19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 4
SP-06-The people-centred framework for national and subnational TB planning and programming: early adopters share lessons learned and experiences
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SP-06-The people-centred framework for national and subnational TB planning and programming: early adopters share lessons learned and experiences
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In the era of the End TB Strategy, the Sustainable Development Goals, and recent COVID-19 pandemic, national tuberculosis (TB) programmes are under increasing pressure to balance demands for ambitious programme targets with limited/diminishing resources. The resulting requirement for prioritisation and 'hard choices' threatens to curtail effective TB programming. Rwanda, Uganda and Ethiopia, early adopter countries, share their experiences applying the people-centred framework in their latest NSP development. The people-centred framework was designed to help countries to better streamline and utilise increasingly available evidence/data for decision making along the care continuum (including utilisation of mathematical impact and cost-effectiveness modelling), and facilitate evidence-based, optimised, people-centred responsive and resilient strategic planning and programming.

12:30 - 12:35: Introduction

12:35 - 12:47: Introduction to the people-centred framework for TB planning and programmingThe people-centred framework (PCF) for tuberculosis (TB) programming encourages us to rethink our approach to analysis, planning, implementation and evaluation of TB programmes. The presentation will introduce the philosophy, concept, approach, elements and some initial experiences (when and how to employ it). A future is envisioned in which evidence is reviewed and analysed in a patient-centred manner. Priority gaps are identified and closed ensuring access for all to high-quality services for prevention, diagnosis, treatment and care of TB, including post-treatment follow-up care. Data consolidation along the TB care continuum, impact optimisation of interventions, subnational validation and health service delivery optimisation form the four cornerstones of the PCF-based national strategic plan (NSP) 2.0. PCF will help countries to decide how best to allocate resources and use pre-populated data and automated data visualisations to continuously and critically assess the performance of TB-NSP implementation.
Emmy van der Grinten

12:47 - 12:59: Using the people-centred framework for national strategic plan development while on lockdown due to COVID-19The COVID-19 pandemic and lockdown to mitigate spread impacted the finalisation of the national strategic plan (NSP) and development of the NSP-based TB & HIV combined Global Fund funding request. Under unprecedented circumstances, how did Rwanda manage to adopt the people-centred framework (PCF), data consolidation and visualisation along the care continuum and TIME modelling, to support prioritisation and optimisation, before the lockdown? And also a patient pathway analysis to assess the alignment of care-seeking and service availability, with distant support from consultants due to international travel restrictions? Plus the intervention package scenarios to compare budget to best impact and the GFFR development, with a mix of in-country and distant TA? Patrick Migambi will share challenges, experiences, creative solutions and lessons learned.
Patrick Migambi

12:59 - 13:11: Developing an evidence-informed national strategic plan using epidemiological, people-centred and systems-related dataUganda is one of the early adopter and approach shaper countries for the people-centred framework for tuberculosis (TB) programming. The development of the Uganda national TB strategic plan (2020/21-2024/5) employed a patient-centred approach and was informed by the evidence gathered through a data consolidation process along the TB care continuum. The process included a patient pathway analysis (PPA) that was carried out to assess the alignment between country-level service provision and initial care-seeking by the population. Data was consolidated into an excel tool with automated data visualisations based on key performance indicators that provided evidence on epidemiology, people and systems. The evidence generated provided a basis for problem identification, prioritisation, root cause analysis, intervention identification and optimisation. 
Stavia Turyahabwe

13:11 - 13:23: Developing an optimised national strategic plan using TIME Impact & TIME EconomicsEthiopia, under the now ending national tuberculosis strategic plan, has made significant strides to achieve the End TB goals. By the end of 2018, 96% of public hospitals and health centres; 71% of private hospitals; 6.5% of private specialised clinics; and 22% of private medium clinics were providing TB diagnostic and/or treatment services. However, the country still remains among the top 30 high TB, TB-HIV and multidrug-resistant TB burden countries, and over a third of estimated 165,000 TB cases were missed in 2018. The country’s TB programme had about 60% funding gap in 2018. In an effort to address the remaining challenges, we analysed policy, programmatic and implementation gaps and did root cause analyses using the people-centred framework (PCF). We combined our in-house modelling capacity with support form external consultants to develop an optimised national strategic plan. We share our experience with the PCF approach with particular focus on TIME Impact and TIME Economics modelling.
Taye Letta

13:23 - 13:50: Q&A session

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SP-13-Deadly partners - COVID-19, non-communicable diseases and tobacco
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SP-13-Deadly partners - COVID-19, non-communicable diseases and tobacco
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There has been a great deal of discussion about the potential relationship between COVID-19 and tobacco use. The underlying logic of a smoking-COVID-19 relationship is that smoking is an established risk factor for respiratory infections because it undermines the immunological response that a person can otherwise mount against a viral infection. Furthermore, there is a very strong relationship between smoking and non-communicable diseases that has emerged as a risk factor for COVID-19 severity and death. Studies from China show that the odds of progression towards serious illness are 14 times higher among people with a history of smoking.

16:30 - 16:35: Introduction

16:35 - 16:47: COVID-19, non-communicable diseases and impact on young peopleYoung people, especially those living with non-communicable diseases (NCDs) and its associated risk factors are vulnerable and susceptible to developing COVID-19 and its complications. This includes incomplete treatment regimens and restricted access to public health services for chronic conditions in times of lockdown and social distancing. Not to forget the major impact on mental health of young people. On the other hand, young people are also critical in promoting preventive messages for risk mitigation, disseminating information to their families, peer groups and community during this global crisis. Therefore, meaningful involvement of young people during the time of pandemic, as well as prevention of NCDs, is significant to the preparedness efforts, for not only the current, but also future public health crises.
Ishu Kataria

16:47 - 16:59: COVID-19 and lung healthCurrently evidence is lacking on how underlying lung disease will affect the severity and outcomes of COVID-19.  The longer term impact of COVID-19 on lung health is unknown but with large numbers of people requiring high flow oxygen and/or ventilation there are concerns regarding residual lung damage in COVID-19 survivors. The data on these areas will be reviewed as well as discussing what services need to be planned for COVID-19 survivors.
Grania Brigden

16:59 - 17:11: Deadly partners: COVID-19 and tobaccoTobacco smoking appears to be an important and entirely avoidable risk factor for a poorer prognosis in COVID-19. COVID-19 has not only severely constrained health systems, but also could have a cascading impact on the progress that countries were making towards different goals and targets of the United Nations Sustainable Development Goals (SDGs). With the looming danger of economic recession, it becomes even more vital to avert the huge financial cost of tobacco use to the global economy. The urgency to prioritise stronger action on comprehensive tobacco control is mandatory for optimal response to contain the COVID-19 pandemic.
Tara Singh Bam

17:11 - 17:23: Responding COVID-19 and non-communicable disease risk factorsTobacco causes eight million deaths every year and is a known risk factor for severe disease and death from many respiratory infections. Emerging evidence has suggested that smoking increases the risk of severe COVID-19 outcomes as well as the risk of death from COVID-19. However, in the absence of robust population studies to date, the association between smoking and infection with SARS CoV2 and between smoking and hospitalisation has not been reliably quantified.  This presentation will review the evidence on smoking and COVID-19 and will position the findings within the context of the wider literature and body of evidence. It will also look at risk communication of the findings on tobacco use and COVID-19 in the overall context of harms from tobacco use that are well established.
Hebe Gouda

17:23 - 17:50: Q&A session

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SP-14-Is TB elimination in the European Region a realistic goal?
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SP-14-Is TB elimination in the European Region a realistic goal?
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The World Health Organization, in collaboration with the European Respiratory Society, formulated a framework towards the elimination of TB in 33 counties with currently low TB incidence, to be achieved by 2050. The symposium provides the stage for a pro/con discussion on the feasibility of this framework. It addresses the current state of affairs around some of the key priorities stated in the framework as being instrumental to reach TB elimination in low-incidence counties. These include the care for vulnerable groups, dealing with cross-border health seeking and investments in research and new tools for diagnosis and prevention.

16:30 - 16:35: Introduction

16:35 - 16:45: Mission possible: TB elimination in EuropeThe European Union (EU) and European Economic Area (EEA) observes a decline in tuberculosis (TB) notification rate of about 5% per year. This is not enough to reach TB elimination or a reduction of the TB incidence rate of 80% by 2030 (SDG target).  The too slow decrease of TB incidence is partly due to the increasing percentage of TB cases in migrants; in many EU/EEA countries with a low TB notification rate, >75% of TB cases are among migrants. Cases in migrants need to be diagnosed and treated but may be hard to prevent if infection occurred outside of the EU/EEA. Therefore, elimination can be better defined as no local transmission as measured by whole genome sequencing. By using whole genome sequencing data (EU/EEA wide and from selected countries) the potential for TB elimination will be presented and challenges identified.
Marieke van der Werf

16:45 - 16:55: Mission impossible: TB elimination in EuropeProjecting the incidence data of tuberculosis (TB) from the past decade into the future, suggests that elimination of TB in the European Union/European Economic Area (EU/EEA) might be achieved by 2035. However, in a globalised world, elimination of TB in the EU/EEA appears unlikely and even if this unlikely scenario were to happen, the elimination of TB in Europe would still be far out of reach. Only a small fraction of patients with TB in Europe live in the EU/EEA. Some countries in central and eastern Europe still have a high incidence of TB and central/eastern Europe is one of the hotspots of multidrug-resistant/rifampicin-resistant TB globally. The obstacles on the way to elimination are in all areas: prevention, diagnosis and treatment. Without a vaccine that protects contacts of patients with TB from the development of TB, elimination of TB will not be achieved, neither in Europe nor anywhere else.
Christoph Lange

16:55 - 17:05: Translational research and new tools in the pipeline to eliminate TB in low burden countriesTuberculosis (TB) elimination in low burden countries requires a comprehensive effort with existing and new tools. This presentation will familiarise the audience on recent diagnostic innovations in the pipeline to improve active case finding, infection detection and prediction of risk.
Morten Ruhwald

17:05 - 17:15: Access to care for vulnerable populations in EuropeTuberculosis (TB) burden in Europe is particularly high among vulnerable population groups. These groups also have an increased risk of inadequate access to diagnosis and treatment results. This is why access to healthcare for vulnerable groups, including migrants, is both important for individual care of patients and to ensure a reduction of transmission that would be necessary for TB elimination in Europe. Here, we will discuss 1) current evidence on access of care for vulnerable population groups in Europe; 2) evidence on strategies and policies effective at increasing access to care and lowering transmission of TB, and 3) some considerations on ethics, equity and legal issues in the design of these policies
Berit Lange

17:15 - 17:25: Research collaborations informing TB control strategies in Europe: TBnet and ERS-CRC approachTBnet has performed a large number of clinical and operational studies in the field of tuberculosis (TB). The consortium is supported by the European Respiratory Society, through a clinical research collaboration. The activities provided insight in - amongst others - the unequal distributions across Europe in terms of infection control facilities, the staff available, and inpatient vs. outpatient management of TB, the inclusion of 'hard to reach' groups, the cost and availability of molecular diagnostic tests for multidrug-resistant TB, the availability, cost and stability of drug supply, the adverse effects of new drugs, and the confounding effect of relapse on treatment outcomes.  
Graham Bothamley

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

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SP-11-Treating mild asthma: a paradigm shift
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SP-11-Treating mild asthma: a paradigm shift
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Management of mild asthma has for a long time been unsatisfactory and the treatment of mild asthma has not been tested in clinical trials. The use/overuse of short-acting beta-2 agonist (SABA) alone in patients treated as mild asthmatics has become a concern and the association with severe adverse events has become clear. Access adherence with regular inhaled corticosteroid (ICS) treatment is a major issue in this population. The rationale efficacy of treatment with as needed ICS and rapid acting bronchodilator will be discussed in this session.

Learning Objectives:

Review concerns associated with the use of rescue SABA in the absence of maintenance treatment.

Discuss the merits of as-needed ICS treatment strategies in mild asthma in adults and children.

16:30 - 16:35: Introduction

16:35 - 16:47: GINA 2019: a fundamental change in asthma managementNew recommendations about the treatment of mild asthma, published by the Global Initiative for Asthma (GINA) in early 2019, have been described as the most fundamental change in asthma management in 30 years. These recommendations represented the culmination of a decade-long campaign by GINA to develop new strategies for mild asthma with the aim of reducing asthma morbidity and mortality, particularly in low-resource countries. They were prompted by concerns about the risks and consequences of treating mild asthma with short-acting beta2-agonists alone. This presentation will describe the background to the changes, the evidence obtained from large, new clinical trials and observational studies which provided the basis for the new GINA recommendations, the issues and priorities that were taken into account, and the global challenges and evidence gaps that remain.
Helen Reddel

16:47 - 16:59: As-needed use of ICS and SABA in separate inhalers? Applicability to childrenOne of the more frequent issues in difficult asthma in children is adherence. Using inhalers only when they are needed could be a good way to improve adherence and control. This presentation would update the evidence on the efficacy of treating asthma in children using as needed combination of short-acting beta-2 agonists and corticosteroids combined in the same inhaler, as compared to the standard approach in GINA guidelines. If this is approach is safe and effective in children, as well as being more affordable, it should be seriously considered.

Luis Garcia-Marcos

16:59 - 17:11: Combination inhaler (ICS/ formoterol) applicability to children: a low- resource setting perspective.Asthma in children is increasing in prevalence in children in low- and middle-income countries. Risk factors for this increase and poor asthma control in this population are poorly studied. One of the critical gaps in asthma treatment is access to affordable and safe medication delivered via an appropriate delivery system. The current Global Initiative for Asthma recommendations encourage the use of combination therapy to improve asthma control, but this may not be possible in settings where there is poor access to spacer delivery systems and unaffordability of drugs. Motivation for one drug device to manage asthma is an attractive option in this setting where there is an overuse of short-acting beta-agonist, together with interventions and advocacy, to improve access to asthma treatment and this may be a solution to this issue in low-income settings.
Refiloe Masekela

17:11 - 17:23: Obtaining optimal control of asthma in resource-limited settings: theory and practiceThe management of asthma requires medicines relaxing airway smooth muscles and reducing airway inflammation. Rapid-acting b2 agonist does not effectively address the underlying problem of airway inflammation. Excess use of inhaled bronchodilators alone for symptom relief may result in a delay in seeking health care. Inhaled corticosteroid (ICS) is critical in the treatment of airway inflammation but is underused. A substantial proportion of patients with persistent asthma in resource-limited settings have no access to affordable ICS for long-term treatment. Studies have shown that the use of both ICS and rapid-acting b-agonist as needed for symptom relief might be a better option.
Chen-Yuan Chiang

17:23 - 17:50: Q&A session

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SS5-History of The Union
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SS5-History of The Union
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Session Organised by: German Central Committee against Tuberculosis (DZK)

„History of The Union”
The centennial of The Union is a good opportunity to look back on some aspects of its long history. Since it is not possible in the allotted time to recognize all other important organizations worldwide, which are linked to The Union including their African, Asian-Pacific and South American Regions, the session has to concentrate on a few others. It is moderated by Dean Schraufnagel, former member of the Board of Directors of The Union and Past President of the ATS.
Since the Centennial of The Union coincides with the 125th anniversary of the German Central Committee against Tuberculosis (DZK), this year's Robert Koch Lecture provides a good opportunity for Robert Loddenkemper, Past President of DZK, of the Europe Region of The Union and of the ERS, to underline the close relationship of the DZK with The Union. The Robert Koch Lecture was initiated by Rudolf Ferlinz, Secretary General of DZK and President of the Union, at the 1994 World Conference in Mainz/Germany. Since 1994 six Robert Koch Lectures have been given by prominent TB experts at The Union World Conferences.
The roots of the Union are going back to the International TB Congress in Berlin 1902, where an "International Central Bureau for the Fight against Tuberculosis" was established, which can be seen as predecessor of The Union. It had the headquarters in Berlin, and Gotthold Pannwitz, Secretary General of DZK, took over the management of the bureau and of the international monthly journal "Tuberculosis". In 1895, Pannwitz was also the main initiator of the foundation of the “German Central Committee for the Establishment of Sanatoria”, one of the oldest national TB organizations worldwide. In 1905 the name of the Committee was changed to “…for the Fight against Tuberculosis". Out of this reason Robert Koch, being critical of the sanatorium movement, finally accepted to join the Committee.
Periodic international conferences systematically addressing clinical, research, and sociological aspects of TB were held until the outbreak of World War I in 1914. After the war, in 1920, a conference on TB was convened in Paris, at which the International Union Against Tuberculosis (IUAT) was founded. Until 1939, ten international conferences followed, the 11th Conference was planned to take place in Berlin in September 1939, but had to be cancelled because WW II was started by Germany on 1ST September. When the Nazis came into power in January 1933, a very dark chapter in TB control started under the general health-related motto “Public interest comes ahead of self-interest”. The horrible consequences for TB patients are described in detail. In June 1940, after the occupation of Paris, the Nazis closed the IUAT Office, which was reopened again after the war, in 1946.
During World War II, TB mortality had increased steeply in many belligerent and non-belligerent countries. This induced a broad international cooperation. Mario Raviglione, year-long former Director of the Global TB Programme at the WHO, describes in the second lecture, how the WHO was officially established by the UN in 1948, when malaria, TB, and venereal diseases were declared as the “3 main scourges demanding prior and special attention”. Just from the beginning, the Executive Committee established for TB a close relationship with the IUAT, the beginning of a very fruitful cooperation. In the mid-1960s, the Tuberculosis Surveillance Research Unit (TSRU) with The Union and the WHO as important members was initiated by KNCV. The results of the annual meetings were published in several guidelines/reports on Drug Resistance, which are now incorporated into the annual Global TB Reports of the WHO.  With the advent of HIV in the mid-1990s, the collaboration was intensified. The concept on DOTS, developed by Karel Styblo, Executive Director of The Union, was promoted by the WHO as a new strategy for TB control. There were many other fields of close cooperation, amongst them the World TB Day initiated in 1982 by The Union and later recognized officially as an annual event by the WHO.
Philip Hopewell, former President of the North American Region of The Union and of the ATS, describes in the third lecture the long and close relationship of the North American organizations from Canada und USA with The Union. The North American Region of The Union was founded in 1990. North American organizations with “informal” but influential relationships with The Union are United States Agency for International Development (USAID), the US Centers for Disease Control and Prevention (CDC), many academic institutions in US and Canada and NGOs (FHI 360, MSH, PATH). Lobbying effort for funding of global TB control were initiated by ALA/ATS in 1992. ALA/ATS convened advisory groups including the Union and the Tuberculosis Coalition for Technical Assistance (TBCTA), which was founded in 2000 at the request of USAID and original partners (The Union, WHO, CDC, KNCV, ALA/ATS). Between 2000-2019 USAID alone funded more than 900 Million USD for TB control.
In the last lecture, Giovanni Battista Migliori, Past President of the Europe Region of The Union, former ERS Secretary General and at present Chair of the Global TB Network and one of the two Chief Editors of the IJTLD, describes mainly the many activities in Europe during the last thirty years. The Europe Region of The Union was founded only in 2002 with the particular aim to increase the collaboration between Western and Eastern Europe, the latter with its high TB incidences and frequent drug resistances (MDR-TB). European organizations, which had been active already before, are WHO-Europe, KNCV, The Union and the ERS. All supported the two-yearly conferences of the Europe Region in Budapest, Bucharest, Moscow, Riga, Dubrovnik, London and Bratislava. KNCV organizes since 1990 the Wolfheze Workshops, at which experts from low incidence countries developed basic TB principles and documents allowing Europe to equip itself with surveillance, policies and guidelines for TB control and elimination. In other initiatives the Europe Region collaborates closely with ERS, WHO-Europe, ECDC, EU and many national respiratory societies, also on topics like prevention of smoking and non-communicable diseases.

18:15 - 18:19: Introduction


18:19 - 18:42: Robert Koch lecture: the history of the German Central Committee against Tuberculosis and its close relationship with The Union

Robert Loddenkemper

18:42 - 19:01: The World Health Organization and its close relationship with The Union

Mario Raviglione

19:01 - 19:20: North American organisations and their close relationship with The Union

Philip Hopewell

19:20 - 19:39: European organisations and their close relationship with The Union

Giovanni Battista Migliori

19:39 - 19:43: Closing remarks


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SP-15-Short, all-oral regimens for rifampicin-resistant TB: progress towards programmatic implementation at country level.
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SP-15-Short, all-oral regimens for rifampicin-resistant TB: progress towards programmatic implementation at country level.
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In March 2019, the World Health Organization (WHO) consolidated guidelines on rifampicin-resistant tuberculosis (RR-TB) included the recommendation that modified all-oral regimens to treat RR-TB should be adopted under operational research conditions.  Based on newly available data, the WHO released a Rapid Communication in December 2019 that recommended a specific all-oral, bedaquiline-containing regimen for programmatic use.  This workshop shares insights from countries that have early programmatic or operational research experience with all-oral shorter RR-TB treatment regimens, with particular focus on implementation planning and interim treatment outcomes.  

11:00 - 11:05: Introduction

11:05 - 11:17: Early adoption of a modified, all-oral shorter rifampicin-resistant TB regimen with group A and group B drugs in GeorgiaGiven a high prevalence of intolerance/confirmed resistance to several drugs in the standardised, injectable-based shorter regimen, Georgia initiated guideline revisions and protocol development after the World Health Organization consolidated guidelines in December 2018. In addition to guidance for longer, all-oral rifampicin-resistant TB regimens, national guidelines recommend a modified, all-oral shorter regimen (mSTR) of bedaquiline/linezolid/levofloxacin/clofazimine/cycloserine for nine months, with delamanid substitution for toxicities.  The guidelines and protocol were submitted to the Ministry of Health in January 2019, approved in June 2019, and fully implemented the same month.  To ensure rapid transition, drug quantification and ordering, along with training for all clinicians and staff, took place in parallel to approval processes.  While national policy allows use of mSTR programmatically, Georgia is committed to evidence generation as part of the World Health Organization Euro’s operational research initiative. As of April 2020, 106 patients have received mSTR; 17 have completed treatment with cure, 2 lost to follow-up, and 87 remain on treatment.
Nino Lomtadze

11:17 - 11:29: Rapid implementation of an all-oral, shorter rifampicin-resistant TB regimen during the COVID-19 pandemic in the PhilippinesTo improve on successful treatment outcomes of 58% in patients with rifampicin-resistant tuberculosis (RR-TB) in 2016, the Philippines introduced the standardised, injectable-based shorter regimen (SSTR) in January 2017 under programme conditions.  Treatment success of 68% for patients receiving the SSTR in 2017, revealed high rates of lost to follow up primarily due to adverse events from the injectable agent.  The national TB control programme met in January 2020 to plan the transition to an all-oral,shorter regimen based on the World Health Organization's December 2019 Rapid Communication; a departmental memorandum in February 2020 mandated all health facilities providing drug-resistant TB services to implement a standardised, shorter, all-oral bedaquiline based RR-TB regimen (SSOR) by 1 March 2020. Additional orientation and training on the guideline update were provided March-April 2020. Despite the evolving COVID-19 pandemic, within one month from release of local guidelines, there are more than 150 patients enrolled on SSOR in the Philippines.
Mary Rosary Santiago

11:29 - 11:41: Adopting best practices in rifampicin-resistant TB management in Zambia: implementation of WHO recommendations for all-oral RR-TB regimensOf the 507 patients started on treatment in Zambia in 2018, 357 (70%) started on the 2016 World Health Organization (WHO) recommended standardised shorter regimen, 132 (26%) started on a longer, conventional regimen, and 18 (4%) started on an individualised regimen with bedaquiline. By the end of second quarter 2019, 60% of all patients started on rifampicin-resistant TB (RR-TB) treatment were receiving a fully oral, bedaquiline-based longer regimen.  The National TB Programme of Zambia has kept pace with WHO recommendations, most recently with an addendum to the national RR-TB guidelines, finalised in September 2019, with immediate plans to phase out the injectable- based shorter regimen and move to fully-oral regimens for a majority of newly diagnosed RR-TB patients. By the start of 2020, all RR-TB patients are being commenced on injectable-free regimens. This presentation will describe the subsequent transition from injectable agents to bedaquiline, within the shorter regimen, from the perspective of clinicians and patients. 
Patrick Lungu

11:41 - 11:53: Impact of the COVID-19 pandemic on full implementation of all-oral shorter RR-TB regimens in PakistanThe National TB Programme (NTP) is among the lead countries with prompt implementation of World Health Organization (WHO) rifampicin- resistant/multidrug-resistant TB(RR/MDR-TB) recommendations and guidelines whenever required. The all-oral, longer treatment regimen containing bedaquiline was initiated in July 2019, with over 900 patients having received bedaquiline by December 2019. Following the issuing of WHO's Rapid Communication on the use of an all-oral, shorter treatment regimen in the same month, the NTP subsequently circulated an advisory in January 2020 to start enrolling eligible patients on a shorter regimen containing bedaquiline instead of amikacin. The advisory was immediately put into implementation at all 33 PMDT sites across the country. However, due to the emergence of the current COVID-19 pandemic in Pakistan, enrolments on the all-oral, shorter regimen have not met full potential and the pandemic response is seen as a huge challenge in optimum implementation.  
Abdul Ghafoor

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

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SP-24-The impact of COVID-19 on TB research and development and access: it’s a two-way street
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SP-24-The impact of COVID-19 on TB research and development and access: it’s a two-way street
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The impact of COVID-19 is far reaching, spanning research, programmes, affected communities and the global access to innovations movement. This session will explore the multitude of ways in which COVID-19 is affecting the global response to TB as well as how COVID-19 is benefiting from decades of investments in TB programmes and research. Finally, this session will conclude with an exercise in imagination and where we might be in the COVID-19 response today had we fully funded the global response to TB.

16:30 - 16:35: Introduction

16:35 - 16:45: COVID-19 and TB researchTB research initiatives have largely been put on pause, throwing off trial timelines and delaying long-anticipated results necessary for rolling out new tools to optimize the prevention, diagnosis, and treatment of TB. Yet, TB research investments, innovations, and infrastructure are being leveraged to help advance research and development initiatives focused on addressing the global COVID-19 pandemic. This talk will explore both how TB research is being impacted by and benefitting COVID-19 related research.
Frank Cobelens

16:45 - 16:55: COVID-19 and access to TB toolsTB program investments, interventions, and infrastructure are supporting government efforts to mitigate the spread and severe effects of COVID-19. The need to scale up the response to COVID-19 in high TB burden countries is urgent and necessary to save lives. Still, TB program activities and services must continue and expand, both to prevent unnecessary morbidity and mortality and to keep us on track for ending TB. This talk will discuss the synergies between the global response to COVID-19 and TB, and how to ensure that TB tools which may be able to assist in the COVID-19 response are used in a way that does not reduce access to them by TB programs.  
Madhukar Pai

16:55 - 17:05: COVID-19 and TB survivorsEven when successfully cured, TB can leave a lasting effect on lung health and function, making TB survivors among the populations especially vulnerable to COVID-19. This talk will focus on the experience of a TB survivor, her reaction to surviving one deadly disease only to face another, and her approach to preserving her health, wellbeing, and remaining lung function amidst the COVID-19 pandemic.
Debshree Lokhande

17:05 - 17:15: COVID-19 and access to TB innovationsThe urgency of the COVID-19 pandemic has mobilized unprecedented political will and consensus regarding ideas long promoted by the global access to medicines and innovations movement. This talk will cover access principles and proposals that have gained traction, and how they may have lasting benefits and applications for activists working to promote access to TB innovations and the benefits of TB research and scientific progress.
Suraj Madoori

17:15 - 17:25: COVID-19 in a parallel universe, with adequate funding for TB R&DInvestments in global health, and TB in particular, have translated to many benefits to the global response to COVID-19. But imagine a world in which research and the global response to TB hadn’t been underfunded for the last 50 years. What scientific gains would have been possible, and how could these gains have given us an advantage in our ability to control the COVID-19 pandemic and prevent unnecessary deaths and suffering?
Grania Brigden

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

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SP-48-Understanding the impact of participatory approaches in developing sustainable TB policies
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SP-48-Understanding the impact of participatory approaches in developing sustainable TB policies
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While there is increasing awareness of the importance of engaging civil society, many countries and regions are not yet truly implementing it. Using examples from work in the World Health Organization Europe Region, this session will demonstrate the impact that participatory approaches (that involve community groups, key populations and patients) have had.  The TB Europe Coalition has been working for a number of years, joining civil society and policy makers, to build sustainable TB policy through national dialogues. This symposium aims to encourage countries to build participatory approaches into their policy planning and inform civil society about best practice in this regard.

15:00 - 15:05: Introduction

15:05 - 15:15: The role of national dialogues in ensuring policy sustainability: best practices and lessons learnedUsing the TB Europe Coalition’s extensive experience facilitating national dialogues for participation in policy making, Mariya Makovetska will present the best practices that have been developed in this area to bridge the gap between civil society organisations and the health services to provide people-centred tuberculosis services and lessons learned, for other organisations and regions to use and adapt.
Mariya Makovetska

15:15 - 15:25: Barriers to participatory approaches to policy makingWhile there is increasing recognition of the importance of participatory approaches, this is by no means universal. In this presentation, Paul Sommerfeld will highlight some of the main barriers that TBEC has faced in its work in this regard over the past decade. He will also explore some of the paths he has taken to overcome obstacles and ensure the successful inclusion of civil society groups in policy change. This provides an opportunity for other groups to learn and develop their own strategies.
Paul Sommerfeld

15:25 - 15:35: Civil society on the road to a TB lawIn November 2018, Romania adopted a law for tuberculosis (TB) prevention and control. This includes sick leave entitlement throughout treatment and ambulatory nutritional support. The process of ensuring the law’s adoption was a long process, taking years of consolidated work from civil society. In this presentation, Cristina will explore the ways that civil society groups and individuals worked to ensure the law’s adoption over this period, providing lessons for other countries, as well as demonstrating the vital role of individual and organisational participation in policy development.
Cristina Enache

15:35 - 15:45: Participatory approaches in action: collaboration between the World Health Organization and civil society to end TBThe panel presentation will reflect on the collaboration between the Word Health Organization (WHO) and civil society within the aspects of the participatory approaches, including WHO ENGAGE-TB framework.  This can be seen in the establishment of the WHO Civil Society Task Force on TB and the RCC-THV. Throughout the last few years, the participation of civil society and TB-affected communities in NTP reviews has been facilitated through the support of the WHO Regional Office for Europe. This engagement allowed for grassroots perspectives as to the success and barriers in TB programmes to be voiced, as well as providing recommendations for the format of quality people-centred care based on the personal experience of former patients.
The presentation will raise awareness of the interested stakeholders on the opportunities for participatory approaches to end TB as well as further areas of strengthening intersectorial collaboration.
Yuliya Chorna

15:45 - 15:55: Civil society participation in policy development in AzerbaijanParticipatory initiatives in Azerbaijan, including national dialogues, have been very successful in building the political will to end tuberculosis (TB). After the national dialogue, the government announced a call for proposals on two TB grants and the national strategic plan was developed with the participation of NGOs. In this presentation, Elchin Mukhtarli will explain the impact of national dialogues in developing and improving policy regarding TB. Through this work, intersectorial partnerships (between CSO and parliamentarians, CSO and NTP etc.) have been established, a patients’ community network was created and many more activities have been successfully conducted. Of particular importance has been NGO involvement in the continuation of treatment for people with TB after release from prison. Initially, treatment continuation rates were at approximately 10%. However, following CSO involvement in care in 2011, these have risen to 97%.
Parvana Valiyeva

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

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