Message from The EXCO Co-Chair
The purpose of the TB Think Tank (TBTT) is to build a bridge between the incredible TB research community that we have in South Africa and the Department of Health. For the Department, it is a vehicle to draw on available local expertise to strengthen the National TB Control Programme (NTP). Examples of this include the TB Recovery Plan, the development of the NTP Strategy 2023-2028 and the Funding Request to the Global Fund.
For the research community, the TBTT is the best way to translate our research into practice by recommending policy changes based on the latest evidence for which we all work so hard to produce. The Think Tank has been slow, perhaps even clumsy, in converting our raison d’etre into an efficient mechanism but I believe that there is a new momentum upon which we should capitalize now to yield results in the medium term.
Perhaps this new wind in our sails is brought about by the new Chairperson of the Think Tank, Dr Norbert Ndjeka, who has been a champion of innovation, especially in the field of MDR TB treatment. Or it is due to the new Secretariat that is better staffed and better resourced than previously. Or it is part of the general global revival of TB research and programming following the doldrum period of the last 3 years of COVID-19.
Whatever the reason, this is a moment to be grasped. So, Dr Ndjeka and I look forward to working more closely with all the members of the Think Tank to move both TB research and service delivery forward with new energy and determination.
A luta continua!
Dr Fareed Abdullah
SA TB conference: TB Think Tank satellite session
The TB Think Tank was excited to host a satellite session at the SA TB Conference that far exceeded expectations. The session, which was facilitated by Mthokozisi Dube, programme manager of the TB Think Tank Secretariat, was attended by more than 200 delegates.
Dr Priashni Subrayen presented an overview of the TB Think Tank’s vision, mission, and goals, describing how we aim to harness expertise and brainpower in the National TB Programme, the scientific community, civil society, and beyond to end TB in South Africa”. She further discussed the structure of the Think Tank along with the roles of the task teams. Delegates were invited to visit the TB Think Tank’s newly launched website www.tbthinktank.org and follow its Twitter account to stay updated on activities and developments.
Three more presentations followed. One described Think Tank outputs from commissioned work and the other two were on the questions and conversations within the Think Tank, in developing the evidence base to inform policy recommendations, plans, and guidelines.
Mr Abenathi Mcinziba presented one of the Think Tank’s completed outputs: preferences for TB Preventive Therapy (TPT) among South African children, adolescents, caregivers, and health workers. He emphasised the importance of this work, especially within the South African landscape, and the purpose of the research project, which was mainly to inform priority settings along the TPT development pipeline and in TPT implementation policies. The main message was that TPT regimens cannot be one-size-fits-all. All included groups had different and, in some cases, overlapping preferences. Children preferred smaller pills that are not bitter with no side effects. Adolescents preferred local clinic-based services with shorter waiting times and shorter treatment duration coupled with fewer clinic visits. Caregivers preferred easier-to-prepare regimens and smaller pills. Alternative TPT regimens and formulations are essential to provide patient-centred care that meets the diverse needs of different populations.
Ms Erika Mohr-Holland presented on Occupational Health and Safety (OHS): The considerations regarding TB Screening for Health Workers (HWs) in South Africa. She emphasised the fact that HWs face a disproportionate risk of developing TB disease compared to the general population. Additionally, the OHS Policy for HWs concerning HIV and TB has been in draft form since 2016, which is why this work included a rapid review of occupational TB screening for HWs. Considerations for the implementation of screening included training staff, determining the optimal screening modality and interval, as well as exploring a mobile app and EHealth technology screening to reach more HWs rapidly. The recommendations outlined were the requirement of a robust health information management system and the adaptation of occupational TB screening for different resource settings at the provincial level.
Prof Sizulu Moyo presented the landscape of shortened regimens for drug-sensitive TB in South Africa. Prof Moyo mentioned that the search for shorter, safe, and highly potent treatment regimens is ongoing, and cited several key trials that failed to demonstrate noninferiority to the current 6-month regimen. Significant changes in guidance between 2010 and 2022 were laid out. In the last few years, significant developments have been made for the introduction and scale-up of shorter regimens, such as the 4-month regimen. There are, however, additional data still needed for some population groups to consider these shorter regimens. These include data on people with certain forms of extrapulmonary TB; pregnant, lactating, and postpartum women; people with other comorbidities; interaction with other drugs; and people living with HIV whose CD4 counts are <100 cells/µL. Prof Moyo concluded by highlighting that there has been and continues to be rapid development of new TB treatment regimens and that South Africa is well placed for rapid adoption & scale-up using experience from drug-resistant TB.
Conference delegates engaged with comments and questions during the question-and-answer segment, with clarity-seeking and further probing questions to the presentations made. An open invitation was extended for interested delegates to join the Think Tank and several delegates promptly expressed their interest in joining. The satellite session was rounded up with lunch.
SA TB Conference: Department of Basic Education satellite session
The Department of Basic Education (DBE) satellite session was themed “Prioritising Tuberculosis Response Among School-going Adolescents”. At least 110 delegates attended the session, which was co-chaired by Prof Salome Charalambous and Ms Coceka Nogoduka. In her welcome address, Amanda Hozane pointed out that health is a support program within the DBE, and that TB is discussed within the compound of all other communicable diseases in the Life Orientation subject for learners. This leads to a superficial discussion of the subject matter that lacks the necessary depth and misses out key TB issues. She emphasised the need for a plain-language TB guide for schools for relatability and easier understanding. Along with Information, Education and Communication (IEC) material, a TB guide should be readily available on the DBE website. In her conclusion, she indicated that schools are open to stronger TB programs and need occupational safety measures for both scholars and educators.
Dr Angelique Luabeya discussed the epidemiology of TB among school-going adolescents. Adolescents’ global burden of disease data are difficult to obtain, and for infected adolescents, the point of exposure is difficult to identify. Adolescents are highly mobile and engage in a variety of activities, making it difficult to determine exactly where their exposure occurs. In her presentation, Dr Luabeya highlighted interesting data that demonstrated that There is a high prevalence of subclinical TB TB in schools.
Dr Juli Switala shared the story of an adolescent who suffered complications of MDR TB for two years. As a result of a failure to cough, delayed diagnosis and treatment of TB, and poor integration of the TB program for longitudinal care, a child lost two years of health and school while making numerous costly trips to clinics and hospitals. Dr Switala emphasised that there is a need for better platforms to engage the youth and an integrated school program of health to support referrals and provide youth-friendly services.
Dr Graeme Hoddinot discussed the social and structural drivers for TB response in schools, stressing that education is just like health: it is also socially determined. Therefore, there is a need for adolescent-specific clinics and services that are compatible with school holidays to ensure flexibility with care.
The panellists, Katlego Motlhaoleng and Russell Rensburg, in addition to the session speakers, responded to questions during the panel discussion.
To conclude the session, the Deputy Minister of Basic Education, Dr Rginah Mhaule delivered the keynote address, stressing the importance of building momentum in strengthening the integrated health programme for schools and adolescent-friendly health care services.
What to look forward to from the TB Think Tank
- TB Think Tank is looking forward to the new TPT guidelines at an advanced stage of development.
- Monthly webinars to discuss critical policy issues and their crucial building blocks.
- Technical reports and policy briefs on the modelling work for the impact of COVID-19 on TB services.
- National TB programme Strategic Plan 2023-2028