MESSAGE FROM THE CHAIR

This past quarter has been busy in the world of TB. Revised diagnostic algorithms were presented to provinces in August along with a toolkit for strengthening social and behavioural change communication.
On 1st September the NDoH officially launched BPaL-L, the all-oral 6-month regimen for Rifampicin-Resistant TB based on scientific evidence produced right here in South Africa. Following a robust GRADE review and approval from the South African National Essential Medicines List Committee, the new regimen is being implemented at existing clinical access programme sites and will then be scaled up provincially, subject to the availability of Pretomanid.
Support for TB among current and ex-mine workers also gained traction, with a Think Tank working group to be formed to help provide evidence-based guidance for the management of TB in the small- to medium-sized mining sector, managing TB across borders, and facilitating TB compensation for eligible ex-mine workers and their beneficiaries.
In September, we saw the second United Nations High-Level Meeting on the Fight Against TB held during the UN’s General Assembly, with a sizable delegation from South Africa, including government, NGO, and civil society representatives. Successes of the meeting included a commitment to treating 45 million people with TB by 2027, improving targets for the provision of preventive treatment, and increasing annual TB funding from $5.4 billion per year to $35 billion by 2030. Members states also agreed to increase investment in TB research to $5 billion a year by 2027 to support the development of point-of-care diagnostics, vaccines, and better treatment regimens.
Looking ahead, this next quarter will see a number of Think Tank successes come to fruition. These include the tabling of the National TB Strategic Plan 2023-2028 at the National Health Council, updated national algorithms for the use of digital chest X-rays to screen for TB, and the finalisation of the Paediatric TB Guidelines.
Yours Sincerely,
Prof N Ndjeka
TB THINK TANK NEWS
BPaL-L Lauch at Jose Pearson Hospital, 1 September 2023
On September 1st 2023, The National TB Program achieved a significant milestone in the management of Drug-Resistant TB, with the official launch of a new treatment regimen that has a shorter duration and lower pill burden. The TB Think Tank secretariat, the National TB Program delegation, the Eastern Cape Provincial DoH, associated researchers, and donor agencies gathered at Jose Pearson Hospital in Gqeberga to witness the first patient receive the new BPAL-L regimen.
The event began with a welcome and an overview of JP Hospital, followed by a tour of the Outpatient Department. Prof. Ndjeka initiated the first patient on the BPAL-L regimen, which reduces the number of pills a patient takes from 23 per day for nine months to 23 per week for six months.

The second part of the event was held at the Dolphins Leap Conference Centre. The attendees were greeted by Ms Miyakazi Nokwe, the Acting DDG for District Health Management Services, followed by Dr Rolene Wagner, the Head of the Department, and Mr Donald Demana, the Chief Director of Global Fund, who all addressed the delegates.

Prof. Ndjeka gave a presentation on the evolution of Drug-Resistant TB treatment in South Africa, and the necessary collaboration between government, NGOs, and academia. Dr. Francesca Conradie gave a presentation on the BPal-L regimen research study results. The presentation is available here.
Over September, a total of seven sites, from Eastern Cape and Gauteng rolled out the new BPaL-L regimen and a total of forty-three patients were initiated on the new regimen. More sites will follow suit as training is done through the rest of the provinces.
Key takeaways from the United Nations High level meeting:
The UN Member States adopted the Political Declaration of the High-Level Meeting on the Fight Against Tuberculosis at the 78th United Nations General Assembly. The Declaration sets ambitious targets in the fight against TB, aiming to end TB by 2030.
Member states have pledged to provide life-saving treatment to up to 45 million people and preventive treatment for 45 million people. They have also agreed to raise annual global TB funding levels to $22 billion by 2027 and $35 billion by 2030. Additionally, they have committed to mobilizing $5 billion a year by 2027 for tuberculosis research.
Member states have pledged to prioritize TB-affected communities by creating legal and policy frameworks to eliminate TB-related discrimination, stigma, and other human rights barriers. Unfortunately, member states failed to agree on a strong system of accountability in the Political Declaration to ensure monitoring and follow-up, as well as weakened language on a safe and effective new TB vaccine. The adopted version of the Political Declaration will be shared once it’s made available.
GET TO KNOW THE TB THINK TANK

Associate Professor Limakatso Lebina has a passion for public health policy development and is one of the TB Think Tank executive committee members and chairperson for Finding the Missing TB Patients Task Team. She leads the Clinical Trials Unit at Africa Health Research Institute (AHRI) and is also an Associate Professor at the Institute of Global Health, University College London She was the lead writer for the South African National Strategic Plan on HIV, TB and STIs 2023-2028.
Limakatso is a member of the BRICS TB Research network, which was formed by the Ministers of Health to promote collaborative scientific research for the development and innovation on diagnostics, vaccines and management and control of TB. She has co-authored over 70 publications in peer-reviewed scientific journals and presented at both local and international conferences (List of Publications) as well as being an academic editor for PLOS One scientific journal.
In the last 15 years, her research has focused on infectious diseases, focusing on the prevention and treatment of HIV and TB. Some of the studies that she has conducted include clinical trials on TB preventative therapy, new TB drug regimens, vaccines for COVID-19 prevention and HIV pre-exposure prophylaxis in adolescents. Some of her notable work while at the Perinatal HIV Research Unit, was a cluster randomized targeted universal testing for TB (TUTT) study in high-risk clinic attendees, that was conducted in three provinces of South Africa. The results of this study have been utilized to revise the TB screening guidelines and the TB recovery plan 2022-2025 for South Africa.
She also led a team of researchers as part of the TIMS (TB in the mining sector in Southern Africa) project. that provided epidemiological data on TB, Silicosis and HIV among miners and ex-miners to support the selection and design of occupational health services for mineworkers in ten SADC countries.
Her current work includes a HIV pre-exposure prophylaxis using injectables study in young women in rural KwaZulu Natal, new regimes for HIV treatment for people living with HIV and evaluating new agents for COVID-19 treatment. In addition, she is overseeing the Good Clinical Trials Collaborative (“GCTC”) to enhance clinical research in low resource settings under the AHRI PRISM project. The aim of the PRISM project is to promote the unique qualities of randomized controlled trials and the evidence they produce, and support regional research ecosystems to prioritize collaborative, informative, and efficient research responses to public health challenges.
Text
WEBINARS
Follow up on previous TB Think Tank Webinar sessions from the previous quarter.
- 11 Sep 2023: Special edition UN High Level Meeting on TB
- 18 Sep 2023: Umoya Omuhle: TB IPC in primary health centres – what works, and how can it be implemented?
- 21 Aug 2023: Reducing initial loss to follow up among TB patients in South Africa
Click on the poster below to join us for the next Webinar on Monday 16 October 2023.
NETWORK PUBLICATIONS
Recent publications from TB Think Tank Members
- Submitted by Marieke van der Zalm – “Post tuberculosis”: the urgent need for inclusion of lung health outcomes in tuberculosis treatment trials, Quantitation of Circulating Mycobacterium tuberculosis Antigens by Nanopore Biosensing in Children Evaluated for Pulmonary Tuberculosis in South Africa and Clinical standards for drug-susceptible TB in children and adolescents.
- Submitted by Sue- Ann Meehan – Tuberculosis programme stakeholder views on lessons from the COVID-19 response in two South African provinces.
- Submitted by Anura David – Determining cost and placement decisions for moderate complexity NAATs for tuberculosis drug susceptibility testing.
- Submitted by Denise Evans – The lived experiences of tuberculosis survivors during the COVID-19 pandemic and government lockdown in South Africa: a qualitative analysis.
- Submitted by Alison Grant – Time to change the way we think about tuberculosis infection prevention and control in health facilities: insights from recent research.
- Submitted by Prof Salome Charalambous – Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis