Newsletter: Edition 6

It’s been 10 years since the TB Think Tank was established whilst there are many amongst us who have detected the increased regularity and increasing consistency of the operation of the Think Tank and others who point out the increasing scope and depth of the work being carried out, its is much better to formally evaluate our work. With this in mind, the Secretariat has commissioned a formal evaluation of the Think Tank which will properly and more objectively document how effective we have been and provide feedback of areas of weakness which need to be addressed. Many of you will be approached to offer your thoughts during the course of this evaluation. Don’t hold back, Prof Ndjeka and I both would rather have brutal honesty than feigned platitudes. Our job is to constantly improve the Think Tank!

In the first week of June, many of us will be attending the 8th National TB Conference. The conference agenda is exciting and we urge you to register if you haven’t. the reason it is an exciting agenda is that it reflects the excitement that is gaining momentum generally in new scientific and technological developments in the field of TB both in SA and globally. New diagnostics for drug sensitivity and cheaper alternatives to nucleoside amplification testing and new shortened regimens for DS and DR TB are only the starting point. When viewed alongside the search for a new vaccine, the scale up of 3HP, the appearance of UVGI and newer technologies for infection control and so many other innovations, the TB community does appear to be entering a new era of control. New strategic thinking contained in the soon to be released National TB Strategy and new guidelines such as the paediatric treatment guidelines capture much of the new technology and the new thinking. This all feeds into the excitement that is starting to permeate the Think Tank and its task teams. All this in the context of declining incidence.

Our well known frustrations continue to irk us. The quality of services in many facilities still disappoints many among us, the challenges and lack of progress with keeping records and collating basic indicator data and the constant hum of budget cuts and staff shortages over our heads rankles constantly.  This is a life we have learned to live with and yet continue to plug away at addressing these issues and work harder at the challenges that we have some control over such as improving treatment completion rates for adults and children. Let’s keep that uppermost in our minds as we figure out the work that each and every one of us is doing.

TB SYMPOSIUM 2024

On the 23rd of March, the National Department of Health hosted a symposium on BPaL-L and the emergence of Bedaquiline resistance at the Radisson Blu in Sandton, Johannesburg.

It was a well-attended event where cured DR-TB patients who had been on the BPaL-L regimen shared their experiences from a youth’s perspective, touching on issues such as stigma within the community. The group of young gentlemen also anecdotally shared how their appetite significantly changed for the better in an attempt to counter the extreme weight loss due to TB.

In his address, Dr Owen Kaluwa from WHO reiterated a quote from the previous year “shorter more effective treatment for all people suffering from DR-TB”. He mentioned that this call to action can only happen within a framework of well-functioning healthcare systems with the support of multiple in-country stakeholders, partners and civil society. The saying ‘YES, we can end TB’ requires everyone to be involved and play a part which is a call for action to achieve this goal.

NICD colleagues presented on the emergence of bedaquiline resistance. Dr Harry Moultrie spoke on acquired and primary bedaquiline resistance and mentioned how a person who previously didn’t have TB encounters a person who has bedaquiline-resistant TB and would then get infected with bedaquiline-resistant TB for the first time. He further presented a few studies on emergence of bedaquiline resistance. Prof Norbet Ndjeka spoke about the plan to address bedaquiline resistance which entailed close monitoring and further exploration into other regimens.

The very informative session ended with a cocktail-style lunch served in the foyer of the venue where the various stakeholders took to networking with each other.

get to know tb think tank

Dr Karen du Preez

Even though tuberculosis (TB) is preventable, treatable and curable, thousands of South African children are still affected every year.  In this newsletter, we are excited to introduce Dr Karen du Preez, the chair of the TB Think Tank Child, Adolescent and Maternal TB working group.  Karen completed her medical training at the University of Pretoria and joined the Desmond Tutu TB Centre (DTTC) in 2008 to follow her passion to improve child health in lower-middle income countries.
 
Currently Karen holds a senior researcher position at the Department of Paediatrics and Child Health at Stellenbosch University (SU) and leads paediatric TB epidemiology and implementation science research at the DTTC.  Since joining the DTTC, she successfully completed an operational research fellowship at the Union, a distance learning MSc degree in Epidemiology at the London School of Hygiene and Tropical Medicine cum laude, and a PhD at Stellenbosch University.  She has also been a member of the World Health Organisation Child and Adolescent TB working group since 2012.  
 
Over the past 15 years, Karen’s research focused on epidemiological and operational aspects of paediatric TB to allow a more effective response to the TB epidemic in children and adolescents.  She works closely with Department of Health to pilot innovative solutions and measure the impact thereof through rigorous implementation science methodology.  She has successfully implemented and evaluated health system strengthening interventions to improve linkage to care for children with hospital-diagnosed TB and is passionate about improving TB contact management and prevention. Her PhD research provided important insight into the role of different surveillance strategies to measure losses along the TB care cascade which specifically pertains to children. 
 
Karen is currently principal investigator of an NIH K43 Emerging Global Leader award to investigate the burden and outcomes of children with TB meningitis at a global and national level in South Africa. TBM is one of the most debilitating and severe forms of TB in children, and early diagnosis and prevention relies on well-functioning health systems.
 
She has presented at multiple national and international forums and has published nearly 40 articles in peer-reviewed international journals (a full list of her publications can be found at https://scholar.google.com/citations?hl=en&user=vCmAwR0AAAAJ). She is actively involved nationally and internationally to translate research into policy and practice to improve TB care to children. 
 
In her spare time, you will find her often next to the sport field, as she loves to support her 14-year-old daughter and 12-year-old son at their respective sport and culture activities at school.  She also enjoys reading a good book and spending time outdoors jogging or hiking and does NOT miss her weekly Pilates class! 

NETWORK PUBLICATIONS

1. Association between tuberculosis and pregnancy outcomes:a retrospective cohort
study of women in Cape Town, South Africa5,1, Muhammad Osman3,2, Mariette Smith3,2,  Florence Phelanyane1, Rory Dunbar6,5, Aduragbemi Banke-Thomas1, Peter Bock1, Jennifer A Hughes4,1, Florian M Marx3,2, Arne von Delft1, Anneke C Hesseling11. Sue-Ann Meehan  

DOI: https://bmjopen.bmj.com/content/14/2/e081209  

2. Reducing Initial Loss to Follow-up Among People With Bacteriologically Confirmed Tuberculosis: LINKEDin, a Quasi-experimental Study in South Africa  Sue-Ann Meehan,
Anneke C Hesseling, Andrew Boulle, Jolene Chetty,Lucy Connell,
Nomthandazo J Dlamini-Miti, Rory Dunbar, Karen Du Preez,Gavin George, Graeme Hoddinott, Karen Jennings, Florian M Marx, VanessaMudaly, Pren Naidoo, Neo Ndlovu,
Jacqueline Ngozo, Mariette Smith, Michael Strauss,Gaurang Tanna, Nosivuyile Vanqa, Arne von Delft, Muhammad Osman  

DOI: https://doi.org/10.1093/ofid/ofad648 

3. Perspectives from the 2nd International Post-Tuberculosis Symposium: mobilising advocacy and research for improved outcomes Allwood, B.W.1 ; Nightingale, R.2 ; Agbota, G.3 ; Auld, S.4 ; Bisson, G.P.5 ; Byrne, A.6 ; Dunn, R.7 ; Evans, D.8 ; Hoddinott, G.9 ;Günther, G.10 ; Islam, Z.11 ; Johnston, J.C.12 ;  Kalyatanda, G.13 ; Khosa, C.14 ; Marais, S.15 ; Makanda, G.16 ; Mashedi, O.M.17 ; Meghji, J.18 ; Mitnick, C.19 ; Mulder, C.20 ; Nkereuwem, E.21 ; Nkereuwem, O.21 ; Ozoh, O.B.22 ; Rachow, A.23 ; Romanowski, K.12 ; Seddon, J.A.24 ; Schoeman, I.16 ; Thienemann, F.25 ; Walker, N.F.26 ; Wademan, D.T.27 ; Wallis, R.28 ; van der Zalm, M.M.27 ; 

DOI: https://doi.org/10.5588/ijtldopen.23.0619  
https://www.ingentaconnect.com/content/iuatld/ijtldo/2024/00000001/0000
0003/art00003;jsessionid=a6ss9qh2y4u2.x-ic-live-01
   

4. Enhanced active case finding of drug-resistant tuberculosis in Namibia:a protocol for the hotspots, hospitals, and households(H3TB) study  Olga Shavuka1, Etuhole Iipumbu1, Lorraine Boois1, Gunar Günther1,2, Graeme Hoddinott3, Hsien-Ho Lin4, Emmanuel Nepolo1, Stefan Niemann1,5, Nunurai Ruswa 6,James Seddon3,7, Mareli M Claassens1,3 

DOI: https://doi.org/10.1136/bmjopen-2023-082665 

5. Psychosocial needs of adolescents living with TB in Peru and South Africa
Cintron, C.1 ; Hoddinott, G.2 ; Sinche, B.R.3 ; Brown, R.A.2 ; Wademan,
D.T.
2 ; Seddon, J.A.4 ; Chiang, S.S. 

DOI:  https://doi.org/10.5588/ijtldopen.23.0443  
https://www.ingentaconnect.com/content/iuatld/ijtldo/2024/00000001/00000003/art00008  

6. The socioeconomic impact of the COVID-19 lockdown on families affected
by childhood respiratory illnesses in Cape Town, South Africa  Michaile G. Anthony,
Graeme Hoddinott, Margaret Van Niekerk, Isabelle Dewandel, Carla McKenzie, Carien Bekker, Helena Rabie, Andrew Redfern, Marieke M. van der Zalm  

DOI: https://doi.org/10.1371/journal.pgph.0003020  
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0003020  

7. Prevalence of subclinical pulmonary tuberculosis in adults in community settings:
an individual participant data meta-analysis Stuck, L., Klinkenberg, ., Abdelgadir Ali, N., Basheir Abukaraig, E. A, Adusi-Poku, Y, Alebachew Wagaw, Z, Fatima, R, Kapata, N., Kapata-Chanda,P, Kirenga, B., Maama-Maime, L. B., Mfinanga, S. G., Moyo, S., Mvusi, L.,
Nandjebo, N, Nguyen, H. V, Nguyen, H. B, Obasanya, J, Adedapo Olufemi, B,
Patrobas Dashi, P.

DOI: https://doi.org/10.1016/S1473-3099(24)00011-2       
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00011-2/fulltext  

Watch out for the webinars lined up for the next quarter, every third Monday of each month, except indicated otherwise.  

Webinar Catch up

The recent webinars are listed below, with the links provided for your convenience to follow and catch up if you missed the sessions.

19 Feb 2024: Drug Resistant TB Mortality in KZN , with Dr Louisa Dunn.  

04 Mar 2024: Special Edition Webinar on highlights from the BRICS Summit  ,with Prof. Limakatso Lebina and Katlego Motlhaoleng. 

18 Mar 2024:  A closer look at the Global TB Report  , with Dr Nkateko Mkhondo and Mathieu Bastard.

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