Newsletter: Edition 9

Looking Ahead: 2025 with the TB Think Tank
As we reflect on the achievements of 2024, we celebrate milestones like the updated Child & Adolescent TB Guidelines and the 2nd  TB Modelling Symposium in eThekwini.Notably, strides in HIV-related TB care included a package of care for hospitalised adultswith possible TB, developed in collaboration  with the National Department of Health and the NHLS.Looking forward to 2025, major outputs are on the horizon: optimising digital chest X-rays for TB screening, advancing a national algorithm for community screenings, and developing a TB data dashboard through innovative evaluations. This year also brings leadership elections—an opportunity for members to shape the TB Think Tank’s future.Don’t miss the chance to submit your abstracts for the 12th South African AIDS Conference (closing date: 31 January 2025) and dive deeper into these updates. Click here to read the full forward of full TB Think Tank Co-Chair, Prof F Abdullah.

Read the full story here.

Compliments of the season to members of the TB Think Tank. We had many successes in 2024, including the release of the updated Child & Adolescent TB Guidelines and the hosting of the second TB Modelling Symposium in eThekwini. We also made strides in HIV-related TB with the development of a package of care for severely ill adults with HIV who are hospitalised with possible TB. As part of this project, the Optimising Treatment Outcomes Task Team has been working with the National Department of Health and the National Health Laboratory Service to add the standardised testing of urine by GeneXpert, where indicated, to the document version to be released in early 2025.

Foreword continued here. In 2025 we anticipate a number of major TB Think Tank outputs. These involve several projects already well underway, including the optimisation of digital chest X-ray to improve throughput and the finalisation of a standardised national algorithm for TB screening by digital chest X-ray in communities. The Data Systems and Innovation Task Team has also commissioned an evaluation of TB data access, quality, and usage to inform the future Electronic Medical Records system and is making strides to advance the development of a national TB dashboard.

 

2025 also marks an election year for the TB Think Tank, with several leadership positions opening in the second quarter. We encourage members to apply for these positions or nominate colleagues to take up the task. Stay tuned for more information on nominations in the coming months.

As we turn our attention to the first full year of implementation of the Vision 2028 strategy, many of its innovations will go live when the next round of three-year funding from the Global Fund hits the ground running in the second half of 2025.

Finally, we are happy to highlight that abstracts are now open for the 12th South African AIDS Conference which will take place from 23-26 June in eThekwini. The abstract closing date is 31 January 2025.

The Union World Conference on Lung Health 2024, held in Bali, brought together experts from 157 countries to showcase advancements in lung health through over 2,200 presentations. Key highlights included groundbreaking studies on drug-resistant TB, AI-powered diagnostic tools, and improved care for children with TB. Critical issues such as climate change’s impact on lung health, equitable access to care, and the power of global collaboration were also in the spotlight.

The conference emphasised innovative solutions and global partnerships to transform lung health outcomes and tackle pressing challenges. Click here to read the full article for detailed insights and
key takeaways.

Read the full story here.

Highlights from The Union World Conference on Lung Health 2024 

  1. TB Prevention and Treatment 

Among over 120 abstracts focused on drug-resistant TB, a standout study (Abstract #OA-01-1014) presented promising results from the first clinical trial dedicated exclusively to individuals with pre-extensively drug-resistant TB (pre-XDR-TB), offering hope for more effective interventions against drug resistance. 

  1. Artificial Intelligence in TB Detection 

Advancements in artificial intelligence (AI) and computer-aided detection (CAD) tools were discussed in nearly 90 abstracts related to diagnostic innovation. A featured study (Abstract #OA-02-2025) demonstrated AI’s utility in analysing chest X-rays to detect TB cases in resource-constrained settings across Africa, illustrating how technology can enhance early diagnosis and treatment. 

  1. Paediatric TB Management 

Research presented in over 50 abstracts focused on paediatric TB, addressing a critical gap in care for children. A notable study (Abstract #OA-03-3036) explored innovative diagnostic tools and treatment regimens tailored to this vulnerable group, paving the way for more effective paediatric TB care. 

 

Key Focus Areas 

  1. Climate Change and Lung Health 

With over 70 abstracts exploring the pressing issue of climate change’s impact on lung health, experts highlighted the increasing prevalence of respiratory diseases linked to environmental factors such as air pollution and extreme weather. One study (Abstract #OA-04-4047) emphasized integrating sustainable healthcare practices to mitigate these impacts. 

  1. Access to Care and Equity 

Addressing barriers to accessing quality TB and lung health services was a prominent focus, with more than 100 abstracts examining solutions. One study (Abstract #OA-05-5058) showcased successful community-based models that improved treatment adherence and reduced stigma in underserved populations, offering scalable approaches for equitable care delivery. 

  1. Global Collaboration 

The conference emphasized the importance of partnerships across disciplines and borders. Networking sessions and panels drew insights from nearly 50 abstracts that shared best practices for scaling innovative interventions globally. A highlighted session (Abstract #OA-06-6069) provided actionable strategies for fostering effective collaborations to combat lung diseases. 

Conclusion 

The Union World Conference on Lung Health 2024 served as a powerful platform for advancing knowledge and driving action in lung health. The event underscored the urgency of innovative solutions and strengthened global alliances in the fight against lung diseases. 

As the conference concluded, participants departed with renewed determination to accelerate progress, ensuring that no one is left behind in the pursuit of healthier lungs and healthier lives. Find the link to the conference abstracts here

Save the date: The next Union World Conference on Lung Health will take place in Copenhagen from 18-22 November 2025. 

In September 2024, the South African National TB Programme unveiled an updated guideline for the management of drug-susceptible tuberculosis (TB) in children and adolescents. This initiative stemmed from a collaborative effort between the TB Think Tank Child, Adolescent, and Maternal TB working group and the National Department of Health, with financial backing from the South African Medical Research Council. The updated guidelines are aligned with the most recent, evidence-based recommendations from the World Health Organization (WHO) regarding the management of paediatric TB, as outlined in the 2022 guidelines, while being contextualized for the South African healthcare landscape.

Read the full story here.

Recognizing the significant treatment gap for TB among younger populations, a pivotal addition in this update is the implementation of a clinical decision algorithm designed to streamline the diagnostic process for TB in children. This algorithm is tailored for use in settings with limited access to specialized diagnostic tools, thereby enabling timely diagnosis and initiation of treatment. The guidelines further offer practical criteria to assist clinicians in determining the eligibility of children and adolescents for shortened treatment regimens in non-severe drug-susceptible TB cases. Comprehensive guidance is provided throughout the continuum of care, addressing critical steps in managing TB in younger patients.

Provinces are currently gearing up for the implementation of these guidelines in 2025, with ongoing support from the Think Tank’s Child, Adolescent, and Maternal TB working group. The Think Tank extends gratitude to all members for their invaluable contributions during the development of these guidelines. It is anticipated that this evidence-based, user-friendly framework will empower healthcare professionals in South Africa across all levels of care to effectively manage TB in children and adolescents. Click here for more on the guidelines. 

Dr Marian Loveday, a dedicated public health researcher at the South African Medical Research Council, has been instrumental in shaping TB policies in South Africa and globally. Her work in health systems, implementation research, and clinical studies has informed national strategies, including decentralised RR-TB care and WHO guidelines on ambulatory RR-TB treatment.

Dr Loveday’s research spans maternal and infant health, exploring outcomes of RR-TB treatment during pregnancy and contributing to the 2022 WHO RR-TB guidelines. She currently leads an NIH-funded study investigating RR-TB treatment adherence and drug exposure in pregnant and breastfeeding women.

As a founding member of the TB Think Tank, she has co-led task teams focused on improving treatment outcomes for vulnerable groups, including pregnant women. Outside of her impactful work, Marian enjoys mountain biking, running, singing, and reading.

 

Read the full story here.

Marian joined the South African Medical Research Council (SAMRC) in 2007 after working for over 20 years at different levels of the public health system. She is a public health researcher with expertise in health systems, implementation and clinical research in tuberculosis, rifampicin-resistant tuberculosis (RR-TB) and HIV.

Using implementation research frameworks and primary quantitative and qualitative research methods she has worked with national policy makers in evaluating National TB Control Programme strategies and with clinicians and health care workers in evaluating local interventions. Her research has national and international impact. It directly informed national policy for decentralised RR-TB care and contributed to the WHO supporting ambulatory RR-TB treatment in their 2011 guidelines. More recently, she has  been involved in a cohort study investigating maternal treatment, pregnancy and infant outcomes in women exposed to RR-TB treatment during pregnancy. The outcomes from the first 108 patients informed the WHO 2022 RR-TB guidelines on the management of pregnant women. In 2018, she initiated a collaboration with colleagues from the University of Cape Town (UCT), and in a sub-study have started to explore plasma concentrations of second-line TB drugs in these women and their infants. She has also led several qualitative studies exploring factors contributing to poor adherence to TB treatment and ART.

 Marian currently holds specialist scientist research position at the South African Medical Research Council.  She has presented at multiple national and international forums, collaborated with national and international colleagues, and published over 70 articles in peer-reviewed journals (a full list of her publications can be found at https://www.ncbi.nlm.nih.gov/myncbi/1BeMmrqNDVyQm7/bibliography/public/). 

She is currently the principal investigator of an NIH R01 that aims to compare adherence to RR-TB treatment in pregnant and non-pregnant women of childbearing age, determine the effect of pregnancy on exposure to bedaquiline, delamanid, linezolid, and levofloxacin (BDL/L), and determine concentrations of these drugs in the breastmilk and plasma of breastfed infants. 

 

Marian has been part of the TB Think Tank since its inception and has led the Treatment Outcomes Task Team for TB Think Tank 2 and 3. She is currently co-leading one of the Treatment Outcomes Task Team activities with Jenny Hughes from the Child and Adolescent Task Team, which aims to document treatment outcomes in pregnant women treated with new regimens, such as the BDL/L regimen.

 

In her spare time, Marian rides a mountain bike (and falls off sometimes), runs, sings in a choir, and reads as much as she can. 

This multidisciplinary Symposium draws together leaders in the field of post-tuberculosis outcomes, including TB survivors, clinicians and TB program staff, researchers, and stakeholders.
State of the art presentations and workshops spanning the breadth of life and outcomes after tuberculosis will be held, with opportunities to establish priority knowledge gaps in the field and consensus to move the post-tuberculosis agenda forward. More Information. 

This pivotal event will bring together key leaders, researchers, implementing partners, academics and advocates from around the world to address the evolving landscape of HIV care and prevention. Join us as we explore the latest in HIV/AIDS research, policy, and practice. Click here for more information.

Don’t miss our upcoming webinar series, scheduled for every third Monday of the month, unless otherwise noted! Mark your calendar for our webinar series happening on February 17th as we dive into Evaluating the influence of the TB THINK TANK on South African policy, featuring insights from the TB-CHAMP trial.

If you’ve missed any recent sessions, don’t worry! Catch up on key discussions from our past webinars using the links below. Join the conversation, stay informed, and be part of the movement driving TB innovation forward!

Anthony MG, Van Niekerk M, Hesseling AC, Hoddinott G, van der Zalm MM. An item bank to measure health-related quality of life among young children0-5-years-old) affected by respiratory illnesses – expert stakeholders and end-Users from the Western Cape,
South Africa.
DOI:  https://doi.org/10.1186/s12955-024-02308-0  https://hqlo.biomedcentral.com/articles/10.1186/s12955-024-02308-0 

 
Palmer M, van der Zalm MM, Schaaf HS, Goussard P, Morrison J, Seddon JA,
Hissar S, Baskaran D, Kinikar A, Raichur P, Wobudeya E, Chabala C, Lebeau K, Crook AM, Turkova A, Gibb D, Hesseling AC. 
Approaches and processes for paediatric chest X-ray classification used in the SHINE TB treatment-shortening trial. 
DOI: https://doi.org/10.5588/ijtld.24.0076 
https://pubmed.ncbi.nlm.nih.gov/39468018/ 
 
Brooks JT, Solans BP, Béranger A, Schaaf HS, van der Laan L, Sharma S, Furin
J, Draper HR, Hesseling AC, Garcia-Prats AJ, Savic RM. Linezolid
Pharmacokinetic-Anemia Modeling in Children with Rifampicin-Resistant
Tuberculosis. 
DOI: https://doi.org/10.1093/cid/ciae497
https://pubmed.ncbi.nlm.nih.gov/39422476/ 
 
Jennings K, Lembani M, Hesseling AC, Mbula N, Mohr-Holland E, Mudaly V, Smith M, Osman M, Meehan SA.  A decline in tuberculosis diagnosis, treatment initiation and success during the COVID-19 pandemic, using routine health data in Cape Town, South Africa. 
DOI: https://doi.org/10.1371/journal.pone.0310383 
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0310383 
 
Seddon JA, McQuaid CF, Mafirakureva N, Hesseling AC, Fox GJ, Dodd PJ.
Household contact management and preventive treatment for drug-resistant
tuberculosis. 
DOI: https://doi.org/10.1016/S2214-109X(24)00265-1  
 
 
Sossen B, Székely R, Mukoka M, Muyoyeta M, Nakabugo E, Hella J, Van Nguyen H, Ubolyam S, Erkosar B, Vermeulen M, Centner CM, Nyangu S, Sanjase N, Sasamalo M, Dinh HT, Ngo TA, Manosuthi W, Jirajariyavej S, Nguyen NV, Avihingsanon A, Kerkhoff AD, Denkinger CM, Reither K, Nakiyingi L, MacPherson P, Meintjes G, Ruhwald M; Fuji LAM Study Consortium. 
Urine-Xpert Ultra for the diagnosis of tuberculosis in people living with HIV: a prospective, multicentre, diagnostic accuracy study. Lancet Glob Health. 2024 Dec;12(12):e2024-2034. 
DOI: https://doi.org/10.1016/S2214-109X(24)00357-7  
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00357-7/fulltext 
 
Isabel Foster, Amanda Biewer, Nosivuyile Vanqa, Goodman Makanda, Phumeza Tisile, Sally E. Hayward, Dillon T. Wademan, Michaile G. Anthony, Rachel Mbuyamba, Michelle Galloway, Wieda Human, Helene-Mari van der Westhuizen, Jon S. Friedland, Andrew Medina-Marino, Ingrid Schoeman, Graeme Hoddinott & Ruvandhi R. Nathavitharana 
“This is an illness. No one is supposed to be treated badly”: community-based stigma assessments in South Africa to inform tuberculosis stigma intervention design. BMC Global Public Health
DOI: https://doi.org/10.1186/s44263-024-00070-5 
https://bmcglobalpublichealth.biomedcentral.com/articles/10.1186/s44263-024-00070-5#citeas 
 
Helene-Mari van der Westhuizen, Janet Giddy, Renier Coetzee, Goodman Makanda, Phumeza Tisile, Michelle Galloway, Siyavuya Bunyula, Ingrid Schoeman & Ruvandhi R. Nathavitharana 
Strengthening accountability for tuberculosis policy implementation in South Africa: perspectives from policymakers, civil society, and communities
DOI: https://doi.org/10.1186/s44263-024-00077-y 
https://bmcglobalpublichealth.biomedcentral.com/articles/10.1186/s44263-024-00077-y#citeas 
 
Helene-Mari van der Westhuizen, Rodney Ehrlich, Ncumisa Somdyala, Trisha Greenhalgh, Sarah Tonkin-Crine & Chris C. Butler
Stigma relating to tuberculosis infection prevention and control implementation in rural health facilities in South Africa — a qualitative study outlining opportunities for mitigation
DOI: https://doi.org/10.1186/s44263-024-00097-8
https://bmcglobalpublichealth.biomedcentral.com/articles/10.1186/s44263-024-00097-8#citeas

MG Anthony, LS Johnson , M van Niekerk , A Mfwaze , B Bavuma , AC Hesseling , G Hoddinott ,MM van der Zalm 
Health-related quality of life in children with presumptive TB 
DOI: https://doi.org/10.5588/ijtldopen.24.0355 
https://pmc.ncbi.nlm.nih.gov/articles/PMC11558787/
 
M Galvin, Evans D, Moolla A, L Coetzee, V Maluleke, P Leshabana, J Miot
Adopting sustainable innovations for remote access to TB and HIV Care in South Africa. 
DOI: https://doi.org/10.1371/journal.pgph.0003792 
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0003792 
 
Denise Evans, Kamban Hirasen, Clive Ramushu, Lawrence Long, Edina Sinanovic, Francesca Conradie, Pauline Howell, Xavier Padinalam, Hannetjie Ferreira, Ebrahim Variaiva, Shakira Rajaram, Aastha Gupta, Sandeep Juneja, Norbert Ndjeka
Patient and provider costs of the new BPaL regimen for drug-resistant tuberculosis treatment in South Africa: An economic evaluation
DOI: https://doi.org/10.1371/journal.pone.0309034 
https://pubmed.ncbi.nlm.nih.gov/39432463/ 
 
Farzana Sathar, Salome Charalambous, Kavindhran Velen, Katherine Fielding, Andrea Rachow, Olena Ivanova, Mohammed S Rassool, Julieth Lalashowi, Olumuyiwa Owolabi, Pedroso Nhassengo, Violet Chihota, Denise Evans
DOI:https://doi.org/10.1136/bmjph-2024-001002 
https://bmjpublichealth.bmj.com/content/2/2/e001002

Brooke E Nichols, Alexandra de Nooy, Naseem Cassim, Lucia Hans, Manuel Pedro da Silva, Kamy Chetty, Kyra H Grantz, Alvin X Han, Andrew N Phillips, Lise Jamieson, Lesley E Scott, Wendy S Stevens
Ten-year health impact, economic impact and return on investment of the South African molecular diagnostics programme for HIV, tuberculosis and SARS-CoV-2
DOI: https://doi.org/10.1136/bmjgh-2024-015830 
https://gh.bmj.com/content/9/12/e015830

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