient use of existing capacities for all 3 diseases.
During the COVID-19 pandemic this integrative capacity building approach has proven to be beneficial not only for TB, HIV and viral Hepatitis but also for SARS-CoV-2 testing. This presentation gives an overview of the Eli's activities.
Soudeh EHSANI

11:15 - 11:25: Algorithm for laboratory diagnosis and treatment monitoring of pulmonary TB and drug-resistant TB using state-of-the-art rapid molecular diagnostic technologiesThe World Health Organization (WHO) European Laboratory Initiative (ELI) has produced a key technical document describing how tuberculosis (TB) laboratories and programmes in the WHO European Region can increase the timely and accurate detection of TB and multidrug-resistant TB. The approach emphasises the importance of molecular-based diagnostics through the use of detailed algorithms for diagnostic and treatment progression. It helps laboratories and clinicians improve their joint understanding of what the test results mean, their limitations and the therapeutic actions that follow. It builds on the ELI online courses which provide practical training on the interpretation of WHO-endorsed tests for drug-resistant TB.
Francis Drobniewski

11:25 - 11:35: European Laboratory Initiative online course on drug-resistant TB: how to interpret rapid molecular test resultsThe European Laboratory Initiative for tuberculosis (TB), HIV and viral hepatitis has recently launched a free online course that provides practical guidance and expert advice on the interpretation of selected World Health Organization-endorsed tests for drug-resistant TB. More specifically, it covers the latest guidance for the interpretation of rapid molecular drug-susceptibility testing assays by Cepheid (GeneXpert MTB/RIF and GeneXpert MTB/RIF Ultra) and Hain Lifescience (GenoTypeMTBDRplus VER 2.0 and GenoTypeMTBDRsl VER 2.0). This presentation will introduce the course, assess its reception to date and outline future plans.

Claudio Koeser

11:35 - 11:45: Integration of multi-disease testing platforms for infectious diseases to maximise the benefit in time of need: using TB, HIV, and hepatitis C as an example.The presentation will focus on the role that integrated diagnosis and monitoring responses can have in the region as a means to provide high quality, more person-centred services, making use of the systems already in place. Drawing on examples from tuberculosis, HIV and hepatitis C, it will reflect on opportunities and barriers moving forward, and provide examples of how systems can adjust in order to provide more effective responses.

Daniel Simoes

11:45 - 11:55: External quality assurance dashboard for TB drug-susceptibility testing: why a once-a-year evaluation is insufficient to guarantee for quality drug susceptibility testing resultsThe use of World Health Organization-recommended new anti-tuberculosis (TB) medications is emphasised in the new guidelines. High quality drug susceptibility testing (DST) and high DST coverage for notified TB cases is required. There is a global challenge with the number of bacteriologically-confirmed notified TB cases, despite excellent annual panel testing results. To ensure the quality of phenotypic DST and to verify the steps of diagnostic process, a comprehensive DST assessment tool has been developed to be used in future independently by laboratory workers. The tool aims to identify gaps and suggest ways to improve the drug susceptibility testing: i) evaluation of the performance and role of the laboratory in bacteriological confirmation among notified TB cases; ii) quick identification of weak points in the existing laboratory workflow; iii) recommendations for laboratory development; iv) standardisation of assessment process, uniform results; v) help in implementation of the recommended algorithm and laboratory quality indicators calculation.

Natalia Shubladze

11:55 - 12:20: Q&A session

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Channel 6
OA-16-TB Xpert in low- and middle-income countries: ensuring quality and quantity
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OA-16-TB Xpert in low- and middle-income countries: ensuring quality and quantity
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12:30 - 12:35: Introduction


12:35 - 12:43: OA-16-598-22-Phased scale-up of external quality assurance for GeneXpert MTB/RIF testing under national TB elimination programme , India India's TB programme has rapidly scaled-up GeneXpert MTB/Rif testing, almost doubling the sites (628 to 1180), and testing has increased by five times (578173-2407211) from 2016 to 2018. To ensure a quality testing process, it strategically implemented External Quality Assurance (EQA) in a phased manner to monitor the quality of testing.

K Reena

12:43 - 12:51: OA-16-599-22-South Africa’s Xpert MTB/RIF Ultra external quality assurance experience: a need for good laboratory practice to minimise contamination South Africa's experience using external quality assurance in detecting contamination, due to Xpert® MTB/RIF Ultra’s increased sensitivity, and the need for improved good laboratory practice. A notable increase in the number of discordant results was analysed to advise on programme training needs and procedures to be reviewed for minimising contamination in routine settings.

Puleng Marokane

12:51 - 12:59: OA-16-600-22-Mentoring TB labs for improving and sustaining quality management system implementation and ISO 15189 accreditation: experiences from India The abstract focuses on experiences from India for improving and sustaining quality management system (QMS) implementation and ISO 15189 accreditation at 11 tuberculosis laboratories through mentoring support over the last three years

Tarak Shah

12:59 - 13:07: OA-16-601-22-A pilot study on the implementation of proficiency testing dried tube specimen production at a national public health laboratory: National Tuberculosis Laboratory, Kenya The external quality assurance panels enable facilities to identify diagnostic gas on time to enable continuity of quality services.
The Kenya National Tuberculosis Reference Laboratory demonstrated competency for panel production and managing the pilots, including corrective actions. These was made possible by mentorship from the US CDC, Atlanta, and the SRL, Uganda.

Solomon Bundi

13:07 - 13:15: OA-16-602-22-Role of GeneXpert technology in early detection of rifampicin-resistant TB in Afghanistan Elimination of tuberculosis (TB) is a major health priority for Afghanistan. Multidrug-resistant tuberculosis (MDR-TB) poses enormous challenges to health systems due to the complexity of diagnoses and treatment. For better diagnostic of presumptive MDR-TB patients, new bacteriologic-confirmed patients and extra-pulmonary TB, the national TB programme installed 49 GeneXpert machines.

Del Aqa Safi

13:15 - 13:23: OA-16-603-22-Overcoming barriers to GeneXpert optimisation in Nigeria: an analysis using the access concept GeneXpert optimisation is key to improving tuberculosis (TB) diagnosis, including rifampicin-resistant TB. However, Nigeria is yet to achieve the optimisation goal. This qualitative case-based study analyses barriers to effective GeneXpert optimisation using the ‘access concept’ and proposes proven health system and community strategies to surmount them.

Ogoamaka Chukwuogo

13:23 - 13:31: OA-16-604-22-The use of Xpert MTB/RIF in mobile vans: experience from Namibia A Namibian experience of using Xpert MTB/RIF instruments in mobile vans to demonstrate the feasiblility of use of these instruments in field-based screening activities. This demonstration proves that Gene X-pert can be utilised effectively outside routine laboratory settings to screen and diagnose drug-resistant tuberculosis (TB) in order to combat TB transmission.

Anita Beukes

13:31 - 13:50: Q&A


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