47th Union Conference on Lung Health: Liverpool, United Kingdom
At the end of October, I had the opportunity to attend my first tuberculosis (TB) conference. I was among over 3000 individuals from 126 countries who travelled to Liverpool, UK to attend the 47th Union Conference on Lung Health. This year’s theme was “Confronting Resistance: Fundamentals to Innovation” and offered symposiums, workshops, “meet the expert” sessions, poster presentations, and a chance to create new collaborations.
At the opening inaugural session, attendees were starkly reminded of the urgency of tackling the TB epidemic. On the large screen behind Lucica Ditiu, president of the Stop TB Partnership, was a clock representing every second that had passed since the beginning of the conference. Next to the ticking clock was a count of how many individuals had died of TB since the beginning of the conference – one person every 18 seconds. From the moment that I sat down in the large arena, approximately 350 people had already died from a completely curable disease. Nineteen days after the beginning of the conference, that number reached over 92 000 people. A feeling of helplessness could easily have emerged upon those of us staring at the ticking clock and from once again hearing the newly released numbers of the WHO Global TB report: 10 million new cases of TB and 1.8 million TB deaths last year. Yet, a powerful keynote by Stephen Lewis, the co-founder and co-director of AIDS-Free World, challenged us to step up and not be afraid of controversial and creative solutions. He highlighted the need for more United Nations (UN) agencies dedicated to TB, calling out UNICEF’s lack of involvement in the issue even though 210 000 children died of TB last year. He called for an increase in advocacy, new strategies to fill the funding gap still facing TB and a need to bring multi-drug resistant TB to the center of the antimicrobial resistance (AMR) discussion. Jane Carter, president of the Union, furthered this message of encouragement by quoting Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has”. The many researchers, health care workers, program managers, politicians, students and advocates that I heard speak throughout the week would reveal novel ideas, promising technologies, successful interventions and community activism, all working towards this change.
9th FIND Symposium
During the conference, I attended the 9th FIND symposium, which revealed new advances in research, implementation challenges and future needs for TB diagnostics. Presentations and discussions revolved around advancements in next generation sequencing for diagnosing drug-resistant TB, blood tests for predicting TB and the upcoming release of the GeneXpert Omni point of care (POC) diagnostic device. These new and exciting patient-centered approaches to diagnostics are promising. However, as research and development continues, we cannot forget the important role of proper implementation and operational research to facilitate the linkage between new technologies and the people needing diagnosis and care.
A panel called “Adapting diagnostic pathways to patient needs” (listen here), moderated by Dr. Madhu Pai from McGill university, featured panelists working in TB control in their respective countries: Brazil, Philippines, Tanzania and Myanmar. It also included TB experts working for Treatment Action Group, the Bill and Melinda Gates Foundation (BMGF) and Macalester College. Following the many presentations on innovation in diagnostic technology, it was interesting to hear the panel reveal that new diagnostics alone will not solve the many issues facing the quality of TB care. Centralized testing with GeneXpert occurs in all countries represented in the panel, yet panelists reported that in their countries, around 20-25% of TB patients do not receive their test results and if they do, it can take 2 to 6 weeks to obtain them. This is for a test that returns results in under 24 hours, proving that even though the technology is efficient, there is a need for improvement in processes surrounding the technology. In Tanzania, for example, getting results to patients quickly and efficiently is a challenge because lab results are still paper-based. In Brazil, people are dying from TB even though there is a record of an Xpert positive result in their file. Panelists agreed that emerging POC diagnostics at the village level (level 1) would address some of these issues, but not in isolation. The panelist from BMGF explained that level 1 POC devices would still need to be paired with the transportation of sputum samples and a centralized laboratory for drug sensitivity testing. She expressed that there is a need to focus on health system solutions such as strengthening specimen transport, lab networks, referral systems, and communication of test results to patients. Also, by incorporating HIV and malaria into health system solutions, the benefits to the patient will be greater, the burden on the health care workers (HCW) reduced and the solutions will be more cost-effective and sustainable.
Another panelist noted other aspects to consider when implementing new technology, such as: who will take care of the supply chain, what will be the burden on health care workers, what is the optimal distribution of the device, and will the quality of results be acceptable? Several panelists advocated for the creation of an essential diagnostics list in which TB would be included. This list would encourage countries to distribute resources towards WHO recommended tests, ensure access and availability of these tests, limit import duties and encourage the strengthening of supply chains. This essential diagnostic list would not only benefit individuals suffering from TB but those suffering from other included diseases.
The week in Liverpool reminded me that there is no silver bullet for ending TB; technological innovation cannot be isolated from its social setting, nor from highly relevant comorbidities such as HIV. It will be critical to work together to connect bench science to operational research in order to bring people the care they need. The Union conference is an ideal place to create these linkages. To echo many presenters in Liverpool this year, holding future Union conferences in high burden countries would make them more accessible to a greater number of individuals who are at the center of TB work. I was lucky to be able to benefit from the knowledge shared in Liverpool, and would love to see those who are most affected by the disease benefit from these opportunities as well.
Danielle Cazabon graduated in May 2016 with a Master's of Science in Public Health, focused on Global Health. After spending the summer as an intern at Grand Challenges Canada, she returned to McGill to work as a project manager for the McGill International TB Centre. She is the winner of a McGill International TB Centre travel award.