Rapporteur Session 2017 Abstract submissions and acceptance 2008

Rapporteur Session 2017

Abstract submissions and acceptance, 2008 -2017 50. 1% accepted

Session type Abstracts submitted Oral abstract presentations Short oral abstract presentations Poster presentations Abstracts accepted for presentation at the conference 128 in 19 sessions 1681 187 in 18 sessions 542 in 57 sessions

Introduction to the Coordinating Committee of Scientific Activities, sub-Group 2 Name Stacie C. Stender James Seddon Mercy Annapoorni Keren Middelkoop Omara Dogar Wendy Wobeser Alaine Umubyeyi Nyaruhirira Linette Mc. Elroy Alejandro Perera/Simeon Cadmus Section / sub-Section Adult Child and Lung Health Civil Society / Encuentro HIV Tobacco Control Tuberculosis Bacteriology & Immunology Nurses and Allied Professionals Zoonotic TB Position Chair Programme Secretary UCAP Representative Programme Secretary Programme Secretary

A big THANK YOU to Session Chairs who contributed to the report I. D. Rusen Bradley Wagner Dean Schraufnagel Janet Ginnard Lisa True Quan Gan Bruce Devasena Jean-William Aakshi Kalra Lynette Mabote Riitta Dlodlo Struminger Gnanashanmugam Fitting C. Robert Manuel Sandoval Abdulai Sesay Einar Heldal Jeffrey Hafkin Robert Makombe Horsburgh, Jr. Díaz Adrie Bekker Carol Nawina Evaline Kibuchi Jonathan Daniels Mark Hatherill Ronald Ncube Martin Ajay Kumar Caterina Casalini Frederick Quinn Karen Du Preez Shitong Huan Castellanos Alaine Umubyeyi Catharina Gan Quan Katharina Kranzer Michael Kimerling Silvia Kelbert Nyaruhirira Boehme Alberto Garcia. Charles Ssonko Harry Hausler Kathleen England Molly Franke Stacie Stender Basteiro Chawangwa Amrita Daftary Ignacio Monedero Keren Middelkoop Netty Kamp Tefera Agizew Modongo Kevin Nii Nortey Hanson Anete Trajman Chris Bullen Ingrid Oxley Thomas Matte Schwartzman -Nortey Anne Jones OAM Chris Gilpin Jaime Robledo Laura Olbrich Paolo Denti Tom Boyles Claudia Anthony Harries James Johnston Lin Yan Patrick Phillips Vivian Cox Denkinger D'Arcy Austin Obiefuna James Seddon Linette Mc. Elroy Paul Nunn Wendy Wobeser Richardson Haileyesus Wim Vandevelde Xiaolin Wei Geraint Davies Nicola Zetola Amy Bloom Getahun

Student session, Friday 16: 00 -17: 30 • 9 presenters from 8 countries • Topics from air quality and TB to zoonotic TB

A to Z in 50 minutes • • Adult and Child Lung Health Bacteriology and Immunology Civil Society & Community Common HIV Nurses and Allied Professionals Tobacco Control Tuberculosis Zoonotic Tuberculosis

Adult and Child Lung Health

Perception of asthma control among in an out-patient clinic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia - PD-725 -13 Tewodros Haile Gebremariam Physician assessment of asthma control Patient perception Good control of asthma control Poor control Well/partly controlled Uncontrolled 109 42 29 2

Accelerating access to Quality Paediatric TB care though improved diagnostic strategies – SOA-358 -12 Neeraj Raizada Induced Sputum/Sputum; 19178; 41% 4 cities covering 14. 3 Mn population Linkage with FOC Rx under RNTCP Rapid reporting (within 24 hours) via SMS and email Paediatric TB Project Both pulmonary & EPTB samples subjected to Xpert testing CSF; 3171; 7% Pus/FNAC/Lym ph Node; 1327; 3% Pericardial Fluid; 74; 0% Hub & Spoke model: FOC testing through One High throughput Xpert lab/city BAL; 1193; 2% Pleural Fluid; 1498; 3% Ascitic Fluid; 304; 1% Rapid specimen transportatio n linkages with public & private health facilities Others; 431; 1% Gastric Aspirate/ Lavage; 19703; 42%

Incidence of latent tuberculosis infection and tuberculosis disease in paediatric contacts of patients with drug-resistant tuberculosis patients in Armenia - SOA-360 -12 Helena Huerga IDENTIFICATION OF THE CONTACTS Latent TB Infection Prevalence baseline % (95%CI) Incidence /100 personyears Prevalence baseline % (95%CI) Incidence Overall 55. 2 (46. 963. 5) 17. 4 (10. 828. 1) 1. 4 (0. 25. 5) 0 0 -4 years 44. 6 (31. 258. 1) 16. 1 (8. 032. 1) 3. 6 (0. 08. 6) 0 5 -14 years 62. 1 (51. 772. 5) 18. 9 (9. 836. 3) 0 0 Initial assessment Diseased Infected (LTBI) Non. Infected Treatment Follow up for 24 months (every 3 -6 months) Remains Non-Infected Remains Infected Becomes Diseased TB disease

Use of Monocyte-to-Lymphocyte Ratio to Diagnose Tuberculosis in HIV-infected Children – SOA-359 -12 Rewa Choudhary Sensitivity Specificity Optimal MLR cutoff: 0. 38 Sensitivity: 79% Specificity: 75% N = 179 0. 5 0. 4 0. 3 0. 2 0. 1 0 GEE adjusted for CD 4 % and time: p = 0. 02 Confirmed TB, 0. 12 * 0 4 8 p = 0. 23 vs Unlikely TB, 0. 10 12 16 Visit Week 20 24

Recommended age of BCG vaccination: Modelling the impact on global paediatric TB mortality – OA 2911 -13 Partho Roy

Bacteriology and Immunology

IMMUNOLOGY AND HOST GENETICS Biomarkers Database- Bm 2 Dx • FIND the tuberculosis biomarker database • Dedicated to TB biomarker discovery, validation and confirmation – launch in Jan 2018 • To help test developers and research groups and promote accelerated translation into clinically useful tools (OA-206) Database – systematic review • A systematic review with full data extraction from 375 studies. This is likely to be the largest collection of data of its kind (PD-1009 -14) More studies on Tuberculosis genetics immunology and serological markers in Poster sessions and Short Oral Sessions

IMMUNOLOGY AND HOST GENETICS Helminth infection is associated with an increased rate of TB progression and decreased TB immunity • Study exploring mechanism: Helminths cause persistent change in gene expression and function causing disturbance of immunological function (epigenetically-mediated TB immune perturbations) (SOA-322 -12) Tuberculous lymphadenitis: extreme high rate in south-west Ethiopia • High diversity of MTBc genotypes responsible for it • Zoonotic transmission of M. bovis infection has been excluded as a major factor in TB Lymph Node. (SOA-327 -12) • Risk of hepatotoxicity is related to patient´s genotypic characteristics

RESISTANCE TO NEW AND OLD DRUGS WITH NEW MUTATIONS Bedaquiline and clofazimine resistance in MDR- and XDR-TB patients. • Examined mutations conferring resistance to BDQ and/or CFZ which is highly relevant to DR-TB care (SOA-300 -12 ) Discordant results in phenotypic and genotypic resistance • Are we missing INH resistance? Another gen mutation (kat. G Arg 463 Leu) was shown to be responsible for INH resistance in 14% (14/100) of our otherwise negative MDR-TB (SOA-301 -12) • Genotypic methods (LPA) are not able to reliable predict Low Level of R-INH (SOA-215) Short Oral Abstract session (SOA)

TB laboratory service implementation PD-831 -13 - Impact of Xpert® MTB/RIF on treatment initiation and outcomes of TB and MDR-TB patients in Vladimir TB Dispensary, Russia, 2012 Time-to-treatment comparison pre- and post-Xpert groups • RIF-susceptible cases: No difference • RIF-resistant cases: considerable difference • Treatment outcome: no difference • Impact on transmission: very likely considerable

IMPLEMENTATION CHALLENGES GENEXPERT Poster discussion sessions PD-827 -835 -13 • Significant challenges persisted with the machines – Need of local Gene. Xpert repair center for in-service provision and monitoring of instruments, – Need for spare parts and spare modules • Power interruption. • Recurrent stock-outs • Inconsistent internet connectivity • Customs clearance Botswana, Ethiopia, Indonesia, Malawi, Namibia, Nigeria, Tajikistan, Tanzania, Uzbekistan, Vietnam, Bangladesh, Nigeri Uganda. Poster discussion sessions PD-836 -844 -13 SOLUTIONS • Quarterly onsite Continuous Quality Improvement (CQI) training • Using Gx. Alert Report for troubleshooting of problems • Performance-based remuneration scheme for Xpert testing , however, there's need for close supervision to ensure quality • Awareness creation among clinicians on the testing algorithm

MORE APPLICATIONS OF RAPID MOLECULAR TESTS • Finding more patients by double testing with Gene. Xpert but at high financial costs • Incremental yield, especially for smear-negative specimens • PTB : US$17 vs US$353 EPTB: US$26 vs US$220 (PD-661 -12). • Geno Type MTBDRplus v. 2. 0 and Gene. Xpert as a rapid diagnostics tool in smear-negative pulmonary tuberculosis (SOA-304, SOA-455) • Using Gene. Xpert for testing of urinary samples (PD-993 -14) • Potential tool for monitoring transmission of rifampicin-resistant tuberculosis • Used pool of test results of Rapid diagnostic tests (Xpert, Hain, Nipro) • Sufficient discriminate power to distinguish mutant sequence profiles (PD-99114) • New: Xpert® MTB/RIF Ultra cartridge: increased sensitivity –reduced specificity • Introduction of Xpert Ultra requires consideration of consequence of new test with reduced specificity in local epidemiological setting before a decision to implementation is made (OA-201 -14)

SOLUTION TO OTHER LABORATORY IMPLEMENTATION CHALLENGES Poster discussion session PD-836 - 844 Sputum and transport improvement • Testing of OMNIgene® SPUTUM: a new reagent for sample preservation. • Innovation and new way of non-invasive sampling for molecular diagnosis of TB sample collection with can be evaluated particularly for people who can have no sputum like children (SOA-460 -14) E-Lab Register • Digitalisation of microscopy centres in Andhra Pradesh (SOA-453 -14) Linking private pharmacists to public/PPM centers • Private pharmacists refer and provide treatment after diagnosis • Qualitative data findings from patients revealed that they found it very convenient to receive DOT from pharmacists (PD-651 -12)

Civil Society & Encuentro

Accelerating TB Elimination: governance, architecture for urban health care. Encuentro. Symposium (13 October) Objective: To discuss some of the initiatives undertaken in context with social mobilization, community ownership and involvement of partners for Universal Access to TB care in India. Results: They have proved TB Elimination programmes can be done by mobilizing resources from within.

National Strategic Plan 2017 -25 Thrust areas

Collaborative model for Resource Generation India

PD-860 -13 Political leadership in TB control - Learning from the Zimbabwe experience OBJECTIVE: Drawing Political Will from Zimbabwe Policy Makers and Parliamentarians to support TB and advocate for increased domestic funding. INTERVENTION: Dialogue with 30 Parliamentarian Portfolio Committee; Sensitizing them on the prevailing gaps. RESULTS : # In 2015, 137 (33%) out of 350 signed the Barcelona Declaration as a commitment to put TB on the National Political Agenda. # In 2016, Establishment of a National TB Caucus resulted in Zimbabawe elected to Co- Chair the African Regional Caucus. # In 2017, 13 MP’s took public TB Screening during the World TB Day. # They have pledged to engage the Ministry of Finance to increase Allocation for TB. # Raise Awareness and encourage TB Screening in their Constituencies.

"FREEZE MOB" by GCTA for inclusion of TBaffected communities for a successful HLM

Help us get “Louder Than TB”

HIV

Patient education versus clinician mentoring for increasing IPT uptake C Hanrahan, B Jarrett, K Motlhaoleng, J Golub, N Martinson Week 1 • • • Lecture on National IPT Guidelines Reinforcement with role playing Group discussion of barriers and challenges Weeks 2 -3 • Peer-to-peer mentoring (Understand clinic setting and support nurses as they prescribe IPT) Week 4 • • Group development of an action plan by choosing actions to address key barriers discussed in week 1 Elect an “IPT Champion” from among staff Months 2 -4 • • Support action plan execution Continued mentoring Month 5 • Support via text message only

Results: IPT uptake • Proportion of HIV positive patients/month with IPT prescription Intervention: Patient arm: 127/3404, 3. 7% (3. 1 -4. 4%) Clinician arm: 218/3279, 6. 6% (5. 8 -7. 6%) Pre. Intervention OA-116 -12 Post-Intervention

Pediatric isoniazid preventative therapy in HIVpositive patients …in Swaziland A Rosen-Gooding, A Kay, N Mthethwa, S Dlamini, K Ngo, A Mandalakas Are certain pediatric patients less likely to receive IPT? (N = 1778) IPT (N = 1036) No IPT (N=742) Overall Age Prior TB Treatment CD 4 ARV Adherence (N = 1554) SOA-397 -13 0 -4 5 -14 15 -17 No Yes 0 -199 200 -499 500 -999 >999 < 95% 95 -105 >105% 58% 235 702 99 823 213 37 106 427 456 25 807 40 42% 76 501 165 510 232 27 97 302 316 39 604 37 a. OR (CI) 3. 7 (2. 5 -5. 5) ref 0. 5 (0. 3 -0. 6) ref 0. 6 (0. 4 -0. 8) 3. 6 (1. 7 -7. 4) 1. 9 (1. 2 -2. 9) 0. 7 (0. 9 -1. 5) ref 0. 5 (0. 3 -0. 9) ref 1. 2 (0. 6 -2. 2)

What is the effect of IPT on ARV adherence? ARV adherence before vs. during IPT (N = 586) ART adherence (pill count) decreased by 0. 5% (p=0. 001) during IPT as compared to the preceding year in the cohort as a whole ARV adherence before vs. during IPT (N = 23) Those with <95% ART adherence before IPT initiation increased ART adherence by 4. 4% (p<0. 001) during IPT SOA-397 -13

High HIV/TB burden but suboptimal HIV services uptake for pediatric TB patients…. . in Tanzania B Ngeno, W Kohi, B Ngowi, S Pals, G Munuo, G Ruhago, C Emerson, S Modi PD-675 -13

Effect of HIV Status on Risk of AG-induced Hearing Loss Author Year Country N AG Type 95% CI Weight 151 Ak, Km, St, Cp 1. 73 1. 25 2. 39 11. 01 93 Ak, St, Cp 1. 50 0. 84 2. 68 3. 05 91 Km 0. 81 0. 40 1. 64 3. 62 57 Ak, Km, St, Cp 1. 34 0. 50 3. 61 1. 97 Modongo et al. 16 2014 Botswana 437 Ak 1. 13 0. 96 1. 33 40. 64 Modongo et al. 17 2015 Botswana 28 Ak 0. 76 0. 29 2. 02 2. 18 Harris et al. 12 2012 Seddon et al. 13 2013 Brust et al. 14 2013 Sagwa et al. 15 2013 South Africa RR Namibia Sagwa et al. 18 2015 Namibia 342 Ak, Km 1. 18 0. 99 1. 40 33. 75 Kelly et al. 19 2016 South Africa 121 N/S 1. 58 0. 78 3. 20 3. 78 M-H pooled RR OA-119 -12 1. 22 1. 10 1. 36 100. 00 Hong, H. , Budhathoki, C. , Farley, J. E. Forest Plot 1. 22 3. 61

Pulmonary function before and after ART initiation in South African adults with pulmonary TB and HIV S Auld, P Maenetje, S Ravimohan, N Ratsela, R Wallis, H Kornfeld, G Churchyard, GR Bisson Changes in pulmonary function and symptoms • FEV 1 – Mixed changes over time – 49% with initial decline ≥ 100 ml – No association between declines in FEV 1 and CD 4 count, VL, culture time to positivity, CAT score • COPD Assessment Tool (CAT) – 32% with initial decline ≥ 2 points – 21% with initial increase ≥ 2 points SOA-400 -13

Feasibility and yield of routine bi-directional screening for TB and DM in primary health settings in Zimbabwe N Degner, J Wang, J Golub, P Karakousis TB patients screened for DM: Apr 2016 – Mar 2017 *Over 40% of al TB patients had an elevated RBS. This may represent transient hyperglycaemia associated with active TB ** Significant losses in the screening cascade OA-2885 -13

DM patients screened for TB: Apr 2016 – Mar 2017 ** Not all DM Late Breaker patients presumed to have active TB had sputum collected for diagnosis OA-2885 -13

Diabetes increases mortality during tuberculosis treatment and metformin use reverses this effect N Degner, J Wang, J Golub, P Karakousis p<0. 001 OA-2971 -13

Figure 2. Time to Mortality Among Diabetics During Tuberculosis Treatment (n=634). Intention-to-Treat Analysis Log-Rank χ2 <0. 001 n=418 n=216 46 patients with CKD Stage 3 b or higher were excluded from the study due to concerns for confounding. Effect not due to blood glucose control (Metformin A 1 c 8. 9 v Non-met A 1 c 8. 2, p=0. 02) OA-2971 -13

Nurses and Allied Professionals

Symposium 06: Elimination of TB in indigenous people – developing positive relationships between community and TB programmes • M King (Canada) • J M H Sarmiento & L Velasquez (Columbia) • M Castellanos (Mexico) • S del Pino (Mexico)

OA-210 -14: Training and involvement of ‘Slum Community Volunteers’ in urban TB control: intervention to overcome slum TB in West Bengal P Bhattacharyya (India)

SOA-311 -12: Evaluating the effectiveness of TB care providers on treatment outcomes in Afghanistan: a crosssectional study G Q Qader, S M Sayedi, M K Ayubi, M H Akhgar, A B Maseed, N A Zahid

Symposium 45: Innovative approaches to increase the performance of your health workforce • Mobile phones to build the capacity of community healthcare workers in Kenya – C Wanyonyi (Kenya) • Photo. Voices to give a voice to TB patients and make TB care more patient-centred – N Kamp (Netherlands)

Symposium 14: Adapting an innovative approach to TB workforce development: implementing the ECHO telementoring model in a variety of contexts • M Kamene Kimenye (Kenya) • N Singla (India) • D Fortune (USA) • K Moser (USA): Mexico-US Binational ECHO Project • G Kuchukhidze (Georgia) • D P Forno (Guatemala) Extension for Community Healthcare Outcomes

Symposium 57: Nursing interventions for support of patients with multi-drug resistant TB • An essential care package for drug-resistant TB – D Richardson (USA) • Pilot job aide to assist nurses in assessing and addressing side effects among patients on treatment for DRTB – A Raftery (USA)

Currently being pilot tested - Goal is to complete by World TB Day 2018 Want to field test? Email: annraftery@ucsf. edu

Tobacco Control

Global perspective PD-622 -12 Reduction in prevalence of tobacco use in Punjab, India • Systems strengthening: – Implementation of Cigarette and Other Tobacco Product Act (COTPA) 2003 – Ban on flavoured e. cigs, chewing tobacco products and hookah bars – Effective enforcement via state and district level task force committees • Comparison of National Family Health Survey (2005/6 and 2015/16) • Decline in tobacco use: – Men (33. 8% to 19. 2%) – Women (0. 8% to 0. 1%)

Using media campaigns to raise awareness PD-754 -13 Deglamourizing depiction of tobacco on screen by real images of tobacco victims • #Reel vs Real campaign (Jan-Feb 2017): – Raise awareness of tobacco free film/TV rules – Combat positive portrayal of tobacco use in films/TV • Coverage and reactions: – 122 leading news publication – 53000 reactions on Facebook and twitter

Multi-country experiences in tobacco industry interference OA-179 -13 Tobacco Excise as Innovative Funding for Universal Health Care (UHC) deficit in Indonesia • Expenditure on UHC=> tobacco tax revenue • Need for additional cigarette tax dedicated to cover UHC OA-196 -13 Tracking Investments by financial institutions in tobacco companies • Socially Responsible Investment (SRI) precludes not investing in tobacco industry • Globally, € 4. 1 trillion in assets and investments are managed through SRI funds. • 42 of the top 50 global banks invest in tobacco companies (March 2016). • Tracking investments can influence mitigating the proliferation of tobacco industry in the future.

SOA-448 -14 Tobacco cessation an integration in TB control Tobacco cessation counselling can improve TB treatment adherence among TB patients who smoke-Karnataka, India Tobacco use and tuberculosis syndemic Tobacco cessation support (5 As and 5 Rs) provided to TB patients

Tuberculosis

Vulnerable populations OA -144 -12 Integration of social support into NTP in Nicaragua • 91 vs. 86% treatment success in those with social support • Income generating activities continued beyond treatment – 73% at one year

Mental Health MSF HIV/TB Clinic in Mumbai • 226 DR-TB patients 40% with HIV – 1/3 required psychiatric consultation • Depression, anxiety and psychosis – Rarely secondary to drug (cycloserine associated psychosis) OA-167 -13

Infection Control Nigeria FAST strategy – tertiary care facility OA-173 -13 OA-168 -13 OA-171 -13 – Cough monitors and Gene. Xpert • 66. 7% increase TB cases detected Georgia FAST strategy – Pilot in 2 general hospitals • 188/1565 (12%) unsuspected cases tested diagnosed with TB – 2% with rifampin resistance • FAST rolled out country wide Ethiopia Infection Control Strategy for Outpatients – Improved administrative measures • Designated focal point, IC plan, staff TB screening, • tracking system of possible cases, open windows, etc.

LTBI PD-767 -13 SOA-430 -13 PD-761 -13 • Indonesia – Care cascade – 369 contacts <50% evaluated and 3% initiate therapy • Adult primary care clinics demonstrate major fall off in cascade - Denver – 9, 397/32, 452 eligible tested • Surveillance of SAE with 3 HP Taiwan – 2652 initiated 3 HP • 29(1%) possible SAE • Flu-like illness during 1 -4 dose

OA-2950 -13 High dose rifampicin • Pan. ACEA MAMS-TB study • High dose rifampicin • 2100 mg dose showed better activity – reduced time to culture conversion – Estimated rates of hepatotoxicity variable

OA-137 -12 Treatment – novel adherence measure • Wirelessly observed therapy (WOT) – FDA cleared device with edible ingestion sensor, external wearable patch and paired mobile device – RCT of 75 subjects vs. DOT of Rifamate • WOT confirmed 50% more doses than DOT

Epidemiology - MDR PD-503 -12 OA-3002 -13 • Rwanda – decline in MDR with programmatic rapid molecular tests – MDR 3. 9% to 1. 4% (2005 to 2015) – 822 MDR registered – median delay from first contact to MDR treatment initiation 127 to 26 days over period of observation • Mexico – relatively low rates of MDR

Treatment – MDR toxicity PD-684 -13 PD-691 -13 • Baseline hearing loss among new drug resistant cases in South Africa – 40% of 674 with baseline hearing loss • Higher in those with HIV and prior TB treatment and low CD 4 • QT prolongation management – 78% of participating European centers monitor QT • STREAM

Treatment - MDR OA-217 -14 • Bioequivalence of dissolved vs whole bedaquiline – 24 healthy adults 4 x 100 mg tablets (mixed sequence, cross over) – Bioequivalence demonstrated

OA-188 -13 Treatment – MDR outcome OA-2905 -13 • Culture conversion & reversion of MDR on bedaquiline in Georgia and Armenia – Conversion 31 and 74% months 2 and 6 – 10/54 converting reverted – most (8) after 6 months • Questioning limit of 24 weeks of bedaquiline • Combined bedaquiline and delamanid – Armenia, India and South Africa – 26/28 alive at 6 months – no significant QT prolongation

Treatment - MDR PD-546 -12 PD-876 -14 • Scale up MDR treatment Niger – 213 treated with success rate of 82% – Suspicion to treatment start 165 to 12 days from 2008 to 2016 • Mortality for MDR falling in Peru – Increased identification of MDR (MODS and Xpert)

Programs PD-524 -12 PD-911 -14 • Active case finding Health facilities – Philippines – Digital Xray, LED Fluorescent microscope and Gene. Xpert • 6, 496 possible cases identified • 780 (11. 8%) diagnosed with TB • Vietnam – community wide screening (≥ 15 years) – Single sputum sample for all to Xpert Mtb – Prevalence fell 389 to 176/100, 000 over 3 years – Planned LTBI survey in children

Programs - prison SOA-345 -12 OA-2962 -13 SOA-342 -12 – Health camp approach for increased participation India • Intervention – first sensitization then health camp • Health camps detected 51 cases vs 26 by sensitization – Promising TB case finding - 10 Indonesian prisons • Instituted mass screening – symptoms, CXR and Xpert • The majority 171/236 (72%) of cases overall identified through mass screening – 5% with MDR – High prevalence of cough may influence cost effectiveness of CXR screening – South Africa • Cost per case detected > US$20, 000

Programs PD-566 -12 PD-701 -13 • National TB prevalence survey Zimbabwe – 20142015 – 5, 469 presumptive TB identified (symptoms and CXR) • Sputum done – 2% smear positive and 45% Mtb culture + (20% contaminated) • Need for more targeted approach • Ethiopia – early warning system to support medicine procurement – Quan. TB Tool • Postponed procurement US$750, 000 • Wastage avoidance US $950, 000

Zoonotic Tuberculosis

Highlighting the ZTB Roadmap Launch Body copy here

Highlights of Abstracts Presented at Poster Session 1. First appraisal of genetic diversity of Mycobacterium tuberculosis isolated from captive Asian elephants (Elephas maximums) (India). 20/100 elephants examined by post-mortem had M. tb, highlighting need for collaboration between human and animal health authorities to reduce transmission. 2. Knowledge awareness and practices of small household milk producers regarding zoonotic tuberculosis in rural India (India). Only 12% of households owning cattle in a rural area of India were aware of animal to human transmission of TB. In contrast, knowledge of anthrax and rabies transmission was 44% and 34%, respectively. 3. Genotyping of mycobacterial isolates from Ghana’s tuberculosis prevalence survey- M. bovis not found (Ghana).

4. Detection of drug resistance and efflux pump mutations in M. bovis in cattle and human isolates from Baja California, Mexico, using whole genome sequencing (Mexico). There was unequivocal evidence of transmission of M. bovis from cattle to humans and between humans. 5. Mycobacterium bovis on Michigan dairy farm evidence of animal-to-human transmission (USA). 6. Molecular epidemiology of M. bovis among patients with pulmonary tuberculosis in Ethiopia 0. 2% (2/1599) of the patients had M. bovis, with one of the isolates being rifampicin resistant.

Key Highlights of Symposia I & II Sessions; Meet the Expert Symposia I: New models and diagnostic methods for studying and screening tuberculosis in humans and animals: i) use of tongue swabs as non-invasive method of collecting samples (potential use in pediatrics). ii) ferret models for studying tuberculosis transmission (they sneeze like humans!) iii) whole genome sequencing as precision tool – economic implications in outbreak investigations Symposia II: TB surveillance platforms i) WGS platform: globally standardized, validated pipeline and curated sequence data repository ii) emerging threat of M. orygis in cattle and primates in India. iii) active case finding for zoonotic TB among pastoralist population in Nigeria. iv) opportunities and challenges towards effective zoonotic TB control in poor resource settings. Meet the Expert: use and benefits of WGS in the epidemiology of TB in humans and animals.