Newsletter: Edition 7

2024 marks the 10th year of the South African National TB Think Tank. Read a message from the TB Think Tank Secretariat Lead,

Read more here.

2024 marks the 10th year of the South African National TB Think Tank. We would like to take this opportunity to reflect on, be grateful for, and celebrate our incredible journey together over the past decade. 

As we look back on the years gone by, we are reminded of the passion, dedication, and unwavering commitment of each and every member of the TB Think Tank. From groundbreaking research initiatives to impactful policy recommendations, from innovative treatment approaches to community engagement efforts – each achievement stands as a testament to our members’ collective brilliance and dedication. From developing the evidence base for the first joint TB & HIV investment case and supporting the 2017-2021 national TB programme’s strategic plan (NTP-SP) in the very early days to the more recent support of the TB Recovery Plan and the 2023-28 NTP-SP.  

To our EXCO Chairs: Prof Ndjeka, Dr Mvusi and our Department of Health colleagues thank you for allowing us to be part of this important journey to contribute to a long and healthy life for all South Africans.’ Thank you also to the people who laid the foundations of the TB Think Tank: Dr Yogan Pillay, Prof Gavin Churchyard, and Mr David Mametja, as well as our steadfast and reliable EXCO Co-Chair, Prof Fareed Abdullah. We also want to acknowledge the crucial role of our task team Chairs and Co-chairs, the driving force behind each pillar in the TB care cascade. Your ongoing commitment and tireless efforts to develop and oversee task team workplans have been instrumental in keeping the work in motion. 

We also extend our heartfelt appreciation to our funders, whose recognition of this platform has been instrumental in our success. The ongoing support from the US Agency for International Development, US Centres for Disease Control and Prevention, the Bill and Melinda Gates Foundation, and the South African Medical Research Council has enabled us to bring together local experts, scientists, researchers, and implementers to collaborate, share knowledge, and influence local policy and guideline development.

As we celebrate this significant milestone, let us reaffirm our shared commitment to END TB in our lifetime. Let us push boundaries, challenge the status quo, and strive for excellence in all we do. Thank you for your dedication, passion, and unwavering commitment to the South African National TB Think Tank mission. Here’s to the next ten years of collaboration, innovation, and impact.  

Dr Priashni Subrayen  

TB Think Tank Lead, 2021 – present

The TB Think Tank is happy to announce the National Department of Health’s formal release of the National TB Programme’s Strategic Plan 2023-28 (NTP-SP)  at the 8th South African TB Conference in eThekwini. The Think Tank would like to extend thanks to all our members for contributing to the development of this important document, which was informed by the National Strategic Plan on HIV, TB, and STIs (NSP) and, in turn, informed TB Recovery Plans 2.0 and 3.0.  

TB Think Tank members meet up at the annual stakeholder meeting in Johannesburg.  

On 23 May, the TB Think Tank hosted its annual face-to-face stakeholder meeting in Johannesburg. Highlights included an opening address from Prof Norbert Ndjeka, a new Child and Adolescent TB Guidelines presentation, and a celebration of the TB Think Tank’s 10th anniversary.

Read more here.

Annual TB Think Tank face-to-face stakeholder’s meeting 

The South African national TB Think Tank members met in Johannesburg on 23 May for the annual face-to-face stakeholders meeting. The meet-up was an opportunity to review the previous year’s successes and challenges. Prof Norbert Ndjeka, Chief Director of the National Department of Health’s (NDoH) TB Cluster and TB Think Tank Chair, opened the day’s events with a summary of progress from Recovery Plan 3.0. He also noted the NDoH priorities for 2024-25, which set the tone for TB Think Tank workplan development during the afternoon session. Prof Ndjeka underscored the need to do the TB basics well, including prioritising adherence, monitoring bedaquiline and isoniazid resistance, mass TB testing campaigns, developing community-driven TB awareness campaigns, and strengthening implementation of targeted universal testing for TB.  

Following Prof Ndjeka’s address, Ms Yulene Kock took the stage to update on the BPaL-L scale-up, the six-month all-oral drug-resistant TB treatment regimen. While 83% of eligible clients have been started on the new regimen, Ms Kock highlighted some limitations, including stock availability, data completeness, and the need for a comprehensive approach, including nutritional support. 

Dr Lindiwe Mvusi presented on the challenges with the scale-up of 3HP, the three-month TB preventive treatment (TPT) recommended for people with HIV and close contacts of people with TB since the release of the 2023 guidelines for the treatment of latent TB infection. A three-year phased approach was implemented in high-burden Districts in 2021 to prepare the environment and account for supply constraints. The three-year targets were unmet as several conflicting challenges presented themselves, including further supply constraints, quality concerns, poor stock management, delays in Provincial approvals, reliance on single-dose formulations, use of paper registers, and low demand. New suppliers are being considered to provide fixed-dose combinations, and updated TPT registers are being circulated to Provinces.   

Later in the day, Dr Priashni Subrayen reflected on 10 years of the TB Think Tank. Dr Elias Ramarumo presented on the updated community and clinic algorithms for TB screening using dCXR, while Dr Karen du Preez gave an overview of the new child and adolescent TB guidelines, which are currently undergoing review by the National Essential Medicine’s List Committee (NEMLC). 

Updates were also presented on SMART4TB and the RePORT Consortium. Prof Neil Martinson presented three Phase 3 trials (PRISM-TB, SMILE, and BREACH-TB), which look at treatment shortening. He also presented updates on the other SMART4TB priorities, including work on novel diagnostics, vaccine readiness, and capacity building for up-and-coming operational researchers. Prof Mark Hatherill presented an update on the work of the Regional Prospective Observational Research in TB (RePORT-TB) Consortium split between eight South African sites and four US sites to conduct TB biomarker and epidemiological research on standardised data and sample sets. He discussed the challenges of the use of current biomarkers to predict TB disease in people with sub-clinical TB and described the need to perform biomarker analysis and TB phenotype in tandem. Prof Hatherill also gave an open invitation to collaborate on the analysis of longitudinal data and sample sets among cohorts of i) people with pulmonary drug-susceptible TB and ii) household contacts of people with TB. Those interested can contact a local RePORT investigator or the international coordinating centre

TB Think Tank at the South African TB Conference 

A TB Think Tank (TBTT) satellite session was held at the 2024 SATB conference. The session aimed to showcase the work done by the various task teams in the TBTT.

Read more here.

A TB Think Tank (TBTT) satellite session was held at the 2024 SATB conference. The session aimed to showcase the work done by the various task teams in the TBTT. Mr Mthokozisi Dube opened the session with an overview of the Think Tank, the secretariat’s activities, an invitation for interested delegates to join, and directions on where to contact the TBTT. The TBTT membership is growing, with just over 380 members from over 63 institutions. 

Prof Limakatso Lebina, the Finding Missing People with TB task team lead, mentioned that the biggest gap in the TB care cascade is access to TB diagnostics. The task team has been working on updates to the Standard Operating Procedures for the use of digital chest x-rays in TB screening to help support standardisation nationally as well as advocacy among researchers to promote community-based interventions. 

Dr Pria Subrayen, the Data Systems and Innovations task team lead, emphasised that data access affects data monitoring, and we need to measure the impact of interventions. There is ongoing input into the development of a TB Module for the new electronic medical records system and advocacy for the support of Health Patient Registration System. The task team is exploring the possibility of using the Department of Health Information System 2 App (DHIS-2), which is intra-operable with DHIS, to collect interventions not captured by TIER.Net. Working with the private sector is also being prioritised to encourage using the Notifiable Medical Conditions (NMC) App for TB to allow access to private sector data. 

Dr Mmamapudi Kubjane, the chair of the Epidemiology, Modelling, and Health Economics task team, highlighted that the ongoing activities include leveraging the TB Prevalence Survey data for additional analysis and to inform modelling studies, supporting the writing of the Global Fund Grant Proposal and supporting the mid-term review of the TB Cluster’s National Strategic Plan and the National Strategic Plan for HIV, TB and sexually transmitted infections. 

Drs Marian Loveday and Lee-Ann Davids, Chair and co-Chair of the Optimising Treatment Outcomes task team, highlighted key ongoing activities to improve adherence to drug-susceptible (DS) and drug-resistant (DR) TB treatment: normalising the challenge of adherence, differentiated care, and the development of a vulnerability assessment to be administered at the start of treatment to identify people at risk of poor adherence. Given the challenges of the shortened regimen for DS-TB, they also suggested implementation at pilot sites with robust monitoring and evaluation systems, which could inform wider roll-out.

Prof Barry Kistnasamy, the lead of the TB in the Mines task team captivated the audience with an in-depth history of TB in the mines and outlined the disease burden in ex-mineworkers from 1980 to present day. He presented the various enhanced services to current & ex-mineworkers which included digitization of files and a tracking & tracing call centre. The presentation concluded with the work being undertaken by the Think Tank in submission for funding.

Ms Deanne Goldberg who forms part of the Prevention Task Team co-leads began her presentation with an overview of how prevention is the 4th pillar within the TB National Strategic Plan and is deemed as important as treatment. She went on to highlight the Task Team’s achievements over the recent year as well as the priorities for the year to come.

Dr Karen du Preez, as the chair of the Child & Adolescent Working Group covered the work they have undertaken for the year 2023/2024: the South African Child and Adolescent TB Guidelines. The working group lead mentioned that the guidelines are in the finalization phase and will be released as soon as they are signed off.

Highlights from the South African TB Conference By Tanyaradzwa Dube   

The South African TB Conference, held from 4-6 June 2024, at the Durban International Convention Centre, convened 1708 local and international delegates. The conference covered tracks on i. Basic/Clinical Sciences, Diagnostics, and Prevention; ii) TB Vaccines And Treatment Strategies; iii) Epidemiology, Health Systems, And Implementation; and iv) Human Rights, Civil Society, Advocacy, And TB Policies.

Read more here.

The South African TB Conference, held from 4-6 June 2024, at the Durban International Convention Centre, convened 1708 local and international delegates. The conference covered tracks on i. Basic/Clinical Sciences, Diagnostics, and Prevention; ii) TB Vaccines And Treatment Strategies; iii) Epidemiology, Health Systems, And Implementation; and iv) Human Rights, Civil Society, Advocacy, And TB Policies.

Attendees actively exchanged knowledge during oral and poster presentations, plenary sessions, and symposiums. Focus was placed on innovative diagnostic methods like combining TB screening with digital chest x-rays, Targeted Universal Test and Treat (TUTT), and LAM tests to enhance diagnostic accuracy, particularly for asymptomatic people. Emphasis was also placed on TB prevention using vaccines and TPT (3HP). Progress on the implementation of DR TB treatment game-changer BPaL was shared. Digital Adherence Technologies (DATs) like pill boxes may have the potential to improve support for TB treatment adherence. Post-TB lung rehabilitation through counselling and exercise was found to improve quality of life. The importance of person-centeredness and viewing TB holistically using the multifactorial approach, including social determinants of health, was highlighted.

During the conference, the South African National AIDS Council launched a human rights charter on HIV, TB, and STIs for Key and other Priority Populations. Also, the Department of Health launched #MyTBStory to combat TB stigma by sharing personal narratives from survivors, families, and healthcare workers. The National TB Think Tank highlighted the significant accomplishments of the past decade in utilising research and program implementation evidence to inform NTP’s policy, guidance, and programming. 

Overall, the conference proved to be enlightening and motivating, encouraging attendees to persist in the global fight against TB.

Dr. Lee-Ann Davids serves as the co-chair of the TB Think Tank Optimising Treatment Outcomes Task. She completed her undergraduate medical degree (MBChB) at the University of KwaZulu Natal and had initially considered pursuing a degree in Obstetrics and Gynaecology,

Read more here.

Dr. Lee-Ann Davids serves as the co-chair of the TB Think Tank Optimising Treatment Outcomes Task. She completed her undergraduate medical degree (MBChB) at the University of KwaZulu Natal and had initially considered pursuing a degree in Obstetrics and Gynaecology. After completing her community service and a postgraduate diploma in Obstetrics (Dip Obst—CMSA) in the same year, she pivoted towards a career in primary health care, having observed the immense strain that the HIV epidemic had placed on the public healthcare system. 

She spent roughly 7 years working in primary health care, both in the public and private sectors and the private emergency health care setting. During this time, she gained a wealth of experience and exposure to infectious diseases, particularly HIV, both in adults and children and all forms of Tuberculosis. She also completed a postgraduate diploma in HIV management (CMSA) and a Master’s Degree in Public Health from the University of the Western Cape during this time. Additionally, she led a subdistrict team aiming to improve HIV and TB outcomes in a high-burden area by improving health systems. She is part of the South African HIV Clinician’s Society Expert HIV GP network.

Lee-Ann’s research experience is predominantly in the field of Tuberculosis, though she has extensive experience working on COVID-19 vaccine trials. She has been involved in several drug-resistant and drug-susceptible TB treatment trials and, in particular, treatment-shortening trials. Notably, she was part of the NIX TB trial study team, which informed the BPaLM regimen. Lee-Ann currently occupies the position of Technical Lead in the Office of AIDS and TB Research at the South African Medical Research Council, where she can effectively integrate her knowledge and experience of HIV and TB medicine and research. She provides technical guidance for large implementation projects focused on improving HIV and TB outcomes. One of her main functions is designing and implementing innovative financing models to drive performance and improve health outcomes, particularly HIV and Tuberculosis. 

In her spare time, Lee-Ann loves to spend time outdoors. She embraces an active lifestyle by participating in long-distance running and would also like to travel more. 

Shobana Balasingam, Keertan Dheda, Sarah Fortune, Stephen B Gordon, Daniel Hoft,
James G Kublin, Colleen N Loynachan, Helen McShane, Ben Morton, Sujatha Nambiar, 
Nimisha Raj Sharma, Brian Robertson, Lewis K Schrager, Charlotte L Weller.
Review of the current TB human infection studies for use in accelerating TB vaccine
development: A meeting report. 
DOI: https://doi.org/10.1093/infdis/jiae238  
https://pubmed.ncbi.nlm.nih.gov/38709726/     

Keertan Dheda, Fuad Mirzayev, Daniela Maria CirilloZarir Udwadia, Kelly E Dooley, 
Kwok-Chiu Chang, Shaheed Vally Omar, Anja Reuter, Tahlia Perumal, 
C Robert Horsburgh Jr, Megan Murray, Christoph Lange. Multidrug-resistant tuberculosis.  
DOI: https://doi.org/10.1038/s41572-024-00504-2
https://pubmed.ncbi.nlm.nih.gov/38523140/   

Keertan Dheda, Giovanni Battista Migliori. New framework to define the spectrum
of tuberculosis  
DOI: https://doi.org/10.1016/s2213-2600(24)00085-7  
https://pubmed.ncbi.nlm.nih.gov/38527483/  

Emily Hall, Katherine Davis, Julius Ohrnberger, Michael Pickles, Simon Gregson,
Ranjeeta Thomas, James R. Hargreaves, Triantafyllos Pliakas, Justin Bwalya,
Rory Dunbar, Tila Mainga, Kwame Shanaube, Graeme Hoddinott, Virginia Bond,
Peter Bock,Helen Ayles, Anne L. Stangl, Deborah Donnell, Richard Hayes, Sarah Fidler,
Katharina Hauck & The HPTN 071 (PopART) study team. 
Associations between HIV stigma and health-related quality-of-life among people
living with HIV: cross-sectional analysis of data from HPTN 071 (PopART).   
DOI: https://doi.org/10.1038/s41598-024-63216-   
https://www.nature.com/articles/s41598-024-63216-3#citeas

Ilhan EI, Jola LN, van der Zalm MM, Bernstein M, Goussard P, Redfern A, 
Hesseling AC, Hoddinott G, McCollum ED, King C. Designing a Smartphone-Based
Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative
Analysis of Human-Centered Design Workshops With Health Care Workers  
DOI: https://doi.org/10.2196/54983
https://www.ncbi.nlm.nih.gov/pubmed/38825834   

Andrew Medina-Marino, Dana Bezuidenhout, Charl Bezuidenhout,
Shelley N Facente,Bernard Fourie, Sanghyuk S Shin, Adam Penn-Nicholson,
Grant Theron.   In-home TB Testing Using GeneXpert Edge is Acceptable, Feasible,
and Improves the Proportion of Symptomatic Household Contacts Tested for TB:
A Proof-of-Concept Study   
DOI: https://doi.org/10.1093/ofid/ofae279   
https://academic.oup.com/ofid/article/11/6/ofae279/7670785   
 

Susan E. Purchase ,Dillon T. Wademan, Nosibusiso L. Tshetu, Mohhadiah Rafique,
Graeme Hoddinott, James A. Seddon, H. Simon Schaaf, Anneke C. Hesseling.
Holistic acceptability of an adult levofloxacin formulation in children and adolescents on a
tuberculosis preventive treatment trial
DOI: https://doi.org/10.1371/journal.pgph.0003381  
Holistic acceptability of an adult levofloxacin formulation in
children and adolescents on a tuberculosis preventive treatment trial |
PLOS Global Public Health
 

Raad, R., Dixon, J., Gorsky, M, & Hoddinott, G.  Cycles of antibiotic use
and emergent antimicrobial resistance in the South African tuberculosis programme  
DOI: https://doi.org/10.1080/17441692.2024.2356623   
https://www.tandfonline.com/doi/full/10.1080/17441692.2024.2356623  

Philippa Randall, Aliasgar Esmail, Lindsay Wilson, Edson Makambwa, 
Anil Pooran, Michele Tomasicchio, Keertan Dheda, Mpiko Ntsekhe.
GeneXpert MTB/RIF Ultra vs Unstimulated Interferon γ (IRISA-TB)
for the Diagnosis of Tuberculous Pericarditis in a Tuberculosis-Endemic Setting.   
DOI: 10.1093/ofid/ofae021   
https://pubmed.ncbi.nlm.nih.gov/38510916/   

Alex John Scott, Mohammed Limbada, Tahlia Perumal, Shameem Jaumdally,  Andrea Kotze, 
Charnay van der Merwe, Maina Cheeba, Deborah Milimo,  Keelin Murphy, 
Bram van Ginneken, Mariana de Kock, Robin Mark Warren, Phindile Gina, Jeremi Swanepoel, 
Louié Kühn, Suzette Oelofse, Anil Pooran, Aliasgar Esmail, Helen Ayles, Keertan Dheda.
Integrating molecular and radiological screening tools during community-based
active case-finding for tuberculosis and COVID-19 in southern Africa.  
DOI: https://doi.org/10.1016/j.ijid.2024.107081  
https://pubmed.ncbi.nlm.nih.gov/38701914/   

Wademan, D.T.; Saule, Z.; Marthinus, A.1 ; Viljoen, L.; Nortier, E. ;  Hughes, J.; Courtney,
I.
; Palmer, M.; Garcia-Prats, A.J.; Hesseling, A.C.;  Hoddinott, G.  Acceptability of
clofazimine capsules in children and adolescents with rifampicin-resistant TB  
DOI: https://doi.org/10.5588/ijtld.23.0517   
https://www.ingentaconnect.com/content/iuatld/
ijtld/2024/00000028/00000005/art00008;jsessionid=628jmotdvtm5a.x-ic-live-03

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

We are hosting a special webinar edition on 19 July 2024 to discuss Urine TB tests for patients with HIV: an expanding diagnostics landscape, presented by Dr Bianca Sossen and Prof Graeme Meintjes. 

The recent webinar is listed below, with the link provided for your convenience
so you can follow up and catch up if you missed the session. 
TB meningitis in children – global estimates, local health systems and COVID-19.

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