19 October-1 December 2020
The 51st Union World Conference On Lung Health
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Channel 7
OA-25-TB: deep into molecular structure
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query_builder 11:00 - 12:20 | Event time (GMT+2)
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OA-25-TB: deep into molecular structure
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-25-655-23-Transmission of Mycobacterium tuberculosis genotypes and their association with drug resistance in Mumbai, India Transmission of drug-resistant Mycobacterium tuberculosis complex (DR Mtbc) strains of particular subtypes/genotypes in high burden areas like Mumbai, poses a scenario of rapid spread of DR Mtbc strains.  We attempt to determine transmission levels, through genome-based cluster analysis of Mtbc strains from Mumbai city, using whole genome sequencing.

Viola Dreyer

11:13 - 11:21: OA-25-656-23-Delineate TB transmissions for outbreak investigations using whole genome sequencing in Taiwan For facilitating tuberculosis (TB) control, whole genome sequencing needs to be combined with classical epidemiological methods for improving resolution of transmission networks and for improving outbreak investigation. Preliminary results showed that higher SNP threshold might be required to define a multidrug-resistant TB outbreak. 

Tai-Hua Chan

11:21 - 11:29: OA-25-657-23-Characterisation of mutations in the rifampicin resistance-determining region of the rpoB gene associated with multidrug-resistant TB in Zambia For many low-income settings, access to full drug susceptibility testing (DST) is limited. Innovative ways of interpreting laboratory results, informed by existing laboratory data, can contribute positively to management of drug-resistant tuberculosis in the absence of full DST results.

Winnie Mwanza

11:29 - 11:37: OA-25-658-23-MIRU-VNTR genotyping indicates marked heterogeneity of TB transmission in the United States, 2009–2018 Heterogeneity in the number of secondary tuberculosis (TB) cases per source case is important in modelling the impact of control strategies on incidence. We used genotyping data from U.S. TB cases to estimate the distribution of the number of secondary cases per source case and found a highly skewed distribution.

Carly Rodriguez

11:37 - 11:45: OA-25-659-23-Tuberculosis Molecular Bacterial Load Assay (TB-MBLA): a method to speed early phase tuberculosis TB clinical trials Pharmacodynamic (PD) biomarkers in Phase II studies measure drug efficacy to define phase III studies would be appropriate. Current culture-based techniques impose significant delay and cannot be used for treatment monitoring. TB-MBLA is a molecular measure of the number of live bacteria by detecting16S rRNA, allowing rapid treatment monitoring.

Evelin Dombay

11:45 - 11:53: OA-25-660-23-Impact of Randomised, blinded rechecking programme on the performance of the acid-fast bacilli microscopy laboratory network in Uganda: an eleven years' retrospective study Microscopy’s yield highly depends on the staining technique and reading ability of laboratory personnel. Uganda set up a randomised, blinded rechecking in 2008, an external quality assessment programme. We conducted an eleven-year, retrospective study to evaluate the programme impact on the performance of Uganda’s microscopy laboratory network.

Andrew Nsawotebba

11:53 - 12:20: Q&A


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Channel 1
OA-32-Reaching the most vulnerable
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OA-32-Reaching the most vulnerable
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-32-694-24-The positive externalities of migrant-based TB control strategy in a Chinese urban population with internal migration: a transmission- dynamic modelling study We created a transmission-dynamic model of tuberculosis (TB) in the context of large-scale, rural-to-urban migration, using rich demographic, clinical and molecular epidemiology data from Songjiang District, Shanghai. Using this model, we investigated the contribution of different epidemiological mechanisms to TB incidence and assessed the potential impact of new interventions.

Chongguang Yang

11:13 - 11:21: OA-32-695-24-TB whole genome sequencing and MIRU-VNTR analysis in the main foreign-born groups and among Dutch: high transmission in second generation and pre- and post-entry in asylum seekers For targeted tuberculosis (TB) control policies, such as latent TB infection screening in immigrants from high risk-countries, insight in transmission is needed. Whole genome sequencing and MIRU-VNTR phylogenetic analysis maps pre- and post-entry TB transmission within and across foreign-born, second generation and Dutch communities.

Hester Korthals Altes

11:21 - 11:29: OA-32-697-24-High prevalence of smoked illicit substance use in a cohort of patients with drug-susceptible TB in Worcester, South Africa We analysed the prevalence of smoked illicit substance use among a prospective cohort of patients initiating drug-susceptible tuberculosis (TB) therapy in Worcester, South Africa, and evaluated associations of smoked illicit substance use with sociodemographic variables and markers of TB infectiousness.

Bronwyn Myers

11:29 - 11:37: OA-32-698-24-Evaluating access to, and use of, TB and HIV services among urban refugees: developing standardised tools Tuberculosis (TB) and HIV strategic plans often include refugees and asylum seekers but little is known about their access to healthcare, particularly in urban settings. We developed and field-tested knowledge, attitudes and practices tools to assess access to primary care, TB and HIV services among urban refugees and asylum seekers.

Michael Melgar

11:37 - 11:45: OA-32-699-24-Results of the 2019 pilot project on TB screening for residents in shanty towns in South Korea The Korea Centers for Disease Control and Prevention (KCDC) conducted a pilot project for tuberculosis (TB) screening for residents in shanty towns to develop a screening and treatment protocol for TB management of socially, and economically, disadvantaged people. This paper describes the study results.

Eun Hye Shim

11:45 - 11:53: OA-32-700-24-Are humanitarian organisations capable of implementing complex clinical trials? Key insights from a phase II/III multidrug-resistant TB drug trial designed to produce registration standard data (TB-PRACTECAL-NCT02589782) Médecins Sans Frontières (MSF) has implemented TB PRACTECAL, a regulatory-level phase II/III randomised controlled trial, studying six-month oral regimens containing bedaquiline and pretomanid for multidrug-resistant tuberculosis. We aim to share key innovative and successful approaches related to strategic partnering, governance, site selection/support, capacity development and trial monitoring.

Emil Kazounis

11:53 - 12:20: Q&A


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Channel 4
SP-44-Self-clearance of Mycobacterium tuberculosis infection: needs and consequences
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query_builder 12:30 - 13:50 | Event time (GMT+2)
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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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SP-46-Subclinical TB disease: lessons and questions from field to lab
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query_builder 15:00 - 16:20 | Event time (GMT+2)
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SP-46-Subclinical TB disease: lessons and questions from field to lab
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Prevalence surveys suggest that subclinical tuberculosis (TB), which is defined as culture-positive TB disease without reporting TB symptoms, constitutes around half of the undiagnosed disease burden. Policy makers are now looking to understand and address this apparently asymptomatic reservoir to prevent ongoing Mycobacterium tuberculosis transmission in their communities. This symposium will bring expertise across disciplines and the audience together to discuss lessons from past and current symptom-agnostic screening programmes, explore the biological basis for the subclinical TB phenotype and explore how, and how much, asymptomatic individuals contribute to population-level transmission.  

15:00 - 15:05: Introduction

15:05 - 15:15: Subclinical TB disease: what do we know, what do we need to knowIt is becoming clear that a two state latent active paradigm is overly simplistic and limits approaches to tuberculosis (TB) control. In this talk, data will be presented from both a historical systematic review and a contemporary study to provide fresh insight into the subclinical disease state and the heterogeneous kinetics of disease progression. The implication of this for diagnostic and intervention strategies will then be explored.
Hanif Esmail

15:15 - 15:25: Lessons from the field: experiences from a mass X-ray screening programmeOne approach to address subclinical tuberculosis (TB) for a TB care and prevention programme is to employ mass X-ray screening. Until recently, this approach has been employed in a number of countries. Rather than re-invent the wheel, there are valuable insights for countries considering this policy option. This presentation will outline the benefits, costs and political background of the mass X-ray screening in Russia.
Nataliya V Stavitskaya

15:25 - 15:35: Lessons from the lab: what is the biological basis for subclinical TB?Blood-based transcriptional diagnostics have been proposed as tests that may be able to identify those with culture-positive prevalent disease and potentially also predict those who will develop disease in subsequent months. This presentation will highlight insights into this from the recently completed CORTIS trial and discuss the strengths and limitations of this approach as a future tool in the active case finding context and insights into the host response during subclinical phase of disease.
Thomas Scriba

15:35 - 15:45: Lessons from the breath: better predictor of transmission or disease?Tuberculosis (TB) is transmitted by aerosolisation of M.tuberculosis (M.tb). Traditionally we have relied upon spontaneous sputum production as the primary sample for case detection and a proxy for infectiousness. While cough is usually considered the primary driver of aerosolisation facilitating transmission, this dogma is now being challenged, especially in the context of subclinical disease. This presentation will build on recent insights using face masks to capture aerosols in community screening, active case finding and transmission studies, and explore the impact of these findings on the current paradigms around M.tb transmission and what this might mean for testing for clinical and subclinical disease.    
Caroline Williams

15:45 - 15:55: Lessons from the population: how infectious is subclinical TB?One of the key questions around subclinical tuberculosis (TB) remains the contribution to transmission from this asymptomatic, bacteriologically-confirmed population. If cough is absent or limited, how effective is transmission and how do other aspects of subclinical disease affect transmission? To address these questions, the presentation will bring together empirical data on the relative infectiousness of subclinical TB. Through a simple model, the presentation will provide an estimate of the proportion of all population transmission that is due to subclinical TB in Viet Nam, a high burden country with a substantial burden of subclinical TB.
Jon C. Emery

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

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