TBnet webinar, the Year in Review by Prof Christoph Lange
More information and the link to the webinar here:
Reports from two important TB meetings
Two important TB meetings took place in the end of November 2022.
Read a short report from these meetings provided by: Dr. Liga Kuksa, Dr Lorenzo Guglielmetti, Dr. Ohanna Kirakosyan and Dr. Andrii Dudnyk.
Regional meeting on implementation of TB action plan for the WHO European Region 2023-2030
Tuberculosis (TB) and drug-resistant TB continue to represent major public health threats in the WHO European Region despite the notable progress in reducing overall TB incidence and mortality.
At the 72nd session of the Regional Committee, September 2022, Member States of the European Region endorsed the TB Action Plan for the WHO European Region 2023–2030, to reinforce Region-specific efforts to reduce TB incidence by 90% by 2030.
To help countries to align national TB strategies with new TB action plan, the WHO has organized the “Regional meeting on implementation of TB action plan for the WHO European Region 2023-2030 for 18 TB high-priority countries” November 21-24, 2022, Istanbul, Turkey. It has been conducted in close collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the Stop TB Partnership and the United States Agency for International Development (USAID).
Dr. Liga Kuksa presenting at the WHO Regional Meeting
The meeting was well attended by the national delegations from Armenia, Azerbaijan, Belarus, Bulgaria, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Romania, Russia, Tajikistan, Ukraine, Uzbekistan and Turkey as the host. Representatives from following organizations were present: TB Alliance, TBnet, MSF, KNCV, TBpeople, TBEC, PAS center, AFEW, Stop TB partnership, GF, GDF, ECDC, WHO EURO and WHO HQ.
Prevention and screening, TB diagnosis, Treatment and care were discussed including an overview of the current guidelines and implementation challenges, access to the drugs, TB Research and Innovation, regional commitments as well as introduction of new tools to help in the implementation of the action plan. Almost all countries were invited to share their best practices and at the same time had possibility to review their own National Strategic plans in accordance with New Regional Action plan.
The TBnet Chair Dr. Liga Kuksa and a TBnet member Dr. Ohanna Kirakosyan attended the meeting. Dr. L. Kuksa had a talk on the access to TB medicines and diagnostics in the EU using the example of Latvia. Concerns on access to Rifapentine worldwide and especially in EU countries were stressed and discussed with different partners and stakeholders referring to the recent joint advocacy statement by ESGMYC, ESM, ERS and TBnet (Guglielmetti et al).
Dr Ohanna Kirakosyan
The European Region is confronted with challenges in reducing the burden of DR-TB and addressing the issue of TB/HIV coinfection, both of which continue to cause premature mortality in the region. The COVID-19 pandemic has severely affected the progress made in the Region towards reaching the TB targets as, from 2020. Service disruptions and barriers in accessing care resulted in substantial reductions in the numbers of both TB notifications and people being enrolled into treatment, especially for MDR/RR-TB, in the Region. In addition, the war in Ukraine has triggered an escalating humanitarian crisis in Europe that may have a serious impact on progress towards regional targets. While new options for TB prevention, diagnosis, treatment and service delivery provide opportunities to accelerate the TB response, the Region’s national health systems are still recovering from the setbacks caused by the COVID-19 pandemic, and more challenges are anticipated due to the humanitarian crisis in Europe.
Jornadas Internacionales sobre tuberculosis XXVI, the traditional International TB Conference took place in Barcelona, November 14 - 15 November 2022
Many speakers, including several TBnet members, presented their work and country updates as for tuberculosis management.
Access to rifapentine in Europe, Guglielmetti et al
Dr. Lorenzo Guglielmetti, TBnet SC member presented recent studies on regimens including rifapentine, a rifamycin with interesting characteristics, and the impact of latest international recommendations for the treatment of latent TB infection and TB disease. He outlined results of the recent TBnet survey (Günther et al, Clinical Microbiology & Infection, 2022) and the ensuing advocacy letter (Geglielmetti et al, ERJ, 2022), pointing out at the concerning lack of access to rifapentine and the need for all TB societies and affected communities to work together to solve this issue. In the following roundtable with Prof Kenneth Castro and Dr Jose Caminero, access issues to drug-resistant TB drugs and drug susceptibility tests were equally underlined and common regional approaches to tackle them were proposed.
Dr Andrii Dudnyk, TBnet contact point, Ukraine presented a talk “How to win the War against TB. Breaking news from Ukraine” highlighting the last achievement of the National TB program and the response to new challenges associated with ongoing war in Ukraine.
Dr Dudnyk mentioned high GeneXpert test coverage in Ukraine, a successful implementation of modified shorter fully oral regimens under operational settings (including the groundbreaking new BPaL-based regimen), the results of a cross-sectional countrywide survey evaluating access barriers to tuberculosis care and out-of-pocket patient costs. Additionally, the national TB service has acquired 168 tablets for video-supported TB treatment and 6 portable X-ray machines for regional TB hospitals. As a result of implementation of new XDR GeneXpert cartridges, the average time between the detection of resistance and the treatment initiation for patients with pre-XDR TB has shortened down to 4.2 days. In September 2022, rifapentine has been purchased for the first time for the national funds to use in preventive shorter treatment regimens. Healthcare facilities have been supported with about 600 Starlink satellite internet stations for non-stop access to high-speed internet. Finally, the project Treatment4Ukraine (www.treatment4ukraine.com) funded by the European Union was launched to facilitate Ukrainians living with TB, HIV, viral hepatitis or taking opioid substitution therapy to access healthcare services within Europe.
Clinical Case presentation, TBnet Circle
TB Clinical Cases on TBnet Circles (www.tbnet.eu) is a series of clinical cases organized by Dr Ilaria Motta. Everyone registered on TBnet website/TBnet Circle can post the cases for discussion and participate in the discussions (activate post notifications). We keep the case discussions under the registration access because of the ethical issues and to provide a safer environment for clinicians to discuss. If you have any questions about the site or Circle registration, please, contact the TBnet Admin: Liga Rusmane, email@example.com.
Dr. Simone Tunesi
Here we present the case posted recently by Dr. Simone Tunesi: Hepatotoxicity and infective glomerulonephritis. Follow it on TBnet Circle and discuss.
“Hello everybody, I would like to discuss a difficult-to-manage case with you. The background is simple: male, 84 years old, former smoker, no big pre-existing conditions, affected by bilateral pulmonary drug susceptible TB.
A standard HRZE treatment is started, but after 3 weeks a major hepatotoxicity (AST/ALT 4N) appears, leading to a treatment interruption. Therefore, after liver enzymes normalize, R+E, then H, then Z are reintroduced.
Under this therapy, liver enzymes start again to increase, but mostly a renal failure appears, leading in a few days to start haemodialysis. HRZE were stopped again. A renal biopsy was performed, showing histological patterns of a rapidly progressive glomerulonephritis. Nephrologists are unwilling to start a high-dose steroid treatment and rituximab due to the active untreated TB. In their opinion, this kind of glomerulonephritis is not caused by drugs, but it's directly related to the infection.
In any case, this treatment should be started immediately in order to have some benefits. Therefore, considering both hepatic and renal issues, we started rifampine 10 mg/kg/day + ethambutol 15 mg/kg after dialysis and we are starting linezolid 600 mg/day in the next days if R+E are tolerated.
What do you think about this case? Which antiTB drugs would you use? After how many days would you start steroids and rituximab? Any other suggestion?”
To discuss this case, go to www.tbnet.eu and log-in to Circle (Blue round button).
Request for Proposals for Tuberculosis Treatment Monitoring Tools (FIND, on behalf of the UNITE4TB consortium)
Provided by Dr Irina Kontsevaya, TBnet contact point for UNITE4TB.
On behalf of the UNITE4TB consortium, FIND is issuing a Request for Proposals (RFP) for assays for treatment monitoring in tuberculosis drug trials. We invite you and your organisation to review this RFP and consider submitting a proposal.
Objective: UNITE4TB aims to shorten the duration of antituberculous drug and regimen development through the selection and evaluation of assays suitable as endpoints in clinical trials. This RFP focuses on assays that: (i) provide quantitative results for monitoring of TB treatment response over time and prediction of long-term treatment outcome, and (ii) are suitable for use in clinical laboratories. UNITE4TB will provide the opportunity for clinical data generation for selected novel biomarker assays and compare these against 1) change of bacterial load in sputum measured by MGIT time-to-positivity, 2) interim analyses based on endpoint 1 to continue or discontinue treatment arms, and/or 3) long-term tuberculosis treatment outcomes. Selected solutions will be included in clinical tuberculosis drug trials beginning Q2 2023.
All TBnet members are invited to read the RFP documents and submit a proposal. Details of the RFP can be found in the RFP documents, along with the instructions on how to apply and the selection criteria.
For more details on the call: https://www.finddx.org/calls-for-partners/
(Request for proposal for assays for treatment monitoring in tuberculosis drug trials)
The deadline to respond to the RFPs is 11:59pm CET, 30 January 2023.