I am proud to be presenting this Newsletter as we start 2024, which marks the 10th anniversary of the South African National TB Think Tank. I feel tremendously privileged to have been part of this team for the past ten years and to have been part of the history of the fight against TB in our country. It was a surreal moment that I remember well when the first sparks of thoughts around the TB Think Tank occurred.
The Aurum team, with Prof Gavin Churchyard as the lead, had requested a meeting with the National DOH with Dr Yogan Pillay, then the Deputy DG, and David Mametja, Chief Director of TB. The discussion was around a grant awarded to Prof Richard White from the London School from Bill & Melinda Gates Foundation to do some mathematical modelling. The request was to have regular meetings with the Department and other TB stakeholders in South Africa to help inform the modelling work. It was Dr Yogan Pillay who suggested that this was an opportunity to form the TB Think Tank. At that time, an HIV Think Tank had already been formed and it seemed appropriate to form something similar for TB.
The first meeting that took place was at the 4th SA TB conference in 2014. Guided and led jointly by Dr Pillay and Prof Churchyard, the first discussions were on the structure and purpose of this group. The idea of the TB Think Tank was met with some excitement but also many questions: how would this work? would the interest be sustained? how would conflicts be resolved? It took us some time to work out the best ways to work together but all the members were united by one sole purpose – the passion to improve the TB situation and stop the endless deaths from TB in South Africa.
Even though it was never easy, the Think Tank has seen many successes which included supporting the National Strategic Plans, and producing numerous guidelines, algorithms, and guidance documents. COVID-19 posed an extremely big challenge to the TB programme, and members of the Think Tank met tirelessly to discuss ways to improve the TB response which led to the TB Response plan that we have now.
So what has been the progress in ten years? In 2014, WHO reported 328 896 cases of TB in South Africa and 26 023 laboratory confirmed cases of DRTB for the previous year. In 2023, it was estimated that there were 280 000 cases in South Africa, showing a reduction of 15% reduction and 11000 DRTB cases (reduction of >50% on DRTB). Some strong strides have been made and we are very hopeful about the new development in diagnostics, treatment and vaccines.
The TB Think Tank is well poised to continue to work hard and to continue collaborate with the Department of Health to combat TB and reduce TB incidence and mortality in our country. There is no limit to what can be achieved with partnership. I would like to thank everyone for all their contributions, giving selflessly to the cause, and to ask you to continue to strive for an end to TB so that we can build a better future for future generations.
Prof Salome Charalambous
Some handpicked sessions and highlights:
1.Highlighting the need for social determinants of TB interventions: The WHO Global #EndTB Symposium emphasized the importance of including interventions that address the social determinants of TB. Social protection interventions were highlighted as a form of “social vaccine” for TB. Evidence presented at various sessions showed the positive impact of social protection, socioeconomic support, and nutritional assistance on TB-related outcomes. For instance, a trial in Uganda demonstrated that unconditional cash transfers improved referrals for testing and treatment initiation.
The reported end-of-treatment outcomes from the study indicated a treatment success rate (cure and completion) of 94.5%(Mirtskhulava et al., Safety and effectiveness of the BPaL regimen: Preliminary analysis of the first multi-country operational research cohort. OA06-242-15). Other discussions in related sessions focused on accelerating the scale-up of the newly recommended six-month treatment regimen for drug-resistant TB. This included a presentation by Ndjeka et al using the introduction of BPaL, a shorter, all-oral, less complex regimen, as an opportunity to strengthen the integration of DS-TB and DR-TB care in South Africa.
South Africa hosted the first BRICS TB research network innovation summit on December 11-13, 2023, under the theme “BRICS Innovations for Ending TB”. The BRICS TB Research Network was established by the Ministries of Health in September 2017, and aimed to establish collaborative research programmes towards developing new diagnostics, drugs and vaccines for TB. In 2022, the BRICS countries accounted for 38% of the TB notifications and 35% of the mortality related to TB disease globally.
The TB research network innovation summit was attended by TB researchers and government officials from the five BRICS countries. Representatives from The World Health Organisation and research for TB Elimination Global TB Programme also joined the meetings as partners of the network. The purpose of the summit was to
• Propose technologies for joint research in the focus areas of public health/programme implementation, therapeutics, diagnostics and vaccines
• Facilitate knowledge sharing among scientists
• Firming up the Network’s resource mobilisation plan
• Develop 2-3 innovative concepts for testing in deployment
Therefore, the three-day programme was structured to include presentations from the various countries’ representatives on innovative TB public health programs, therapeutics, diagnostics and vaccines, as well as discussions on research gaps and how to strengthen collaborations for research. Simultaneous two-way translation in Portuguese, Russian and Chinese was provided for the summit participants to facilitate robust discussions.
Some of the key messages from the presentations included.
• Importance of addressing the social determinants of health in the fight against TB
• Examples of how to reduce catastrophic costs for families affected by TB
• Use of newer diagnostic tools and technologies in finding the missing people with TB
• Fundraising for TB research and programmes
• The pipeline for new TB vaccines and drugs for treatment and prevention
In a true South African style, the summit delegates were also entertained by Zulu traditional dancers during a dinner. It was indeed a successful meeting that will require the BRICS TB Research Network members to follow up on the areas of research collaboration and increasing partners for the network.
As you may know, TB in mines is one of the priorities for the NDOH and is reflected in both the Recovery Plan iterations and the NTP Strategic Plan. We are excited to announce that, as a means to address this issue, the Think Tank established the TB in the Mines Working Group (TIMsG) in October 2023.
This group, similar to the Child and Adolescent Working Group, aims to address relevant issues such as the role of the TB Cluster in compensating ex-miners and providing evidence-based recommendations for TB prevention and control in the small to mid-sized and informal mining sectors, peri-mining communities, and labour-sending areas.
Dr. Barry Kistnasamy leads the team and welcomes interested members to join and contribute to this important task. If you are interested, please send an email expressing your interest to nnkosi@tbthinktank.org
Dr. Mmamapudi Kubjane
Dr. Mmamapudi Kubjane is an epidemiologist and mathematical modeller interested in modelling TB and assessing the impacts of interventions at the population level.
She received her undergraduate training in Mathematics (BSc Hons), followed by an MPH and a PhD in Epidemiology and Biostatistics, all from the University of Cape Town. Her PhD research focused on modelling TB, the effect of HIV on TB, the impact of programmatic interventions, and the drivers of high rates of TB in men in South Africa. This involved extending an existing mathematical model of HIV in South Africa (the Thembisa model) to include TB transmission dynamics.
She currently works at the Health Economics and Epidemiology Research Office, conducting economic evaluations of TB programmatic interventions and supporting the development of the South African TB Investment case. She has been a member of the TB Think for the last four years and now serves as the chair of the Epidemiology, Modelling and Health Economics Task Team, co-chairing with Erika Mohr-Holland and Don Mudzengi.
Dr Florian Marx
On behalf of the TB Think Tank, we would like to extend a special thank you to Dr Marx for his avid and determined leadership of the TB Epidemiology, Modelling & Health Economics Task Team over the past years.
We are proud of all the innovative work, most notably the modelling of COVID -19 and TB healthcare service disruptions as well as the time, especially across different time zones. The secretariat looks forward to a continuing working relationship with Dr Marx alongside the new leadership of the Task Team.
TB TT Secretariat
Exhaled breath specimens subjected to point-of-care lipoarabinomannan testing.
The performance of tongue swabs for detection of pulmonary tuberculosis.
Perceived stigma among people with TB and household contacts.
Quantitative Chest X-ray Radiomics for Therapy Response Monitoring in Patients with Pulmonary Tuberculosis.
Tuberculosis testing patterns in South Africa to identify groups that would benefit from increased investigation.
Rifampicin and protein concentrations in paired spinal versus ventricular cerebrospinal fluid samples of children with tuberculous meningitis.
Reducing Initial Loss to Follow-up Among People With Bacteriologically Confirmed Tuberculosis: LINKEDin, a Quasi-experimental Study in South Africa.
Myburgh, H.; Kaur, M.; Kaur, P.; Santos, V.; Almeida, C.; Hoddinott, G.; Wademan, D. T.; Lakshmi, P. V. M.; Osman, M.; Meehan, S-A.; Hesseling, A. C.; Purty, A.; Singh, U. B.; Trajman, A.
A novel home-based method for preparing suspensions of anti-TB drugs.
Storage of Mycobacterium tuberculosis culture isolates on MicrobankTM beads at a laboratory in South Africa.
Lessons for TB from the COVID-19 response: qualitative data from Brazil, India and South Africa.
More Than a Decade of GeneXpert® Mycobacterium tuberculosis/Rifampicin (Ultra) Testing in South Africa: Laboratory Insights from Twenty-Three Million Tests.
Integrating Molecular Diagnostics and GIS Mapping: A Multidisciplinary Approach to Understanding Tuberculosis Disease Dynamics in South Africa Using Xpert MTB/RIF.
Impaired lung function in adolescents with pulmonary tuberculosis during treatment and following treatment completion.
Watch out for the webinars lined up for the next quarter, every third Monday of each month, except indicated otherwise.
We anticipate A special webinar edition to discuss the recent BRICS Summit led by Prof L Lebina, a session on the recent WHO report led by Dr N Mkhondo and a session with Dr Andrew Marino. Full details will be provided as the dates draw close.
The recent webinars are listed below, with the links provided for your convenience to follow and catch up if you missed the sessions.
