19 October-30 November 2020
The 51st Union World Conference On Lung Health
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E-posters
EP04-Learning from epidemiological analyses
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EP04-Learning from epidemiological analyses
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All E-posters are accessible via the "E-posters" section of the conference platform until 30 November.

EP04-128-21-Results of pulmonary TB screening for the elderly aged ≥ 65 years in Korea, 2019The KCDC selected six regions with a high tuberculosis (TB) incidence rate in the elderly, aged 65 years or over, and conducted TB screening. The project aims to early detect and treat elderly TB patients and prevent TB transmission among the elderly population. This paper describes the study results.
Heeae Kim

EP04-129-21-Excess mortality in TB patients diagnosed at hospital vs at primary healthcare in South AfricaInitial loss to follow-up among tuberculosis (TB) patients is a significant gap in the TB cascade and includes pre-treatment mortality. We evaluated all TB patients diagnosed at primary healthcare, district or tertiary hospitals in two sub-districts of Cape Town. We identified predictors of mortality and demonstrated the time to death using survival analyses.
Muhammad Osman

EP04-130-21-A geo-epidemiological approach to diagnose social inequities among territories vulnerable to TB in the North-East of BrazilIdentify the social inequalities associated with the occurrence of tuberculosis in areas at risk of the disease. This is an ecological study. For the analyses, the statistical model called Generalised Additive Models for Location, Scale and Shape, was used.
Ricardo Arcêncio

EP04-131-21-Poor linkage to care and high mortality among pregnant women with TB in South AfricaThis study describes linkage to care and mortality among pregnant women diagnosed with tuberculosis (TB) in Cape Town, South Africa. Using routinely collected TB data, we describe this cohort of pregnant women with TB, stratified by location of diagnosis and hospital vs. primary health care facility. 
Sue-Ann Meehan

EP04-132-21-Individual associated factors for developing tuberculous meningitis: a cross-sectional studyDiagnosis of tuberculous meningitis (TBM) is challenging. We analysed the data of demographics, comorbidities and concurrent tuberculosis (TB) for TBM and non-TBM in patients from January 2008 to December 2019 in Beijing Chest Hospital (Beijing, China). Individual associated factors for developing TBM were identified by using univariate and multivariate logistic regression.
Mailing Huang

EP04-133-21-Prevalence and risk factors of active TB in Chinese rheumatic patients: a multicentre, cross-sectional studyA tertiary, hospital-based and multicentre cross-sectional study was conducted between September 2014 and September 2015. Eligible patients with confirmed diagnosis of various rheumatic diseases were consecutively recruited and screened for active TB. Calculation of prevalence and analysis of risk factors along with data about demographic features, underlying diseases and past and current medications were obtained.
Xiaoqing Liu

EP04-134-21-Geospatial determinants of TB active case finding among men and working age adults in Lima, PeruIn screening programmes for tuberculosis (TB), men and working age adults often have lower participation. In an active case finding programme for TB in Lima, Peru, we aimed to identify locations that had higher than average attendance by men and working age adults.
Helen Jenkins

EP04-135-21-Geospatial mapping of TB burden in Anambra State, South-East NigeriaWe conducted a geospatial mapping of all the notified tuberculosis (TB) cases in the state to enable a visualisation of hotspots of TB transmission to be targeted with case finding interventions. Patterns of TB burden across the state showed marked differences in urban areas between local government areas in the state. 
Chukwuebuka Ugwu

EP04-136-21-Factors associated with health seeking behaviour of people to be evaluated for TB aged 15 years and above in Indonesia: tuberculosis prevalence surveyThis paper aims to examine the health seeking behaviour of people to be evaluated for tuberculosis (TB). This study included adults to be evaluated for TB aged 15 years old and above based on the Indonesia TB prevalence survey, within the initial behaviour model. 
Permata Silitonga

EP04-137-21-Seasonality and trend of TB incidence rate after GeneXpert MTB/RIF era: a study in a vulnerable region from Brazilian Eastern AmazonEcological study in Macapá, capital of the state of Amapá, region of the Brazilian Eastern Amazon. We applied the interrupted time series method for diagnosing seasonality and the Prais-Winsten method to classify the event trend.
Ricardo Arcêncio

EP04-138-21-TB incidence rates and their determinants: an ecological multicountry analysis, 2005-2015The study identified three intermediary social determinants of health that were associated with changes in tuberculosis (TB) incidence rates across 115 countries between 2005 and 2015. Further action to address these determinants may help to achieve global goals in TB incidence reduction by 2035.
Fiona Alma Koeltringer

EP04-139-21-Risk factors for mortality among patients with multidrug-resistant TB in Uganda: a case-control studyRisk factors for mortality among patients with multidrug-resistant tuberculosis (MDR-TB) in Uganda: a case-control study for patients in the 2016 cohort using the long MDR-TB treatment regimen. This was done under programmatic conditions. 
Enock Kizito

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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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OA-22-Improving the quality of care
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OA-22-Improving the quality of care
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11:00 - 11:05: Introduction


11:05 - 11:13: OA-22-633-23-Enhancing early detection of TB through targeted outreach in hotspots: an experience of Amref Health Africa in Kenya Targeted tuberculosis (TB) outreaches in hotspots to enhance early detection of TB in schools, prisons, health facilities, market places and public transport termini: an experience of Amref Health Africa in Kenya in collaboration with the national TB programme.

Alice Wanyonyi

11:13 - 11:21: OA-22-634-23-A precision public health approach to identify at-risk population segments and their drivers for not seeking care for TB We conducted an 84,625 household community-based survey in 2017-2018 in Chennai, India, and prospectively followed 1,667 people with tuberculosis (TB) suggestive symptoms. We identified contextual and perceptual drivers of care-seeking, segmented respondents by care-seeking behaviour using unsupervised clustering, and estimated the percent of population with TB that would fall into each segment.

Tichakunda Mangono

11:21 - 11:29: OA-22-635-23-Implementing the standardised patient method to evaluate quality of TB care among private practitioners in South Africa We evaluated the feasibility of utilising patient actors (standardised patients) to determine the quality of tuberculosis care among private GPs in two South African cities. We describe the feasibility, challenges and implementation outcomes of this mixed methods project.

Jody Boffa

11:29 - 11:37: OA-22-636-23-Using low-cost interventions to improve availability of TB medicine in Uganda Tuberculosis (TB) commodities management in a resource-limited setting is vital in ensuring access to quality TB care and services. This can be achieved through implementation of low-cost, inventory management interventions to improve the availability of, and uninterrupted access to, TB medicine, resulting in better TB treatment outcomes.

Henry Kizito

11:37 - 11:45: OA-22-637-23-How the dual role of community facilitators as sample transporters and TB patient contact tracers increased contacts coverage and TB case finding in Kampala The laboratory network in Uganda is linked by motorcycles transporting samples. The Uganda tuberculosis (TB) prevalence survey highlighted inadequate systems for TB patient contact tracing in communities. Challenges to TB diagnosis included delays in reaching/linking TB patients contacts to facilities. To address these, The United States Agency for International Development's Defeat TB project integrated sample transportation systems with community TB contact tracing.


Ronald Mangeni

11:45 - 11:53: OA-22-638-23-Quality of TB and HIV care among private general practitioners in two South African cities Little is known about the quality of tuberculosis (TB) and TB-HIV care in South Africa's private sector, despite 29% of people with TB symptoms seeking private care first. We report on the quality of TB and HIV management received by patient actors presenting to private GPs in Durban and Cape Town.

Sizulu Moyo

11:53 - 12:01: OA-22-639-23-Understanding the dynamics of antibiotics and steroids prescription prior to TB diagnosis in South Africa’s private sector Antibiotic and steroid use can lead to tuberculosis (TB) diagnostic delay and/or complications with TB treatment. We report insights into prescription dynamics based on the qualitative findings from a quality of TB care study among private general practitioners in an urban centre of South Africa.

Jeremiah Chikovore

12:01 - 12:20: Q&A


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SP-39-National TB prevalence surveys in Southern Africa: key results, lessons learned and programmatic implications
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SP-39-National TB prevalence surveys in Southern Africa: key results, lessons learned and programmatic implications
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Accurate measurement of the burden of disease through national tuberculosis (TB) prevalence surveys is part of the work of the World Health Organization's Global Task Force on TB Impact Measurement. Four such surveys were recently conducted in high TB-HIV burden countries in Southern Africa - Eswatini, Lesotho, Mozambique and South Africa. This symposium will present the key results, major lessons learnt and the programmatic implications, followed by how these survey results were used to re-estimate TB burden.

16:30 - 16:35: Introduction

16:35 - 16:45: The road to TB elimination in Eswatini: who are we missing and why?Eswatini, a high TB-HIV burden country, successfully conducted its first national tuberculosis (TB) prevalence survey in 2018. Results showed a significant number of TB cases were being missed with the current symptom screening strategy. Innovative approaches are needed to guide the strategic direction for TB elimination against the high background of HIV. This presentation will share the country’s experience and the policy/programmatic implications of the survey findings.
Welile Sikhondze

16:45 - 16:55: Lesotho national TB prevalence survey 2019: results, lessons learned and implications for the national TB programmeLesotho, a high TB-HIV burden country, conducted a national tuberculosis (TB) prevalence survey in 2019 that was led by University Research Company jointly with its partners NEXT2PEOPLE and AQUITY Innovations. The presentation will focus on the rationale for conducting the survey, methodology (including the use of Xpert Ultra – one of the first countries to do so), lessons learned during implementation, key results (that included a high burden among men compared with women, a burden that increased with age, and a very large TB-HIV co-infection rate) and implications for the national TB programme.
Bridget Maama Llang

16:55 - 17:05: The first national TB prevalence survey of Mozambique, 2018-2019: challenges and achievementsMozambique is on all three World Health Organization high burden lists for tuberculosis (TB), HIV-TB co-infection, and multi-drug resistant TB. The country conducted its first national TB prevalence survey to gain more insight in the country's TB epidemic and used the results to guide TB control in the country. This presentation will discuss the methodological approach, key findings and lessons learned including how to guide quality assurance in culture and manage discordant results between Xpert MTB/RIF and culture. It will also underline key operational and technical challenges faced during the field work. Finally, it will describe the impact of the survey results on the design of future strategies for TB control in Mozambique.
Ivan Manhiça

17:05 - 17:15: Insights into the TB epidemic of South Africa: findings from the first national TB prevalence survey, 2019The first ever national prevalence survey in South Africa was completed in 2019; a country with a high TB-HIV burden and where high levels of community transmission of tuberculosis (TB). Screen-positive survey participants ≥15 years were tested for TB by culture and Xpert MTB/RIF Ultra. Findings from the survey are that the country has a high burden of pulmonary TB, that there is a considerable gap in prevalence to notification, and that many prevalent TB cases were not reported by the routine surveillance system of the national TB programme. TB was not uniformly distributed across age groups, prevalence in men was 1.6 times than that of women, prevalent TB was often not symptomatic, and HIV infection was a major risk factor for symptomatic TB. Previous TB was common among survey participants, which showed the limitation of molecular-based tests in the absence of signs and symptoms. 
Lindiwe Mvusi

17:15 - 17:25: Estimating incidence from national prevalence survey results in Southern AfricaA presentation of statistical methods, key results and their limitations will be made, covering the following countries: Eswatini, Lesotho, Mozambique and South Africa.
Philippe Glaziou

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

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OA-31-TB epidemiology
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OA-31-TB epidemiology
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16:30 - 16:35: Introduction


16:35 - 16:43: OA-31-688-23-Estimating the proportion of subclinical TB disease: definitions, associations and screening A significant proportion of the global tuberculosis (TB) burden is subclinical, it is not detectable by current symptom-based screening efforts and is fueling the TB epidemic through continued Mycobacterium tuberculosis transmission. We extracted data from TB prevalence surveys conducted since 1990 and our results revealed the potential of changing TB case finding policies.

Beatrice Frascella

16:43 - 16:51: OA-31-689-23-A high-resolution snapshot of subclinical TB via community-wide sputum testing in an urban Ugandan community We performed population-wide, community-based tuberculosis (TB) testing with sputum Xpert MTB/RIF Ultra for >12,000 adults within a two km2 area, in Kampala, Uganda. We compared clinical and bacteriologic characteristics of individuals with undiagnosed TB, to patients diagnosed through routine care at local health facilities, and also to representative TB-negative community members.

Emily Kendall

16:51 - 16:59: OA-31-690-23-Methods and challenges of national TB prevalence surveys in Asia and sub-Saharan Africa: a systematic review This systematic review characterised the methodological challenges of 28 national TB prevalence surveys in Asia and sub-Saharan Africa. Challenges included under-recruitment, under-representation of risk groups, diagnostic reliance on smear as well as logistical constraints including staffing, security and paper-based tools. Solutions included improved funding, political commitment, context-specific diagnostic algorithms and social mobilisation.

Gokul Mishra

16:59 - 17:07: OA-31-691-23-Trends in molecular epidemiology of drug-resistant TB in Estonia Estonia is on the list of 18 high-priority countries for tuberculosis (TB) control that bear 85% of the TB burden and 99% of the multidrug-resistant-TB burden. The study aimed to characterise Mycobacterium tuberculosis isolates, obtained at different time points in Estonia, to assess trends in evolution of drug-resistant TB.

Igor Mokrousov

17:07 - 17:15: OA-31-692-23-Comparing the epidemiology and clinical characteristics of childhood TB through active and passive case finding Most high prevalence areas perform only passive case finding (PCF) for tuberculosis (TB), evaluating children presenting with significant symptoms, rather than active case finding (ACF) through contact tracing. We compared clinical, radiographic and microbiological characteristics of children diagnosed through ACF and PCF and found important differences that impact recognition and care.

Saki Ikeda

17:15 - 17:23: OA-31-693-23-Increasing TB incidence rates and inequitable treatment outcomes for young people with TB in Brazil: a national retrospective cohort study We conducted a national retrospective cohort study in Brazil between 2015-2018 of 42,291 young people newly diagnosed with TB. We found increasing tuberculosis (TB) incidence in young people and those with homelessness, HIV/AIDS, illicit drug use or identifying with black or brown skin colour, were more likely to have unfavourable treatment outcomes.

Louisa Chenciner

17:23 - 17:50: Q&A


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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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SP-42-Take home messages for active case finding learned from TB prevalence surveys, TB or not TB?
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SP-42-Take home messages for active case finding learned from TB prevalence surveys, TB or not TB?
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Results from tuberculosis (TB) prevalence surveys using both Xpert MTB/RIF and culture testing raised queries on defining TB due to unexpected discordance in results. As surveys are key to providing insights in a country's TB epidemic it is important there is a good understanding of what we call TB. In this session, key lessons from recent surveys will be discussed from the perspective of the capacity of the diagnostic methods as well as the latest global guidance for the conduct of these surveys. The concluding presentation will provide take-home messages for using these results for active case finding.

11:00 - 11:05: Introduction

11:05 - 11:15: The screening and diagnostic algorithm of national TB prevalence surveys: updated global guidanceResults from recent national TB prevalence surveys have been used to update the guidance from the World Health Organization Global Task Force on TB impact measurement on the screening and diagnostic algorithm of these surveys. This presentation will be informing participants about the recent evidence, a chronology of the discussion and the new guidance.  
Charalampos (Babis) Sismanidis

11:15 - 11:25: GeneXpert and culture for all in the Mozambique national TB prevalence survey, ensuring quality of lab procedures and addressing discordant resultsThis presentation will address the key lessons learned from doing culture and Xpert for all participants in a nationwide survey in Mozambique. For all those with discordant field Gene Xpert and central lab culture results, further laboratory testing was done among which subculture on MGIT. Experiences will be shared on the use of the GeneXpert MTB/RIF in the field setting, the performance of the culture including quality control measures for all samples transported to the National Tuberculosis Reference Laboratory (NTRL) as well as staff management. It will highlight, not only the importance of log tags for quality control of samples sent for culture and the use of controls (positive and negative) in the processing of samples in the NTRL, but also the impact of the survey results for tuberculosis (TB) control on the design of future strategies for TB testing in community settings.
David Macheque

11:25 - 11:35: Strategies to minimise culture in TB prevalence surveys: lessons from targeted culture testing in the TREATS projectTREATS measures the impact of the HPTN071 (PopART) intervention of combined universal HIV and tuberculosis (TB) screening and treatment on the burden of TB at population level. Key to measurement is a TB prevalence survey conducted in 56,000 randomly sampled individuals from the trial communities in Zambia and South Africa. To decide on the best algorithm for the study and contribute to global insights for national surveys, an 'intensive diagnostic phase' was conducted to provide robust evidence on the optimal diagnostics algorithm for use in such TB prevalence surveys, resulting in an innovative algorithm minimising the use of culture. Results will be presented outlining the evidence base behind this algorithm.
Eveline Klinkenberg

11:35 - 11:45: Prevalence surveys: diagnostics unpluggedAs we improve the sensitivity of molecular tests, we in turn increase the positivity rates by detecting cases having very low levels of genomic DNA in sputum. Presumably, one genome of DNA correlates to one cell of Mycobacterium tuberculosis. However, the question arises as to if that cell is actively replicating and causing disease or not. In asymptomatic or questionable cases these results are perplexing and may skew prevalent survey and active case finding results. Further, culturing patients with trace detection results can provide even more confusion when culture practices and methods are flawed. Under these circumstances we often see discordance between molecular and culture results. This conundrum challenges case management. “How does one deal with contradicting results?” This presentation will explain current issues with diagnosis and the reliability of current methods, while providing guidance to clinicians for decision making on case management under these very circumstances.
Kathleen England

11:45 - 11:55: Combining the evidence: what lessons can we learn for active case finding?Tuberculosis (TB) prevalence surveys have provided important insight into the diagnostics of TB and led to a discussion on the definition of TB or not TB. These lessons are also key in the context of active case finding at community level where subclinical disease, or previous TB, might be interfering with the diagnostic test interpretation and the need to decide on what we call TB.
Helen Ayles

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

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SP-46-Subclinical TB disease: lessons and questions from field to lab
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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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