Advanced TB Research Training Course

Dr. Cattamanchi is a Professor of Medicine and Epidemiology, and co-Director of the Partnerships for Research in Implementation Science for Equity (PRISE) Center at UCSF. He completed his MD, residency training in internal medicine, fellowship training in pulmonary and critical care medicine and a Master’s in Clinical Research with a concentration in Implementation Science at UCSF before joining the faculty. His research focus on two thematic areas: 1) the development and evaluation of novel diagnostic tests for tuberculosis and 2) improving the delivery and uptake of evidence-based care for tuberculosis in high burden countries. He is currently a PI of 5 NIH R01 and 1 U01 grants related to these themes. In addition to research, Dr. Cattamanchi co-directed the UCSF Implementation Science Program (2015-2021), directs the introductory course in the UCSF Implementation Science Certificate Program and co-directs the IMPACT K12 program which supports career development of junior faculty pursuing implementation research related to heart and lung diseases.

UCSF Profile

Amita Gupta, MD, MHS, is Faculty Chair of the Johns Hopkins India Institute, Deputy Director of the Johns Hopkins Center for Clinical Global Health Education, and Professor of Medicine and Public Health at Johns Hopkins University.
Dr. Gupta has 25+ years of experience in international public health and clinical research and 18 years of working in TB, HIV, and other infectious diseases in India. She is an author of more than 200 peer-reviewed research publications and has mentored more than 35 junior scientists in India and the US.

Johns Hopkins Center for Clinical Global Health Education (CCGHE) profile

Susan Dorman received her B.S. degree in Biochemistry from Trinity College, Hartford, Connecticut, and subsequently received an M.D. degree from Duke University in North Carolina. She completed internship and residency in Internal Medicine at Brigham and Women’s Hospital, Boston. Dr. Dorman served in the US Public Health Service, and completed a sub-specialty fellowship in Infectious Diseases at the National Institutes of Health. She served on the faculty of Johns Hopkins University School of Medicine from 2001 through 2017, and is currently Professor of Medicine at the Medical University of South Carolina in Charleston, SC. Dr. Dorman and her research team have focused on the development and assessment of new tuberculosis diagnostic tests and treatment strategies. She served as a Principal investigator on a U.S. National Institutes of Health-funded contract, the ‘Tuberculosis Clinical Diagnostics Research Consortium’, which conducted assessments of novel diagnostic tests for tuberculosis at study sites in China, South Korea, South Africa, Kenya, Uganda, and Brazil. She also serves as Principal Investigator on phase I, II, and III clinical trials of tuberculosis treatment. She served as Medical Director of the Baltimore City TB Clinic from 2003-2011, and currently serves as TB Medical Consultant to the South Carolina Department of Health. Dr. Dorman is a diplomate of the American Board of Internal Medicine, with certifications in Internal Medicine and Infectious Diseases.

MUSC profile

Professor Tom Scriba (PhD) is Deputy Director, Immunology at the South African Tuberculosis Vaccine Initiative (SATVI), University of Cape Town, where he directs the clinical immunology laboratory. He trained in biological sciences at Stellenbosch University in South Africa and obtained a DPhil (PhD) in T cell Immunology at Oxford University, UK. He returned to South Africa in 2006 to complete a postdoctoral fellowship in paediatric and clinical immunology in TB and vaccinology at the Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town. Dr Scriba’s research focuses on TB vaccine development, immunopathogenesis of M. tuberculosis infection as well as development of biomarkers of key transition points between the clinical stages of M. tuberculosis infection and disease. Dr Scriba’s research is funded by competitive grants from the Bill and Melinda Gates Foundation, European Developing Countries Clinical Trials Partnership, South African Medical Research Foundation, US National Institutes of Health and the European Union.

University of Cape Town IDM profile

Dr. Peter Small is currently independently pursuing his vision to make cough quantifiable and diagnostic. In the distant past he was a medical resident and chief medical resident at UCSF during the dawn of the HIV epidemic. He then moved to Stanford where he completed an Infectious Disease fellowship and spent about a decade on the faculty of Stanford’s Infectious Disease Division. During these years, he published pioneering molecular epidemiological papers that helped to shape the public health response to the resurgence of tuberculosis and seminal papers on mycobacterial genomics. In 2002 he was one of the early employees of the Bill and Melinda Gates Foundation where he developed their tuberculosis strategy, built the foundation’s core partnerships and country programs, hired and manage the Foundation’s TB team and oversaw a large portfolio of vaccine, drug and diagnostic product development activities. In 2011, he relocated to India where he established the foundation’s tuberculosis program in India. In 2015 he joined Stony Brook University as the Founding Director of the University-wide Global Health Institute focused on the use of technology to delivery health care in remote Madagascar and Nepal. He continues to oversee grants and mentor students on tuberculosis research, especially in innovative ways of delivering care such as drone observed therapy. More recently he was a Rockefeller Foundation Fellow exploring a number of efforts culminating in ways to improve medication adherence and Director of Global Health Technologies at Global Health Labs (formerly Global Good) in Bellevue.

UW Dept. of Global Health profile

Dr. Sterling received his medical degree from the Columbia University College of Physicians & Surgeons, residency training in internal medicine at Columbia-Presbyterian Medical Center, and fellowship training in infectious diseases at Johns Hopkins Hospital. He joined the Johns Hopkins faculty in 1998, and moved to Vanderbilt in 2003. He is the Director of the Vanderbilt Tuberculosis Center and Director of Epidemiology Research in the Division of Infectious Diseases. Dr. Sterling’s research interests are focused on the epidemiology and treatment of tuberculosis and HIV. Particular areas of interest include treatment of latent tuberculosis infection, drug resistance in M. tuberculosis (including multi-drug resistance and fluoroquinolone resistance), and HIV-related tuberculosis. He also has an interest in the immunogenetic predisposition to tuberculosis, particularly extrapulmonary disease. Dr. Sterling has ongoing research collaborations in Brazil, South Africa, Peru, and the United States.

VUMC Tuberculosis Center

Robin Wood is Emeritus Professor of Medicine at the University of Cape Town and director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine. He was educated at King Edward VI School in Birmingham, UK and gained a bachelor degree in biophysics at London University and medical training at Balliol College, Oxford University. His specialist medical training was completed at the University of Cape Town followed by an Infectious Disease Fellowship at Stanford University, California and was awarded a degree of Doctor of Science at the University of Cape Town. He was a pioneer in the introduction of treatment and clinical care of people living with HIV and AIDS in South Africa and was strongly aligned with civil society activists fighting for access to antiretroviral therapy in South Africa. His earlier research was in the interactions between HIV infection and tuberculosis and my current research focuses on tuberculosis transmission and disease control. He lead a multidisciplinary team investigating the aerobiology of tuberculosis transmission in the highly endemic communities of Cape Town.

Desmond Tutu Health Foundation

Ann M. Ginsberg, M.D., Ph.D., is Deputy Director, TB Vaccines in the Global Health Division of the Bill & Melinda Gates Foundation. Dr. Ginsberg has conducted and led TB research and product development programs for 25 years, including 15 years leading and designing clinical strategy for development of TB vaccines and drug regimens of high priority for the developing world. She previously served as the Chief, Respiratory Diseases Branch, NIAID, NIH, as Director, Project Management at Merck Research Laboratories, as Chief Medical Officer at the Global Alliance for TB Drug Development, as Chief Medical Officer at Aeras and as Senior Technical Advisor at IAVI. In these roles, she oversaw in addition to numerous early stage drug and vaccine candidates, the early clinical development program of Pretomanid® and two recent, groundbreaking TB vaccine efficacy trials – of BCG revaccination and M72/AS01E. Dr. Ginsberg has served on numerous national and international advisory committees on vaccines and global health, including the U.S. National Vaccine Advisory Committee. Her undergraduate degree is from Harvard University, her Ph.D. in Molecular Biology from Washington University and her M.D. from Columbia University. She was Board-certified in Anatomic Pathology.

Willem Hanekom is director of the Africa Health Research Institute in KwaZulu-Natal, South Africa. He has previously led the South African Tuberculosis Vaccine Initiative (SATVI) at the University of Cape Town and the TB vaccine program at the Bill & Melinda Gates Foundation.

Professor Willem Hanekom is a clinician-scientist who trained in medicine and paediatrics in South Africa and in paediatric infectious disease and research immunology in the USA. He is a renowned TB vaccine expert, having directed the South African Tuberculosis Vaccine Initiative before leading the TB vaccine group at the Bill & Melinda Gates Foundation. Here he developed and implemented the Foundation’s first comprehensive TB vaccine strategy, which resulted in major breakthroughs in TB vaccine discovery and development. Willem has >200 publications and has been awarded competitive funding by most prominent agencies. He is the previous chair of both the South African Immunology Society and the Federation of African Immunology Societies and is a member of multiple international advisory committees in tuberculosis, vaccinology and translational immunology.

AHRI

Dr. Robyn Waite is the Director of Policy and Advocacy at Results Canada – a not-for-profit organization on a mission to generate the political will to end extreme poverty. She is also the secretariat of the Stop TB Canada Network, where she is working tirelessly alongside partners to reinvigorate and mobilize a community of Canadians committed to ending tuberculosis (TB) at home and abroad. Robyn holds a PhD in International Development Studies from SOAS the University of London, an MSc in Global Health from McMaster University, a Graduate Diplomate from the United Nations University Institute for Water, Environment and Health, and a BSc (First Class Honours) in Health Promotion from Dalhousie University. She is skilled, passionate, and well-practiced at bringing people together to take meaningful, high impact action in support of creating a fairer and healthier world for all. She is particularly proud of the role she played recently in supporting a civil society led global survey initiative, which sought to understand and raise awareness of how COVID-19 is impacting the TB epidemic.

LinkedIn

Rhea Lobo is an international award-winning filmmaker with a background in health journalism and is also an extra-pulmonary TB survivor. She is a strong TB advocate and co-founder of Bolo Didi (Translation: Say Sister), an informal network of women TB survivors in India that help people affected by TB navigate health systems, promote treatment adherence and counselling. She has extensive experience in working for both Communicable and Non-Communicable Diseases in organizations such as Dalberg Media, The Union and TBpeople. She is of Indian origin and currently resides in Copenhagen, Denmark.

Rhea has made a number of films on health and women empowerment, with a special interest in TB. Her film on Human Rights and TB, Rights and Wrongs… A Tribute to Dean Lewis, received critical acclaim from Dr Tedros Adhanom, Director General of the World Health Organization. Rhea is also a member of the Stop TB Working Group on New Vaccines and is part of the taskforce that is developing Stop TB Partnership’s Global Plan to End TB by 2030.

I am the Chief Scientific Officer and co-leader of the Diagnostics Program at PATH, a global nonprofit improving public health. I investigate the challenges of infectious diseases and nutrition with a specific focus to identify and develop effective diagnostic tools for use in low resource settings. My primary interests are in improving the diagnosis and management of COVID-19, HIV and TB infections and in providing better population surveillance systems to inform on transmission of vaccine preventable diseases such as pneumococcal pneumonia, polio virus, typhoid and now SARS-CoV-2.

UW Dept. of Environmental & Occupational Health Sciences profile

07:31:24 From Sindhulina : good evening from Bangalore, India
07:31:27 From Juliana Pinhata : Good morning from Brazil!!
07:31:32 From Simon Mendelsohn : Hi from Cape Town!
07:31:35 From Courtney Heffernan : good morning from Edmonton, Canada
07:31:37 From Juan Montenegro : Good morning from Peru
07:31:37 From matovu — : matovu sande from Uganda
07:31:39 From Lucía Loy : good morning! from Guatemala!
07:31:45 From Qader Ghulam : Greetings. Ghulam Qader from Afghanistan
07:31:54 From Pauline Amuge : Good morning team. Pauline from Uganda
07:31:57 From Marina Vetrova : Hello from Russia
07:31:57 From Ffion Carlin : Hello from the UK
07:31:57 From Mmamapudi Kubjane : Hello from South Africa!
07:31:58 From simon walusimbi : Good evening everyone from Arua, Uganda
07:31:59 From Daniel Waiswa : Hi everyone Daniel Waiswa from Uganda
07:31:59 From IVAN IBANDA : Greetings from Ivan Ibanda Ug
07:32:41 From Joel.S. kabugo : greetings from Joel kabugo Uganda
07:32:41 From Benedicto Mugabi : Good evening to you all. This is Benedicto Mugabi from Baylor College of Medicine Children’s Foundation Uganda
07:32:50 From Delfina Ensinck : Hello !
07:32:51 From NELLIE MUKIRI : Nellie Mukiri from Kenya
07:32:59 From Isabelle Munyangaju : hello from Mozambique
07:33:24 From Renee Codsi : Hello from Seattle
07:33:27 From sylvester mbaluka : Sylvester Mbaluka from kenya
07:33:32 From Jefferson Mecha : Jerphason Mecha from Kenya
07:33:37 From Miiro Emmanuel : Greetings from Miiro Emmanuel, a medical student from Uganda at Mbarara University of Science and Technology.
07:33:38 From William Kasozi : William Kasozi from Uganda Karamoja USAID TB program
07:33:51 From Ricardo Alfaro : Greetings to all. I am Ricardo from Peru
07:33:52 From Stavia Turyahabwe : Hello. Stavia Turyahabwe Uganda
07:35:43 From Mandar Paradkar : Hi, Mandar Paradkar from India
07:36:50 From Blessed Shiko : Hello everyone, Elizabeth Mwangi from Kenya
07:36:55 From Emmanuel Biryabarema : Good evening from Uganda 🇩🇪
07:37:32 From Abdou Fofana : Hi everyone, Abdou from Boston University
07:37:48 From Kevin Urdahl : Welcome Blessed, Emmanuel, Abdou, and all!!
07:43:15 From kusiima roland : Hi everyone. Roland from Makerere university school of public health Uganda
07:54:47 From Paul K. Drain : Please feel free to write your questions in the Chat box.
07:56:54 From Jerry Cangelosi : Does host-directive therapy have promise against NTM disease, which is difficult to treat with antimicrobials?
07:57:03 From Jerry Cangelosi : host-directed….
07:58:16 From Abdou Fofana : To what extent do we understand genetic susceptibility to TB (mutation in IFN gamma). What is the contribution of genetic susceptibility to TB spread compared to other factors like Socio-economic status (environmental factors
07:58:36 From Miiro Emmanuel : Could addition of doxycycline to the standard short 6 months anti-TB regimen reduce the duration of treatment further?
07:58:47 From David J. Horne : Great talk tom. My understanding with the IFN gamma/il12 mendeilan disorders is that susceptibility to Mtb is not increased. Why the difference from NTM and BCG?
07:59:04 From Sindhulina : Are these responses similar for Pulmonary and EP TB ?
07:59:40 From Jack Karugah : will HDTs be generalised for all patients/patient groups or shall it be imdividualised?
07:59:50 From Rafaella Osores Urday : How did they choose to test doxycicline? Are other antimicrobials probably helpful?
08:11:02 From Benedicto Mugabi : WHERE ARE THE SLIDES CHETAN IS EXPLAINING?
08:11:24 From Tom Scriba : I can see them
08:11:58 From florence mwangwa : I can see them too
08:14:52 From Chen zi : Would like to hear some comments about the WHO PPCs in guiding novel TB vaccine development especially how NTP should perceive these documents
08:17:54 From Thomas R. Hawn : Please enter any questions that you have in the chatbox or raise your hand when Chetan is done
08:19:05 From Lomonyang Victor : BCG could protect child mortality, does this include deaths related to viruses as well?
08:20:00 From Chris Joss to Ksenia P Koon(Direct Message) : When you have a chance can you resend me the agenda slide? I think you said I was supposed to share that on the break and I can’t find it in my emails..thanks
08:20:13 From Debbie Cross : The gd T-cell finding is really interesting! Do gds expand in adults vaccinated with BCG? Or is this a unique feature of immune responses to BCG in children?
08:20:27 From Abdou Fofana : Is the main problem with BCG that we are giving it to the “wrong people” (Kids, not the biggest infectors).
08:22:00 From Judy Machuka : Does BCG confer sustained innate immunity or would it need to be boosted? Is mTB infection dependent on geographic location?
08:22:29 From Benedicto Mugabi : Where across the world is intravenous BCG administration a policy? and how much does it cost?
08:22:38 From matovu — : Is there a possibility of using interferon Gamma as a therapy against Mtb?
08:25:57 From Debbie Cross : At what age roughly does BCG protection against extra pulmonary TB start to wane?
08:28:01 From Chetan Seshadri : @Lomonyang – Thanks for the question. Yes – BCG protects against respiratory viruses at a minimum. https://pubmed.ncbi.nlm.nih.gov/32798142/
08:29:10 From Chetan Seshadri : @Debbie – Thanks for the question. In our hands, GD T cells do not seem to expand in the periphery in adults. However, their clonotypic diversity does seem to change (unpublished). Unclear what is happening in the lungs.
08:30:33 From Stavia Turyahabwe : Scientific community has been working hard for 100 years and still no break through with the TB vaccine. What hopes do we have now in this area?
08:31:47 From Chetan Seshadri : @Judy – Excellent question. The duration of BCG’s effect on ‘training’ is unclear, but probably not more than 1 year as demonstrated in the 2021 Cell study. mTB infection does not appear to depend on geography, unlike BCG benefit in adults. https://pubmed.ncbi.nlm.nih.gov/7795103/
08:33:09 From Paul K. Drain : @Stavia – Andrew will review the current status of vaccine trials as the last presentation of today. Several promising candidates. Stay tuned!
08:33:12 From Judy Machuka : Thanks
08:34:06 From Chetan Seshadri : @Benedicto – Thanks for the question. Right now, there is no plan to give IV BCG to humans. But the experience in malaria is promising. https://academic.oup.com/cid/article/71/4/1063/5573993
08:35:23 From Chetan Seshadri : @matovu – Thanks for the question. Yes – recombinant IFNG is the treatment for children afflicted with the Mendelian disorders. It is not provided as a therapy to adults without one of these disorders.
08:36:01 From nassozi rashidah : Thanx for session I would like to know if you vacinate an infant .BCG and an induration doesn’t appear are we supposed to inject again thanx
08:36:38 From Chetan Seshadri : @Stavia – Agree that our track record with TB vaccines have not been great. There are many reasons for this, which I hope we will discuss later today. However, because of some of the advances I discussed, I am optimistic.
08:38:38 From Thomas R. Hawn : Questions for Kevin are welcome in the chatbox or raise your hand. thanks.
08:39:26 From Chetan Seshadri : @Nassozi – Thanks for the question. I believe it is not currently recommended to re-vaccinate based on absence of a scar. However, it has been shown that the resulting immune response is different in babies without a scar. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0617-3
08:40:27 From Robert Rousseau : Hi Chetan, from what I have seen. Lung homogenates from mice that have had I/V BCG will have BCG colonies even 3-5 post adminstration. How does I/V BCG not result in septicemia?
08:42:29 From Chetan Seshadri : @Robert – Thanks for the question. The BCG absolutely disseminated systemically, including the lungs. However, they don’t experience any clinical detriment (septicemia) as documented in the 2020 Nature paper.
08:44:35 From Kevin Urdahl : Happy to take any question via chat. I will also participate in later breakout rooms. Or just send me an email kevin.urdahl@seattlechildrens.org
08:45:13 From Chetan Seshadri : Thanks @Kevin! Yes – please also feel free to email me with questions. seshadri@uw.edu
08:49:33 From Judy Machuka : What is the window perod for acute TB infection that would leverage protective immune mechanisms?
09:00:17 From Chetan Seshadri : @Judy – Thanks for the question. Two recent studies show that ‘latent TB’ can protected against active TB. In one, NHP infected with one strain were protected against another strain. In another, mice that were stably infected behind the ear were protected against pulmonary challenge. (1/3)
09:00:23 From Chetan Seshadri : https://pubmed.ncbi.nlm.nih.gov/30312351/ (2/3)
09:01:02 From Judy Machuka : Thanks
09:01:21 From Chetan Seshadri : https://pubmed.ncbi.nlm.nih.gov/32673357/ (3/3)
09:01:47 From Lucia Carratalà : Would this mean a potential TB susceptibility of epigenetic origin during embryological development?
09:03:50 From Stephanie A-Sombke : Is there currently work on TB therapies that are specific for Mtb that reside in interstitial macrophages?
09:13:28 From Chris Joss : To join a breakout..click on “Breakout Rooms” on the Zoom toolbar. Then when the Breakouts window appears, look for a Blue linked number. Hover your mouse over the number and it will change to the word “Join”. Click that and you will go to the breakout
09:17:16 From Chris Joss : If you are having issues joining a breakout room, it may be that you need to update your Zoom desktop client to the most recent version. Zoom client versions 5.3.0 and higher allow participants to self-select breakout rooms. To update the client, with the Zoom desktop application open, do the following:
Click the initials/profile photo (upper right) and select Check for Updates.
Follow the prompts to update and install the latest version.
09:17:44 From Rafaella Osores Urday : Has or may the COVID-19 epidemic change forever transmission mechanisms and target populations?
09:20:34 From Benedicto Mugabi : It is quiet on my side. Is there any presentation or discussion thats going on some where ?
09:20:59 From TONNY KYAGAMBIDDWA : yes
09:21:20 From Isabelle Munyangaju : hi Benedicto, there is a presentation. i think you have a unstable connection.
09:22:07 From Simon Mendelsohn : Shingles/VZV
09:22:27 From Lubega Jason : Varicella Zoster
09:27:08 From Simon Mendelsohn : Does TB preventive therapy (TPT) guidelines complicate trial design (particularly in HIV+ participants or trials in IGRA+)? What if future country guidelines (e.g. South Africa) recommend TPT in IGRA+?
09:27:33 From Pranay Sinha : Are we evaluating any mRNA vaccines for TB?
09:35:50 From Chetan Seshadri : @Pranay – Thanks for the question. Yes – BioNTech has a pipeline for mRNA vaccine for TB and HIV. Not sure about Moderna and other companies.
09:45:19 From Chetan Seshadri : @Willem – Stakeholder involvement is key. Was there really an effort to engage stakeholders for COVID? Or was it self-evident?
09:48:03 From Stavia Turyahabwe : I agree with the time from infection to disease for TB Vs COVID as a limitation to TB vaccine development. Acute Vs Chonic and scare brought about by the diseases in the population for prompting investment to TB as has been seen in COVID
09:50:14 From Isabelle Munyangaju : @Willem…to your comment i would also add serious political commitment to having a TB vaccine. For Covid…every world leader pushed for a vaccine and this pressured or facilitated collaborations across the board…at all levels.
09:51:37 From Teniola Lawanson UniOfEdinburgh : What’s the update on the development of TB vaccines delivered intranasally?
09:53:20 From Stephanie A-Sombke : Are there any other biomarkers in the inflammatory cytokine pathway that can be used? TGFB?
09:53:30 From Teniola Lawanson UniOfEdinburgh : Well said Isabelle. The commitment to funding for TB research, esp novel vaccines is sparse compared to other high burden diseases
10:03:11 From Pauline Amuge-Baylor Uganda : Sorry, we can’t hear Prof Tom
10:03:32 From Simon Mendelsohn : Loud and clear
10:03:36 From Tah Rene Mih : Yes prof
10:05:28 From Pauline Amuge-Baylor Uganda : Ok. Thanks
10:12:08 From Derrick Semugenze : Is it possible to study the immunity of TB resistors to gain more incite into TB vaccine antigen selection?
10:12:24 From Debbie Cross : Thank you all for your insights! Are there any thoughts on whether the correlates of protection against recurrence vs infection vs disease are likely to be different? Appreciate that’s a difficult question given the limitations that have already been discussed.
10:13:01 From DANIEL OKUTU : Are there testing kits for testing TB like the ones for HIV ?
10:14:35 From Paul K. Drain : @Daniel – we’ll be getting into TB Biomarkers &. Diagnostics on Wednesday – stay tuned!
10:15:05 From DANIEL OKUTU : noted thank you
10:15:33 From Chetan Seshadri : @Derrick – Thanks for the question. Yes – there are several studies ongoing with natural models of protection (resisters, non-progressors, etc). With 4000 antigens to choose from, it’s a big task.
10:18:48 From Judy Machuka : Kindly highlight the side effects of efficacious TB vaccines and how these could be mitigated. Thank you.
10:20:24 From Tah Rene Mih : How is TB reoccurrance currently prevented vaccine wise?
10:24:46 From Courtney Heffernan : I agree that a vaccine with efficacy <50% could still provide major pop health benefit – where do you put the lower limit
10:25:30 From Kevin Urdahl : Agree, completely Tom. The TB community is much more collaborative now and that is HUGE.
10:31:11 From Isabel Chin : Thank you!
10:31:16 From Tah Rene Mih : Thank you Prof. Tom
10:31:27 From Courtney Heffernan : thank you
10:32:12 From Daniel Waiswa : many thanks to the speakers
10:33:17 From DANIEL OKUTU : thank you
10:33:31 From Renee Codsi : I don’t see a spot to join the breakout room
10:33:46 From Tah Rene Mih : I also
10:33:46 From Kevin Urdahl : I haven’t gotten a breakout room invite yet either.
10:33:48 From Teniola Lawanson UniOfEdinburgh : Breakout room not coming up
10:33:52 From Álvaro Díaz : thank you for all speakers
10:35:03 From Mphatso Phiri : Thanks to the presenters for the insights
10:51:46 From sylvester mbaluka : of course due to lockdown s ,financial constraints many patients have not be able to access medication
10:56:34 From Gabriella Jackson : thank you!
10:59:52 From Robert Rousseau : Thanks to the speakers, organisers and team for todays discussion 🙂
11:00:07 From Lomonyang Victor : thanks
11:00:08 From Isabel Chin : Thank you!
11:00:08 From IVAN IBANDA : Great time too
11:00:08 From Sarah Jbara : Thank you very much
11:00:11 From Teniola Lawanson UniOfEdinburgh : Thank you!!!
11:00:12 From Courtney Heffernan : thanks to all – wonderful day
11:00:12 From Judy Machuka : Thank you
11:00:12 From Tah Rene Mih : Thanks so much
11:00:13 From Kim Foster : Thank you!
11:00:15 From Yvette Rodriguez : Thank you!
11:00:19 From Haron Gichuhi : Thank you. Bye
11:00:20 From Lucía Loy : thanks
11:00:21 From Carla Achiro : thank you
11:00:24 From Angel Lisa Nakimuli : thank u
11:00:26 From bmugabi@baylor-uganda.org : thank you
11:00:28 From Gabriella Jackson : Thank you!
11:00:28 From Álvaro Díaz : thank you, bye
11:00:30 From Teniola Lawanson UniOfEdinburgh : See you all tomorrow!
11:00:39 From Qader Ghulam : Thank you and bye
11:00:46 From MAGNOLIA LUQUE DURAN : Thank you , bye
11:01:12 From DANIEL OKUTU : thank you good bye
11:01:25 From Irene Ndagire : thanks and bye
11:01:25 From Elizabeth Aoko : Thank you and bye

Advanced TB Research Training Course

Sept 14—Tuesday

Chat Discussion

 

From Isabel Chin to Everyone:  07:30 AM

Good morning!

From Daniel Waiswa to Everyone:  07:30 AM

Hi everyone

From Derrick Semugenze to Everyone:  07:31 AM

Hello everyone

From Delfina Ensinck to Everyone:  07:31 AM

Hi!!

From Isabelle Munyangaju to Everyone:  07:32 AM

yes yesterday was very productive.

From Rafaella Osores Urday to Everyone:  07:33 AM

Hello! From Peru

From Isabelle Munyangaju to Everyone:  07:33 AM

Isabelle Munyangaju from Mozambique

From Lídia Cunha to Everyone:  07:33 AM

hello from Mozambique

From Emma Mudrock to Everyone:  07:33 AM

hello from Seattle, WA

From Lucía Loy to Everyone:  07:33 AM

Hello! from Guatemala!

From Joey Hernandez to Everyone:  07:33 AM

Hello from Manila, Philippines (10:30pm here)

From Qader Ghulam to Everyone:  07:33 AM

Greetings from Afghanistan

From Akemi Matsuno to Everyone:  07:33 AM

Hello from Peru!

From Facundo Colaccini to Everyone:  07:33 AM

Hello! from Rosario, Argentina

From Courtney Heffernan to Everyone:  07:33 AM

good morning from Treaty 6 territory, homeland of Metis in Alberta Canada

From Brian Otaalo to Everyone:  07:33 AM

Good evening from Uganda

From Lubega Jason to Everyone:  07:33 AM

Helllo from Uganda

From STEPHANIE ANOVER-SOMBKE to Everyone:  07:34 AM

good morning from Seattle WA USA

From Suné Liebetrau to Everyone:  07:34 AM

Hello, from KZN, South Africa

From Dra Laura Lagrutta to Everyone:  07:34 AM

Laura Lagrutta from Argentina

From danny.scarponi@lshtm.ac.uk to Everyone:  07:34 AM

Hello from London

From Sindhulina to Everyone:  07:34 AM

Hello from India(8 pm here)

From Cinthya Ruiz-Tagle to Everyone:  07:34 AM

Hello everyone, I am Cinthya from Chile !

From Mphatso Phiri to Everyone:  07:34 AM

MphATSI

From Delfina Ensinck to Everyone:  07:34 AM

Hello from Argentina!

From Ocung Guido to Everyone:  07:34 AM

Hello from Kampala, Uganda🇺🇬

From Tah Rene Mih to Everyone:  07:34 AM

Greetings from Cameroon 🇨🇲

From Daniel Waiswa to Everyone:  07:34 AM

Daniel Waiswa from Makerere University Kampala Uganda

From Juliana Pinhata to Everyone:  07:34 AM

Good morning from Brazil

From Geoffrey Kabaale to Everyone:  07:34 AM

Greetings from Lira, Uganda

From Teniola Lawanson UniOfEdinburgh to Everyone:  07:34 AM

Hello! Good afternoon (3:33pm) from Lagos Nigeria

From Andrew Ndawula to Everyone:  07:34 AM

Ndawula Andrew, Uganda

From Josephine Victo Namugga to Everyone:  07:34 AM

hheyyy hello from uganda

From Nancy Ngumbau to Everyone:  07:34 AM

Good evening from Kenya

From Gustavo Grandez to Everyone:  07:34 AM

Hello from Peru

From Wieda Human to Everyone:  07:34 AM

Hi from South Africa!

From Jenna Daniel to Everyone:  07:34 AM

Good morning from Atlanta!

From Jefferson Mecha to Everyone:  07:34 AM

good evening, Jerphason Mecha from Kenya

From Katherine Ann Lochner to Everyone:  07:34 AM

Good morning from Seattle, WA!

From Gabriella Jackson to Everyone:  07:34 AM

Good evening from South Africa!:)

From Kristin Harrington to Everyone:  07:34 AM

Hello from Atlanta!

From NELLIE MUKIRI to Everyone:  07:34 AM

Hello, from Kenya

From Nsubuga Gideon to Everyone:  07:34 AM

Hello from Uganda

From Ffion Carlin to Everyone:  07:34 AM

Hello from Liverpool

From Sarah Jbara to Everyone:  07:34 AM

Hello from Costa Rica

From Lídia Cunha to Everyone:  07:34 AM

Mozambique

From Derrick Semugenze to Everyone:  07:34 AM

Hello from Makerere University, Uganda

From Álvaro Díaz to Everyone:  07:34 AM

Good morning, from Chile

From Judith Jajaycucho to Everyone:  07:34 AM

Hello from Peru

From Luke Kneeshaw to Everyone:  07:34 AM

Another Seattleite

From Mphatso Phiri to Everyone:  07:34 AM

Mphatso, from Malawi. Greetings

From Samuel Okello to Everyone:  07:34 AM

Okello Uganda good evening it’s 5:30 here in Uganda

From MAGNOLIA LUQUE DURAN to Everyone:  07:34 AM

Hello from Perú

From Charlotte Barungi to Everyone:  07:34 AM

hello everyone. Charlotte from Uganda

From Irene Ndagire to Everyone:  07:34 AM

south sudan

From matovu — to Everyone:  07:34 AM

hello, greetings from Uganda Makerere University

From Samuel Okello to Everyone:  07:34 AM

good evening

From Ian Amanya to Everyone:  07:34 AM

Hello from Uganda!

From Judy Machuka to Everyone:  07:34 AM

Judy Machuka from Kenya

From Ngonie Dube to Everyone:  07:34 AM

Dr Dube, Baylor Children’s Foundation, Swaziland🇸🇿

From Ruth Nabisere to Everyone:  07:34 AM

Kampala Uganda

From Nguyen Kim Cuong to Everyone:  07:34 AM

hello from Vietnam 🙂

From nassozi rashidah to Everyone:  07:34 AM

Rashidah Uganda Kampala

From Carla Achiro to Everyone:  07:34 AM

hello from Uganda at Makerere University

From Fainet Metrine to Everyone:  07:34 AM

Am from Kenya

From IVAN IBANDA to Everyone:  07:34 AM

Hello to everyone here, Ivan Ibanda from Uganda

From Loren Rockman to Everyone:  07:35 AM

Hello everyone. Loren Rockman from Stellenbosch University, South Africa

From Zuweina Kondo to Everyone:  07:35 AM

hello I am from Tanzania currently in the US

From Martial Sonkoue Pianta to Everyone:  07:36 AM

Cameroon

From Joel.S. kabugo to Everyone:  07:36 AM

kabugo Uganda

From John Enzama to Everyone:  07:39 AM

hello everyone. John Uganda .

From Harriet Namyalo to Everyone:  07:42 AM

Harriet Namyalo from Uganda.Mujhu.greetings

From Christine M. Mbuvi to Everyone:  07:43 AM

Hello, Christine Mbuvi – Kenya

From elisa lopez varela to Everyone:  07:44 AM

Elisa Lopez- ISGlobal, Barcelona, Spain

From sanjobo sanjobo to Everyone:  07:44 AM

Hello, Sanjobo -Namibia

From Miiro Emmanuel to Everyone:  07:44 AM

Hello, Miiro Emmanuel, Uganda.

From Collins Wamunye to Everyone:  07:46 AM

Hello, Collins Wamunye- Kenya

From Rose Mary to Everyone:  07:46 AM

Hi everyone. Rose Mary Namwanje Mujhu site nurse

From Luz Quevedo to Everyone:  07:47 AM

Hi everyone. Luz Quevedo, Peru

From Ednah Okwaro to Everyone:  07:47 AM

Greetings everyone, Ednah Okwaro – Kenya.

From Chen zi to Everyone:  07:47 AM

Hi everyone. Chen from Beijing China

From Blessed Shiko to Everyone:  07:48 AM

Hello everyone  .. Elizabeth Mwangi from Kenya

From Anibal, to Everyone:  07:49 AM

Hi everyone.. ANIBAL VILCA – CITBM . PERU

From Paul K. Drain to Everyone:  07:56 AM

Thanks for indicating your location.  Great to see so many countries being represented.

From tamara leiva to Everyone:  07:57 AM

From Chile here, Tamara Leiva

From bmugabi@baylor-uganda.org to Everyone:  07:57 AM

Hello Everyone. Benedicto Mugabi from Uganda

From Pauline Amuge to Everyone:  07:58 AM

Pauline Amuge. Baylor-Uganda

From Nadia Sitoe to Everyone:  07:58 AM

Nádia Sitoe, Mozambique

From Binta Sarr-Kuyateh to Everyone:  07:59 AM

Hi everyone, Binta Sarr-Kuyateh from The Gambia

From Asia Mustafah to Everyone:  07:59 AM

Greetings

Asia Mustafah from Uganda

From Paul K. Drain to Everyone:  08:00 AM

Please write any questions in the chat box.

From Mbulaka Remmy to Everyone:  08:00 AM

Hello

Mbulaka Remmy Allan from Uganda

From Abdou Fofana to Everyone:  08:05 AM

Can bacterial load be considered as an indicator of TB disease progression? How to explain the dynamics of cyclic progressors

From Robert Rousseau to Everyone:  08:05 AM

Are many mtb genes regulated by the same promoter or operon?

From Michael Kakinda to Everyone:  08:06 AM

How can we identify sub-clinical disease?

From Teniola Lawanson to Everyone:  08:06 AM

Is the ESAT-6 a good antigenic target for vaccine development for TB?

From Abdou Fofana to Everyone:  08:06 AM

To what extent do we understand the mechanisms by which other Mycobacteria have loss ESX-1 expression? (Adaptive evolution?)

From Derrick Semugenze to Everyone:  08:06 AM

Thanks Dr. Sherman. Would you please throw more light on incipient tuberculosis?

From Paul K. Drain to Everyone:  08:06 AM

David – great talk!  Is ESX-1 a good target for new drug development – either for treatment or prevention?

From Cinthya Ruiz-Tagle to Everyone:  08:07 AM

Would it be possible to somehow destabilize the granuloma in order to antibiotics gain access to eliminate Mtb?

From Álvaro Díaz to Everyone:  08:07 AM

Hi, what would be the diagnostic (clinical or bacteriological) for subclinical TB?

From Fainet Metrine to Everyone:  08:07 AM

How can one differentiate between primary TB and Covid19 from an X-ray since both have almost similar symptoms

From David Sherman to Everyone:  08:08 AM

Can bacterial load be considered as an indicator of TB disease progression? How to explain the dynamics of cyclic progressors

From Ernest Aben to Everyone:  08:08 AM

Is the TB spectrum the same in pediatrics or are the dynamics different. If so where and how?. Thank you!

From David Sherman to Everyone:  08:11 AM

Excellent question.  The best answer is ‘probably’.  People are working on markers of bacterial load; these may be very important in studying sub-clinical disease AND improving trials.

How can we ID subclinical disease?  biomarkers (that need to be developed) models (that need to be developed). New imaging modalities (that are starting to be applied to TB).

From Kasendwa Martin to Everyone:  08:12 AM

When does an HIV positive person who received the first complete course of TB preventive therapy become eligible for another course?

Any recent evidence on this?

From David Sherman to Everyone:  08:22 AM

Is the ESAT-6 a good antigenic target for vaccine development for TB?  Vaccines — not my field.  But I think probably not.  Esat-6 is secreted — not always attached to the bacteria.

Are many mtb genes regulated by the same promoter or operon?

Are many mtb genes regulated by the same promoter or operon?

Yes! (sorry for the multiple entires)

David – great talk!  Is ESX-1 a good target for new drug development – either for treatment or prevention?  Interfering with Esx-1WOULD stop TB pathogenesis.  But I fear that by the time people know they are infected, ESX-1 will have already done it’s important work.  There MAY however, be other roles for Esx-1 later in infection, in which case interfering w/ it would still be useful.

Destabilize the granuloma to improve drug access? Access is a big issue for some drugs, not for others.  But keep in mind that granulomas are an important host defense mechanism.  In HIV+ people, granulomas break down or fail to form — and that does not work out well for the patient.

From Paul K. Drain to Everyone:  08:26 AM

Lots of great questions!  There will be more opportunities to ask these questions, and perhaps we can get into some discussion during the expert panel.

From David Sherman to Everyone:  08:29 AM

Sub-clinical TB is an important area of current research. There are likely both host and bacterial markers — transcriptional, protein, etc. The course is very likely different in pediatric TB, and also likely affected profoundly by different co-morbidities.

From Paul K. Drain to Everyone:  08:49 AM

Abdou and others – If you want to join the break room room – click on Break Room at bottom of Zoom, then you’ll see a pop-up window.  From there Find the name of the presenter and over their name, you should be able to click “Join”.

From Ngonie Dube to Everyone:  08:50 AM

Can INH monotherapy in the setting of TB preventative be implicated in fueling rise in DRTB?

From Ngonie Dube to Everyone:  08:51 AM

*TB preventative therapy

From matovu — to Everyone:  08:52 AM

To the current speaker, how does mutation lead to drug resistance?

From Nadia Sitoe to Everyone:  08:53 AM

Is a specific TB DR related to the MTB strain?

From Shuyi Ma to Everyone:  08:55 AM

@Abdou, if you have another question, please feel free to ask me, or to email your question.

From Lomonyang Victor to Everyone:  08:56 AM

Why could acquisition of FQ resistance be high in shorter regimen (9Mo)?

From Abdou Fofana to Everyone:  08:57 AM

@Shuyi, Thanks. You said MTB Waxy cell wall makes drug development challenging (correct me if I’m wrong). Please can you elaborate on that.

From Tanya Parish (Faculty) (She/Her) to Everyone:  08:59 AM

@Abdou – it is challenging because many molecules do not get into the bacterial cell, but also because optimising molecules for anti-Tb activity often makes compounds more hydrophobic and this is the opposite of what is need for drug-like properties.

From Shuyi Ma to Everyone:  09:00 AM

Thanks, Tanya :). On the flip side, it’s an attractive target because it’s so different from what humans have, so if you can get something to target successfully, it will more likely be species-selective

From Courtney Heffernan to Everyone:  09:00 AM

wonderful talk! thank you

From Abdou Fofana to Everyone:  09:01 AM

@Tanya and @ Shuyi, Thanks. Can I ask same question for slow TB bacterial growth?

From Tanya Parish (Faculty) (She/Her) to Everyone:  09:02 AM

The slow growth rate is a practical problem – experiments take a long time. Also it might be related to why it takes so long to kill the organism. We don’t know if kill rate is linked to growth rate.

From Shuyi Ma to Everyone:  09:02 AM

Plus, targeting slow bacterial growth is challenging because many of the processes that conventionally have worked for other bacteria don’t work well for Mtb

From Shuyi Ma to Everyone:  09:03 AM

So we need new screening/search strategies that would be effective for Mtb in these slow/no growing states

From Abdou Fofana to Everyone:  09:04 AM

Great! Thanks to @Tanya and @Shuyi.

From Shuyi Ma to Everyone:  09:04 AM

On the flip side, I think that there have been recent findings by Tanya and others that there are drugs that can target slow growing and non-growing Mtb

From Shuyi Ma to Everyone:  09:04 AM

And these agents potentially offer greater selectivity

Since they target more Mtb-specific adaptations

From DANIEL OKUTU to Everyone:  09:05 AM

how does the anti TB drugs affect the liver if one has not adhered to the medication

From Abdou Fofana to Everyone:  09:05 AM

Slow growth is an adaptation? How variable is this feature within MTB?

From Shuyi Ma to Everyone:  09:06 AM

Growth rate appears to vary quite significantly between different Mtb clinical strains

From different lineages

From Abdou Fofana to Everyone:  09:06 AM

Is it associated with any fitness benefit?

From Shuyi Ma to Everyone:  09:06 AM

And the growth heterogeneity within a population also varies between Mtb strains

From Shuyi Ma to Everyone:  09:07 AM

I think the association between growth and fitness is something that is still being investigated

By David, Tanya, myself, and others

From Abdou Fofana to Everyone:  09:08 AM

This is exciting evolutionary question! Thanks @Shuyi

From Courtney Heffernan to Everyone:  09:09 AM

just wondering since so many questions are being answered in the chat, if a log can be sent after the course of the discussion to review along with the recordings?

From Teniola Lawanson to Everyone:  09:09 AM

Seconded @Courtney

From Shuyi Ma to Everyone:  09:10 AM

That should be doable, I think

From Ednah Okwaro to Everyone:  09:10 AM

That would be great! thank you.

From Me to Everyone:  09:10 AM

Thanks Courtney. I’ll work with Chris to see if we can get a chat transcript uploaded to the course website (same place as presentations will be uploaded next week).

From David Sherman to Everyone:  09:10 AM

we’ll check with our technical wizards

From Courtney Heffernan to Everyone:  09:14 AM

thank you! 🙂

From STEPHANIE ANOVER-SOMBKE to Everyone:  09:38 AM

@Dr. Shapiro, are there on-treatment biomarkers in current trials that do show positive/negative effects of the different therapies as they are dosed/ administered?

From Stavia Turyahabwe to Everyone:  09:44 AM

The 4 months regimen uses drugs that are commonly used for other conditions. what challenges are likely to face the TB fight with wide use of such drugs for TB management?

From elisa lopez varela to Everyone:  09:44 AM

Regarding treatment duration, how much of the problem do you think has to do with drugs not reaching the site of disease? Low penetration at the locations and suboptimal concentrations

From Robert Rousseau to Everyone:  09:51 AM

Could the panel comment on anti-tb therapy being delivered by other means. For example is there a future for inhalent drug delivery?

From matovu Sande to Everyone:  09:55 AM

speaking of personalizing therapies for mtb patients, is there evidence of racial susceptibility to TB?

From Paul K. Drain to Everyone:  09:56 AM

Any questions for our panelists – please either type in chat box or raise your hand.

From Chetan Seshadri to Everyone:  09:56 AM

RE: BPaL.  What is the real-life experience with Linezolid at the high dose?  If so few patients can tolerate it, is it really that important for the success of the regimen?

From sanjobo sanjobo to Everyone:  10:01 AM

What was the substitute for linezolid in patients who developed severe bone marrow toxicity on BPaL?

From Judy Machuka to Everyone:  10:12 AM

Considerng personalizing TB treatment, what investigations would be necessary to confirm treatment success and preclude bacterial rebound or potential for disease progression to MDR TB?

From elisa lopez varela to Everyone:  10:13 AM

Willl we eventually move towards treatment where we can monitor the response and adapt duration based on some sort of biomarker that can tell us how bug/host is responding?

From bmugabi@baylor-uganda.org to Everyone:  10:20 AM

Given that TB is a contagious Disease and almost everywhere,Is there a way of having all countries across the world contribute to a common pool a certain percentage of money to support robust approaches and large trials and not be limited or processes slowed down because of lack of funding?

From Paul K. Drain to Everyone:  10:21 AM

Thanks for the plug on Biomarkers and Diagnostics – we’ll spend all of tomorrow on this topic.  There should be several great presentations and discussions!

From elisa lopez varela to Everyone:  10:22 AM

Any thoughts on how we can reduce the gap between policy-practice in some of the high income countries so that we can really see some of this innovative regimens, diagnostics applied in short timeline?

From Judy Machuka to Everyone:  10:23 AM

Thanks for the insight on diagnostics to monitor treatment progress

From Paul K. Drain to Everyone:  10:25 AM

Thanks to all the panelists!  Thank you David for moderating.  Great discussions!

From elisa lopez varela to Everyone:  10:26 AM

Excellent session! Thanks so much

From Paul K. Drain to Everyone:  10:28 AM

Guidance for Breakout Rooms – please enter your room and turn on your video and unmute.  Please go around the room to introduce yourself, share your country/location, and how you are involved with TB research or practice.  Then, please share your experience with the discussions about these new TB regimens in your country and location.

From Andrea Nansereko to Everyone:  10:28 AM

Thank you for this amazing session

10:34:37 From  Andrea Nansereko  to  Everyone:

Glad to be here. I am Andrea Nansereko, Biomedical laboratory technology student at Makerere University. I volunteer at Mulago hospital in Uganda.

10:56:24 From  Robert Rousseau  to  Everyone:

Thanks for your comments Team

10:56:55 From  Shuyi Ma  to  Everyone:

Thanks for the interesting discussions!

10:57:11 From  Benedicto Mugabi, Baylor College of Medicine, Uganda  to  Everyone:

Do you think COVID 19 regulations will have sustained impact on the incidence of TB?

10:57:22 From  Ednah Okwaro  to  Everyone:

is there an extra forum for interaction like whatsapp for the class?

10:57:28 From  Zuweina Kondo  to  Everyone:

I think random is good , as you get to meet different people- hopefully

10:57:45 From  Andrea Nansereko  to  Everyone:

Could we have a whatsapp group for all students for this course for further discussions?

10:57:47 From  Ednah Okwaro  to  Everyone:

Random is good.

10:58:55 From  Fanny Rosas  to  Everyone:

Totally agree|

10:59:09 From  Kasigula Nicholas  to  Everyone:

I agree

10:59:29 From  Kasigula Nicholas  to  Everyone:

a what’s app group would be good

10:59:51 From  martha nakaye  to  Everyone:

Thank you too

07:31:34 From IVAN IBANDA to Everyone:
Hi everyone, Ivan Ibanda from Uganda
07:31:48 From Isabel Chin to Everyone:
Good morning!
07:33:38 From Robert Kyomuhendo to Everyone:
hello, glad to be here.
I’m Robert Kyomuhendo, medical student at Gulu University, Uganda
07:34:04 From Valerie Webola to Everyone:
Hello,
07:34:31 From Renee Codsi to Everyone:
Good morning from overcast Seattle WA, USA
07:34:33 From Valerie Webola to Everyone:
I’m Valerie Webola , from Kenya.
07:34:52 From Sarah Jbara to Everyone:
Good morning, from Costa Rica, very sunny 🙂 celebrating 200 years of independce today
07:35:13 From Renee Codsi to Everyone:
@Sarah; Pura Vida!
07:35:15 From Wieda Human to Everyone:
Hallo from a lovely Spring day in South Africa.
07:35:20 From Veronica Medrano to Everyone:
Helio,
Veronica from Bolivia
07:35:35 From Edson Mambuque to Everyone:
Good afternoon, from Mozambique, Manhiça Edson
07:35:36 From Ngonie Dube to Everyone:
Hello Ngoni Dube here, warm and sunny in Swaziland🇸🇿
07:35:43 From Rafaella Osores Urday to Everyone:
Hello! From Lima, Peru
07:35:44 From Jenna Daniel to Everyone:
Good morning from Atlanta! Rainy and humid here, per usual!
07:35:50 From Carla Achiro to Everyone:
Greetings! Carla from Makerere University school of Public Health, Kampala Uganda
07:35:51 From Joey Hernandez to Everyone:
Good evening from Manila, Philippines! 10:30 pm here, very warm and humid.
07:35:59 From Isabelle Munyangaju to Everyone:
hello. Isabelle 🇲🇿 Mozambique
07:36:31 From martha nakaye to Everyone:
Hello, Martha Nakaye here from the Pearl of Africa, Uganda. Its a sunny evening here.
07:36:34 From Ray Mwin Mat. to Everyone:
Hello everyone, joining from Namibia, very hot here!
07:36:34 From Dra Laura Lagrutta to Everyone:
Hello I´m Laura Lagrutta from Argentina
07:36:34 From Kate Shearer to Everyone:
Good afternoon from a beautiful day in Johannesburg, South Africa
07:36:35 From florence mwangwa to Everyone:
Good evening , am Florence From IDRC- Uganda, its a beautiful evening.
07:36:56 From Delfina Ensinck to Everyone:
Hi! I´m Delfina from Argentina
07:37:01 From Georgetta K. Daffeh to Everyone:
Good afternoon, I am Georgetta from MRC@lshtm in Gambia. Sunny and warm day here
07:37:21 From Mbulaka Remmy to Everyone:
Good evening
Mbulaka Remmy Allan
From Uganda
07:37:44 From mukwatamundu jobterry to Everyone:
Hello, Job from IDRC-Uganda. A sunny evening here
07:38:19 From Daniel Waiswa to Everyone:
Hullo everyone, Daniel Waiswa from Makerere University Kampala, Uganda
07:38:48 From Lídia Cunha to Everyone:
hello from Mozambique
07:39:07 From Lomonyang Victor to Everyone:
hello everyone, Victor Lomonyang Uganda
07:39:16 From Qader Ghulam to Everyone:
Greetings from Afghanistan
07:39:50 From STEPHANIE ANOVER-SOMBKE to Everyone:
Good Morning from Seattle, WA USA
07:46:47 From Qader Ghulam to Everyone:
Is the distribution of DS and DR TB based on the reported cases or based on real Prevalence?
07:47:28 From Harriet Namyalo to Everyone:
Good evening everyone . Harriet Namyalo.MUJHU uganda
07:56:25 From Luz Quevedo Cruz to Everyone:
Luz Quevedo Cruz, Peru
08:02:09 From Debbie Cross to Everyone:
Sorry I missed that, is the cell-free DNA assay identifying subclinical disease? Thank you for the presentation!
08:04:55 From Abdou Fofana to Everyone:
@Paul, on top of the heterogeneity in disease progression we can have bidirectional progression. Example someone can be active and become subclinical a couple of weeks later. Do we know how often that happen? And is this a challenge for diagnostic/Biomarker development? And how are people in the space approaching this issue.
08:06:53 From Sindhulina Chandrasingh to Everyone:
@Paul You had shown a slide where there is a higher MDR /DR TB in areas different from areas with higher incidence. Is that because of better detection ? or is there some other reason ?
08:08:18 From Rose Mary to Everyone:
Hi everyone. Rosemary Namwanje Mujhu site Uganda.
08:09:08 From NELLIE MUKIRI to Everyone:
Hello, greetings from Kenya
08:09:19 From benedicto Mugabi, Baylor Uganda to Everyone:
Hello everyone, Benedicto Mugabi from Uganda
08:09:44 From Paul K. Drain to Everyone:
Thanks everyone for the greetings. Seems like many places are warm and sunny – very nice! Some are staying up late at night – thank you for joining us (hard to find a good timeframe that works for everyone).
08:09:44 From ELIZABETH MWANGI to Everyone:
Hello
08:09:48 From Emmanuel Biryabarema to Everyone:
Hi everyone. It’s Emmanuel Biryabarema from Makerere University, Uganda
08:09:52 From nassozi rashidah to Everyone:
Hello Rashidah Nassozi from Uganda mujhu
08:10:13 From ELIZABETH MWANGI to Everyone:
Hello Elizabeth Mwangi from Kenya
08:11:30 From Paul K. Drain to Everyone:
@Qader – most of the global data reported by the WHO have relied on passive reporting from each country. Some countries are engaging more in active surveillance for better prevalence/incidence data.
08:12:58 From Paul K. Drain to Everyone:
@Debbie – the results for urine cell-free DNA was conducted on symptomatic patients. The next step is to confirm the results and then test the idea on Asymptomatics with sub-clinical TB.
08:13:06 From elisa lopez varela to Everyone:
Elisa Lopez- Spain
08:13:50 From Zuweina Kondo to Everyone:
Hi ! Zuweina- Tanzania
08:16:13 From Charlotte Barungi to Everyone:
Hello, am Charlotte Barungi from Uganda
08:16:37 From Paul K. Drain to Everyone:
@Abdou – Yes, disease progress is very heterogeneous – we recognize that some people will revert from active to sub-clinical TB, and we tried to represent that in the figure with the ‘cyclic’ (or waxing/waning) line. We have very little data on this group of people, but we should seek more understanding.
08:18:58 From Paul K. Drain to Everyone:
@Samuel – yes, there are many risk factors for “sub-clinical” TB and how long someone will stay in that phase – includes HIV/CD4, DM, exposures, and host immune function.
08:19:35 From Stephanie Minnies to Everyone:
Could these signatures be used to predict those who will develop extrapulmonary TB vs pulmonary TB?
08:19:41 From Paul K. Drain to Everyone:
If you have questions for Dr. Shah – Please type in Chat Box or Raise Hand.
08:20:35 From Maryam Amour to Everyone:
Hi everyone! Maryam Amour from Tanzania
08:21:03 From Dennis Mujuni to Everyone:
Are there signatures to differentiate DR and DS TB among Latent TB Infections?
08:21:06 From STEPHANIE ANOVER-SOMBKE to Everyone:
Can the gene signature be adapted for a POC based test?
08:22:10 From Dra Laura Lagrutta to Everyone:
Are there any biomarkers signatures that may have an affordable cost?
08:22:14 From Mugerwa Moses to Everyone:
is there any reason why TB LAM test has been approved for use specifically in people living with HIV ?
08:22:18 From Sarah Jbara to Everyone:
Are those biomakers detected in NTM disease?
08:22:18 From Nadia Sitoe to Everyone:
What about the WB T CD4 specific cell activation and maturation profile using flow cytometry?
08:22:54 From Vanessa Mwebaza Muwanga to Everyone:
Since type I interferons or anything related to interferon signalling comes up a lot when it comes to transcriptomic work on active TB, would we take those to mainly be biomarkers or correlates of risk and not of protection?
08:23:02 From Simon Mendelsohn to Everyone:
Transcriptional signature diagnostic performance seems to have reached a ceiling: Do you think we will be able to break through this ceiling, and how?
08:23:12 From Nguyen Kim Cuong to Everyone:
Can we have the similar biomarker to recognize the transformation from clinical TB to subclinical TB ?
08:24:57 From Emmanuel Biryabarema to Everyone:
is there any reason why TB LAM test has been approved for use specifically in people living with HIV ?
08:25:09 From Emmanuel Biryabarema to Everyone:
Was this answered?
08:27:38 From Paul K. Drain to Everyone:
@Emmanuel – the current LAM test are only accurate among PLHIV with low CD4 – which likely reflects a high TB bacillary load.
08:28:02 From Emmanuel Biryabarema to Everyone:
Thank you
08:33:48 From Ann Ritah to Everyone:
What is the role of the training data and how is done collected
08:36:03 From Simon Mendelsohn to Everyone:
left
08:36:05 From Kim Foster to Everyone:
left
08:36:06 From Isabel Chin to Everyone:
left
08:36:06 From Emmanuel Moreau to Everyone:
L
08:36:06 From Robert Rousseau to Everyone:
left side
08:36:07 From Renée Codsi UW Seattle to Everyone:
Post pandemic the image on the right
08:36:09 From Edson Mambuque to Everyone:
Lesft
08:36:09 From Wieda Human to Everyone:
left
08:36:10 From Lucía Loy to Everyone:
left
08:36:12 From Sindhulina Chandrasingh to Everyone:
left
08:36:13 From Edson Mambuque to Everyone:
*left
08:36:16 From Stavia Turyahabwe to Everyone:
left
08:36:18 From matovu Sande to Everyone:
left
08:36:19 From DANIEL OKUTU to Everyone:
left
08:36:21 From Teniola Lawanson UniOfEdinburgh to Everyone:
Left
08:36:34 From IVAN IBANDA to Everyone:
Left
08:40:43 From Cinthya Ruiz-Tagle to Everyone:
Is LAM testing specific for TB or could it exist cross reaction with M. leprae?
08:41:35 From martha nakaye to Everyone:
Is Urine LAM specific for pulmonary or extra pulmonary TB
08:41:52 From Cinthya Ruiz-Tagle to Everyone:
Since LAM has also been described as possible biomarker for leprosy
08:42:08 From DANIEL OKUTU to Everyone:
what duration of receiving the results while using the oral swab?
08:42:11 From Paul K. Drain to Everyone:
@Cinthya – Yes, LAM is in the cell wall of all Mycobacterium. So, LAM testing can be positive with NTMs.
08:43:42 From Qader Ghulam to Ksenia P Koon(Direct Message):
Greetings Ksenia. Would you please share the link to get the course materials?
08:44:17 From Ksenia P Koon to Qader Ghulam(Direct Message):
Hello Qader. Sometime next week, the recordings of the presentations will be posted here: https://courses.washington.edu/tbresearchcourse/curriculum-schedule/
08:44:58 From Daniel Waiswa to Everyone:
Hullo Dr. Shah which molecular mechanism does M.tb exploit to avoid killing by IL-1B through induction of type I interferon
08:45:06 From Lisa Marie Cranmer MD to Everyone:
@Martha – Urine LAM is more sensitive for EPTB, not specific to distinguish EPTB vs PTB
08:45:10 From Georgetta K. Daffeh to Everyone:
Do you encounter issues of high rate contaminated oral swab samples? If yes how do you overcome this?
08:45:10 From Qader Ghulam to Ksenia P Koon(Direct Message):
Thanks.
08:45:23 From florence mwangwa to Everyone:
Interesting presentation on oral swabs. Have you noticed diurnal variation in sensitivity as for sputum where a morning sample is thought to yield more
08:46:13 From Edson Mambuque to Everyone:
Do you have information if early swab would perform better compared to spot swab?
08:46:59 From Derrick Semugenze to Everyone:
Did you look at the best timing for collection of oral swabs? Would for example an early morning swab detect better?
08:50:01 From martha nakaye to Everyone:
@ Thanks Lisa
08:53:30 From Rose Mary to Everyone:
A swab from tongue does it require fasting?
08:55:39 From Jerry Cangelosi to Everyone:
@Cynthia – I don’t know much about LAM testing for leprosy. I’d love to hear more!
08:55:54 From Ann Ritah to Everyone:
@ Jerry is acoustic monitoring done at patient will whenever they wish to cough or a device is installed in buildings to capture any people that are coughing in a given area
08:56:18 From elisa lopez varela to Everyone:
Bless you1
08:56:52 From Jerry Cangelosi to Everyone:
@Martha – Urine LAM is thought to be more sensitive for detecting extrapulmonary TB. But I wouldn’t call it “specific” for either form.
08:57:52 From Jerry Cangelosi to Everyone:
@Daniel – depends on analysis method. When using Xpert it is possible to receive results in real time (eg 2 hours from sampling to result).
08:57:58 From martha nakaye to Everyone:
@ Jerry , thank you
09:00:37 From Jerry Cangelosi to Everyone:
@Georgetta – We have used a manual PCR for oral swabs which can cause specificity problems. They mostly go away when we use Xpert. Non-disease carriage of TB in the mouth is possible though. But it requires longitudinal studies to know if they are “non-disease” or “incipient disease”. Such studies are very much needed
09:01:33 From Jerry Cangelosi to Everyone:
@Florence – yes, oral swabs appear to be slightly more sensitive in the early morning (so is sputum testing). See Luabeya et al, 2019.
09:02:29 From Georgetta K. Daffeh to Everyone:
Thank you.
09:02:30 From Jerry Cangelosi to Everyone:
@Edson – What is spot swab?
09:03:01 From mukwatamundu jobterry to Everyone:
which could be the best possible time for collecting an oral swab, before or after a patients has coughed?
09:03:03 From florence mwangwa to Everyone:
thanks Jerry
09:03:35 From Jerry Cangelosi to Everyone:
@Ann – acoustic monitoring is very early stage and exploratory. But in theory it could involve either individual or group (site) monitoring.
09:05:07 From Jerry Cangelosi to Everyone:
@Mukwatamundu – great question. It’s possible that oral swabs work better AFTER coughing. But the whole idea is to make sampling easier and safer, so we don’t want coughing as a required step. Most evaluations have omitted preliminary coughing.
09:08:13 From Sylvia M LaCourse to Everyone:
@ Lisa Very comprehensive talk!
09:09:28 From Paul K. Drain to Everyone:
Take a 5 minute Bio-break. We’ll resume at 12 minutes past hour.
09:10:44 From Ann Ritah to Everyone:
@ Jerry; What is the role of the training data and how is done collected
09:17:25 From Jerry Cangelosi to Everyone:
@Ann – When looking at VOCs or cough patterns, there may be differences between different populations. For example, because of different diets, comorbidities, or microbiota. So developers are advised to “train” their algorithms for a specific region. Obviously this is problematic for widespread implementation. This is why traditional microbiological markers (e.g. pathogen DNA) have an advantage.
09:17:33 From Lomonyang Victor to Everyone:
why are incidences high in post pregnancy?
09:18:32 From Lisa Marie Cranmer MD to Everyone:
@Victor: Likely related to pregnancy and postpartum immune changes, which involve lower Th1 responses important in Mtb response. These return to normal in the first 3-6 months postpartum.
09:19:16 From Lomonyang Victor to Everyone:
Thanks!
09:19:19 From Lisa Marie Cranmer MD to Everyone:
See Jonnagaladda’s study on longitudinal ESAT/CFP10 responses during pregnancy/postpartum
09:21:30 From Jerry Cangelosi to Everyone:
@Derrick: oral swabs appear to be slightly more sensitive in the early morning (so is sputum testing). See Luabeya et al, 2019.
09:22:33 From Derrick Semugenze to Everyone:
@Jerry: Thanks
09:27:54 From Ernest Aben to Everyone:
@Jerry, can self collection at home for an early morning oral swab approach improve yield over the onsite collection?
09:27:56 From Sylvia M LaCourse to Everyone:
@ Grace Fantastic overview!
09:28:47 From Charlotte Barungi to Everyone:
good presentation on how to dx for TB in PLWHIV, thanks
09:28:47 From Emmanuel Biryabarema to Everyone:
Thank you @Grace for the Awesome presentation
09:29:09 From Jerry Cangelosi to Everyone:
@Ernest – that is quite possible.
09:29:12 From Lisa Marie Cranmer MD to Everyone:
@Grace fantastic talk!!
09:30:08 From Ernest Aben to Everyone:
@Jerry, in your experience, what would be the likely challenges with home self collection, given ease of the collection procedure…I am thinking of something in this line…and utilize xpert for testing
09:30:33 From Lomonyang Victor to Everyone:
What are the chances of mother with TB giving birth to a child with disease?
09:32:14 From Jerry Cangelosi to Everyone:
@Ernest – We gained a lot of experience on this from the COVID pandemic. Inevitably, unsupervised self-sampling doesn’t perform quite as well as supervised (by clinician) sampling in a clinical setting. But it can still be very useful if it greatly expands the number of people screened. Self-sampling with tongue swabs is not hard to learn. Good training materials are essential.
09:32:15 From Sylvia M LaCourse to Everyone:
Risk much higher through respiratory exposure with close maternal infant contact
09:33:18 From Ernest Aben to Everyone:
Thanks @Jerry, this is very helpful
09:33:57 From Lisa Marie Cranmer MD to Everyone:
@Lomonyang: Congenital transmission ery low, <5% but more ~1%
09:34:04 From Lisa Marie Cranmer MD to Everyone:
Can present as primary hepatic complex – abdominal US useful
09:34:09 From Lisa Marie Cranmer MD to Everyone:
also can present as primary pulmonary complex
09:34:49 From Lomonyang Victor to Everyone:
Thanks Lisa
09:34:52 From Jerry Cangelosi to Everyone:
@Ernest – if you are thinking of using Xpert please write to me and we’ll send you our methodology. Some methods work better than others.
09:39:59 From Ernest Aben to Everyone:
Thanks @Jerry. Will be in touch. Kindly share your email address
09:41:52 From Stavia Turyahabwe to Everyone:
How is COVID testing on Xpert machines threatening progress for rapid TB diagnosis. Is there research for using same sample for TB and COVID testing diagnosis.
09:42:58 From Dra Laura Lagrutta to Everyone:
do you think that FujiFimn can be used in children HIV negatives?
09:43:24 From Jerry Cangelosi to Everyone:
@Stavia – yes, several groups are working on that. Ideally, in TB- and COVID-endemic settings, every sample should be tested for both.
09:44:03 From Lomonyang Victor to Everyone:
What does the panelist say about use of TB LAM testing for other patients than PLHIV?
09:45:15 From Dra Laura Lagrutta to Everyone:
What are the most promising biomarkers in response to treatment?
09:45:42 From Georgetta K. Daffeh to Everyone:
Which of the human sample types is so far more promising for detecting TB aside sputum?
09:48:50 From mukwatamundu jobterry to Everyone:
For treatment follow up for patients on anti TBs, which other possible method/sample may be used for follow up apart from using sputum
09:50:39 From Lomonyang Victor to Everyone:
TB LAM Positive patients are classified as Pulmonary Bacteriologically Confirmed. What is the recommended method for follow up of treatment response.
09:52:56 From Jerry Cangelosi to Everyone:
Good point Emmanuel
10:00:13 From Abdou Fofana to Everyone:
What about risk of TB transmission profile ? (vs risk of developing TB) which will justify the need to detect people with incipient and subclinical TB
10:06:03 From Josephine Victo Namugga to Everyone:
how feasible are anti MS and MPT51 biomarkers in TB diagnosis
10:07:20 From Josephine Victo Namugga to Everyone:
in incipient or subclinical TB diagnosis
10:19:18 From martha nakaye to Everyone:
is it possible to detect LAM antigen in blood, and sputum other than Urine whose sensitivity is low in some populations.
10:19:21 From Derrick Semugenze to Everyone:
Is it possible to investigate mycobacterial mRNA in treatment monitoring?
10:21:57 From Emmanuel Moreau to Everyone:
LAM in blood or sputum: yes. However, whether it will be more sensitive of not is still to be determined.
10:32:57 From Jerry Cangelosi to Everyone:
@Derrick – mRNA – yes but it isn’t perfect. Nick Walter at U. Colorado just published a study on another RNA molecule – rRNA precursor (pre-rRNA). There is potential there as well.
10:34:01 From Lubega Jason to Everyone:
Someone talk about why MPT64 antigen is being sidelined
10:40:43 From Wilson Mangeni to Everyone:
Yes we are doing many procedres
10:40:51 From Jerry Cangelosi to Everyone:
Are you involved with the oral swab analysis?
10:59:24 From Robert Rousseau to Everyone:
Thanks team for the discussion :).

07:26:53 From Rafaella Osores Urday to Everyone:
Hello! From Lima, Peru
07:28:21 From Judy Machuka to Everyone:
Hi from Kenya
07:28:44 From Blessed Shiko to Everyone:
Hello everyone, Elizabeth Mwangi from Kenya
07:30:32 From Lubega Jason to Everyone:
Hello everyone. Hope you all alright!😄
07:31:13 From anibal_medicina@hotmail.com to Everyone:
Good Morning. thanks for the excellent expositions and the update of the TBC themes.
07:31:31 From Isabel Chin to Everyone:
Good morning!
07:31:33 From Lomonyang Victor to Everyone:
Hello! Victor Lomonyang Uganda
07:31:35 From anibal_medicina@hotmail.com to Everyone:
ANIBAL VILCA. CITBM. PERU
07:31:42 From Irene Ndagire to Everyone:
Hi 👋
07:32:03 From Yvette Rodriguez to Everyone:
Good morning from Seattle! 🙂
07:32:47 From IVAN IBANDA to Everyone:
Hi, Ivan Ibanda from Uganda. It is a cloudy evening here.
07:32:49 From Rafaella Osores Urday to Everyone:
Cold cold winter in Peru
07:33:09 From Irene Ndagire to Everyone:
good evening from South Sudan
07:33:38 From Jerphason Mecha to Everyone:
Jerphason Mecha from Kenya-Kisumu City
07:33:44 From Derrick Semugenze to Everyone:
Hello everyone. It is a cloudy evening here in Kampala, Uganda. Glad to be here again
07:34:18 From Isabelle Munyangaju to Everyone:
👋. Isabelle 🇲🇿 Mozambique
07:34:26 From Dra Laura Lagrutta to Everyone:
hello I´m Laura from Argentina
07:35:51 From matovu Sande to Everyone:
good morning, good afternoon and good evening from Makerere Univesity Kampala, Uganda
07:36:16 From martha nakaye to Everyone:
Good evening
07:37:13 From bmugabi@baylor-uganda.org to Everyone:
Hello everyone. Benedicto Mugabi from Uganda
07:38:01 From Teniola Lawanson UniOfEdinburgh to Everyone:
Hello there from Lagos, Nigeria. Teniola Lawanson
07:38:55 From Carla Achiro to Everyone:
Greetings! Carla Achiro MPH student – Makerere University School of Public Health
07:38:56 From Daniel Waiswa to Everyone:
Good morning, good afternoon and good evening.
Daniel Waiswa, Makerere University Kampala, Uganda
07:45:37 From Robert Kyomuhendo to Everyone:
I love the discussion,
Robert Kyomuhendo, medical student at Gulu University.
07:47:03 From Paul K. Drain to Everyone:
Thanks for joining everyone. If you haven’t already, please let us know where you’re located. It’s cool, but sunny in Seattle.
07:48:01 From Suman Gurung to Everyone:
Good evening, I am Suman Chandra Gurung from Nepal
07:48:13 From Tah Rene Mih to Everyone:
Greetings from Cameroon 🇨🇲
07:49:13 From Fainet Metrine to Everyone:
Hello, am from Nairobi Kenya
07:49:21 From Collins Wamunye to Everyone:
Hello everyone, Collins from Nairobi, Kenya.
07:50:05 From Joel.S. kabugo to Everyone:
good evening, kabugo from Uganda 🇺🇬
07:50:53 From Derrick Semugenze to Everyone:
How was the strength of cough measured?
07:52:07 From Derrick Semugenze to Everyone:
During using the CASS machine
07:52:20 From Stavia Turyahabwe to Everyone:
How is the massive universal use of masks affecting transmission of tuberculosis? Any study findings
08:00:52 From Dra Laura Lagrutta to Everyone:
lymph nodes that drain, what would be the possibility of transmission?
08:00:58 From Jerphason Mecha to Everyone:
Nice talk Dave!
08:00:59 From Lomonyang Victor to Everyone:
Great
08:01:23 From Peter Small to Everyone:
👏
08:01:28 From Collins Wamunye to Everyone:
Wonderful presentation Dave
08:01:29 From Michael Kakinda to Everyone:
If ACF is not very effective what options do we have?
08:01:52 From Kevin Sellanga to Everyone:
great presentation Dave
08:03:21 From Paul K. Drain to Everyone:
Great questions. David Horne will NOT move into a speaker room, so please write any questions for David in the Chat box.
08:06:12 From David J. Horne to Everyone:
Great question Kevin re: ACF effectiveness. Whether cost-effective strategies exist is still an outstanding question. Would targeting of small neighborhoods that are geographic hotspots be an effective strategy? Things need to be studied and in the meantime we should implement WHO strategy of TPT provision to household contacts regardless of HIV status. Also better diagnosis of patients that present for care (and are wrongly diagnosed with non-TB illness) is important (evident from national prevalence surveys).
08:06:38 From Charlotte Barungi to Everyone:
Hello every one
Charlotte Barungi from MUJHU Uganda
08:07:01 From Qader Ghulam to Everyone:
Hello to you all. Qader from Afghanistan
08:07:02 From David J. Horne to Everyone:
Derrick – cough strength measured with a simple (and cheap) peak flow meter
08:07:07 From Magnolia Luque Durán to Everyone:
Hello everyone , from Perú.
08:10:04 From David J. Horne to Everyone:
I don’t think of lymph node drainage as usually being infectious in the absence of aerosolization (blasting the sinus tract with a water jet, for example) or some form of direct inoculation.
08:14:32 From Dra Laura Lagrutta to Everyone:
thank you
08:18:20 From Harriet Namyalo to Everyone:
HI
08:21:47 From Peter Small to Everyone:
Jason, i missed one point. In your resister cohort, of the 254 tst negative at 24 months, how many remained tst negative 8-10 years later?
08:23:12 From Stavia Turyahabwe to Everyone:
any ideas on the infectiousness of COVID 19 in sputum compared to MTB. which is more likely to be transmitted through aerosol
08:23:41 From Judy Machuka to Everyone:
While LTBI has protective effects, what is the threshold at whch TB Preventive Therapy become significant to prevent TB disease progression? Thank you
08:23:43 From Nadia Sitoe to Everyone:
Jason, what about the TAM-TB assay to distinguish infected and LTBI?
08:42:55 From Jason Simmons to Everyone:
Thx Nadia, while I’m not an expert in TAM-TB and other novel diagnostics, I think there is still a barrier in sensitivity for ‘latent TB’. There may be more encouraging data and I am hopeful we can do better than status quo to better risk-stratify LTBI for TPT.
08:44:49 From Jason Simmons to Everyone:
Thx Ann, some baseline BAL data was recently published (PMID: 33836031). We are working on more BAL collections for more functional studies (ex vivo infections, etc), stay tuned.
08:45:19 From Jason Simmons to Everyone:
Ann, also the data shared was from blood only.
08:45:46 From Peter Small to Everyone:
Having spent decades with RFLP based mol epi, I’m so envious of your technology… what questions do you think are most important to readdress with your improved technology
08:50:23 From Ann Ritah to Everyone:
Thanks Jason. Great data
08:54:38 From Joshua Herbeck to Everyone:
@Peter That’s a good question. I think the hope for all genomic epidemiology (for all possible pathogens) is to directly inform prevention activities… Perhaps by identifying outbreaks more quickly (“real time” genomic epi), or identifying individual risk factors for transmission. For TB the use of genomic sequence data definitely allows for finer scale resolution of local transmission chains, which can help both of these questions.
09:00:39 From Maryam Amour to Everyone:
How many times should a person living with HIV in TB endemic area use TPT in their lifetime?
09:01:38 From Stavia Turyahabwe to Everyone:
what about for children contacts when would they repeat therapy
09:01:50 From Stavia Turyahabwe to Everyone:
and other contacts
09:02:08 From Peter Small to Everyone:
While I can’t argue against that as a way to prioritize research, i think there is value in fun/fundamental questions… one of my favorite projets was using genetic and geographic distances to infer the impact of human demography on bacterial evolution – it would be interesting to see if the conclusions we made stand up to better genetic distance measures.
09:02:41 From Peter Small to Everyone:
my last comment was directed to Joshua
09:03:03 From Collins Wamunye to Everyone:
What happens for children who don’t complete the TPT due to stock-out at the facilities.
09:03:58 From tamara leiva to Everyone:
And what happen with people witth the diferents treatment of cancer? Does they suffer inmunosuppresion? What to do in this cases? Apply isoniacid profilactic treatment?
09:08:15 From Jack Karugah to Everyone:
Kenya is just started 3hp
09:08:23 From Jack Karugah to Everyone:
*has
09:08:55 From Maryam Amour to Everyone:
Tanzania use 3HP is research settings, it’s not fully rolled out. We still use isoniazid
09:09:17 From Paul K. Drain to Everyone:
Taking a Bio Break – will resume in 5 minutes – or 13 minutes after the hour.
09:09:33 From Ngonie Dube to Everyone:
Swaziland also using 3HP since June
09:09:57 From Joshua Herbeck to Everyone:
@Peter Yes, of course, I do agree that genomic epi (and all research, really) shouldn’t necessarily result in direct actionable results! I brought that up in my previous comment just to highlight that that is what most genomic epi grant applications and paper discussion sections say about the work. And, despite the cool technology and exciting analyses, it is my experience that phylogenetics and genomic epi still has to show that it can add substantial findings above and beyond standard epi.
09:11:08 From Joshua Herbeck to Everyone:
And I say that as a phylogeneticist and fan and supporter of the field!
09:12:18 From Lubega Jason to Everyone:
Uganda also started 3HP treatment and they have done some studies. https://pubmed.ncbi.nlm.nih.gov/34193311/ https://chs.mak.ac.ug/system/files/3HP%20Hybrid%20Type%20Implementation%20Sciences%20DOT%20SAT.pdf https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-021-00173-2
09:29:31 From Jack Karugah to Everyone:
Anyone with pointers to possible regimens for TPT for MDR/RR TB?
09:31:40 From Isabelle Munyangaju to Everyone:
@Jack…in Mozambique we are using Levofloxacin for TPT for RR/TB contacts if the index case doesn’t have resistance to fluoroquinolones.
09:32:43 From Jerphason Mecha to Everyone:
Nice talk Sylvia
09:32:47 From Ann Ritah to Everyone:
in the iTIPS trial, what was the TB status of the mothers
09:33:28 From Lomonyang Victor to Everyone:
Thanks Sylvia, Do under 5 contacts of PCD and EPTB qualify for TPT??
09:34:16 From Kevin Sellanga to Everyone:
excellent presentation Sylvia.
09:34:16 From Maryam Amour to Everyone:
Whats the recommended TPT regimen for pregnant/postpartum women
09:34:22 From Jack Karugah to Everyone:
@Isabelle, Thanks
09:34:36 From Ann Ritah to Everyone:
Did the kids get BCG at birth? This could affect their TST resualt
09:44:22 From martha nakaye to Everyone:
how can you tell that some one is responding to treatment using the hyfe app. and is this comparable to any of the available gold standards like smear microscopy.
09:45:36 From Ann Ritah to Everyone:
@Sylivia, I wonder why the primary out come would be set at MTB infection if the moms were presumably not infected/ without active disease. Where did they think the babies would acquire the MTB infection from?
09:46:13 From Peter Small to Everyone:
good question! like most cough questions the answer is “we don’t know but its testable”. Enrolling treatment cohorts and comparing cough and traditional endpoints would be super interested! Lets do it…
09:46:31 From Sylvia M LaCourse to Everyone:
@ Maryam Amour: current WHO recommendation is still INH, as you saw we need additional safety and PK data for 3HP and 1HP in pregnancy in setting of DTG where it is likely that we wil need to double the dose of DTG.
09:47:12 From Abdou Fofana to Everyone:
@Peter, Are you thinking of adding contact tracing on top of Cough monitoring in the Hyfe App?
09:48:34 From Sylvia M LaCourse to Everyone:
@ Rita – the big issue is that it really difficult to assess exposure and that for many/most children in higher TB burden settings we don’t clearly identify exposures. So the idea is that there is likely a lot of additional exposure that we miss identifying in these youngest children at greatest risk for infection and progression to TB disease.
09:49:35 From Peter Small to Everyone:
that is another interesting application! can it be used to identify prevlent or incident cases
09:50:47 From Isabelle Munyangaju to Everyone:
the cough app is quite revolutionary…but in my view it will be for screening. I still have a problem how it will help me know whether it is resistant or sensitive TB. Because for remote areas that is the point of care test one needs – to tell clinician it is either sensitive or resistant TB…so we can start the right treatment promptly.
09:51:24 From Sylvia M LaCourse to Everyone:
@ Ann Ritah – excellent point RE BCG and TST. yes all children received TST at birth. You’re point is well taken that TST positivity can be associated with BCG. Our current diagnostics including both TST or IGRA have many limitations.
09:53:06 From Sylvia M LaCourse to Everyone:
@ Kevin Sellenga @ Jerphason Mecha: thanks for joining!
09:53:06 From Jerry Cangelosi to Everyone:
MTB DNA can be detected in the oral cavities of >90% of people with active TB. I wonder if a quantitative approach to this can say anything about potential infectiousness? I wonder if it correlates with cough frequency?
09:53:31 From Jason Simmons to Everyone:
Peter – similar comment on the ‘combined power’ that handheld devices to monitor cough and GPS localization (contact tracing). Can you comment on privacy barriers in using technology to identify high-risk transmission sites in public locations.
09:57:13 From Jerry Cangelosi to Everyone:
Agree, it could be a transitory phase.
09:57:41 From Peter Small to Everyone:
@isabelle – I agree we need poc DST. historically we used pts as a biomarker for DST (AFB conversion at 2 months) which was horrible! However, i wonder if failure to resolve cough has clinical prognostic value
09:58:07 From Ann Ritah to Everyone:
@ Sylivia, did any of the kids ever become HIV positive given that they were exposed at birth (by being born to HIV positive moms)? Were there any adverse effects of having given TST at birth and then INH to those who received it? Was there any follow up post INH treatment for the kids? Interesting study, thanks
09:59:43 From Sylvia M LaCourse to Everyone:
@ Anna Ritah- thanks for your questions. Link to paper: https://pubmed.ncbi.nlm.nih.gov/32564076/
10:00:11 From Ffion Carlin to Everyone:
What if cough is due to other respiratory pathology as a consequence of post tb lung disease in a high burden setting? Culture is an imperfect gold standard, CXR often abnormal, what other differentials are not being diagnosed either concurrently or TB mimics.
10:04:11 From Sylvia M LaCourse to Everyone:
@ Ritah 2 children were later dx with HIV. No TST adverse events. SAEs were similar between INH and NO INH arms. Longer term follow up to 24 months is ongoing and was presented at IAS 2021 Abstract OAB0205. https://onlinelibrary.wiley.com/doi/10.1002/jia2.25755?mi=15pn4y5&af=R&AllField=%28HPV+OR+HPV*%29+AND+COBAS+AND+%288800+OR+6800%29&content=articlesChapters&countTerms=true&target=default
10:04:39 From Isabelle Munyangaju to Everyone:
this is a really great discussion
10:06:38 From Peter Small to Everyone:
@Ffion I think TB is the leading cause of non-infectious cough in the world – post treatment bronchiectasis
10:15:40 From Judy Machuka to Everyone:
What is the association between pleural effusion and scarring of the lung tissue with TB infection?
10:26:05 From Peter Small to Everyone:
download the cough app for free at http://hyfeapp.com and send me any feedback peter@hyfe.ai
10:27:21 From Dra Laura Lagrutta to Everyone:
I think that the objective should be to reach the diagnosis at a subclinical stage. before coughing and transmitting
10:28:10 From Ffion Carlin to Everyone:
Thank you for a great discussion
10:29:20 From DANIEL OKUTU to Everyone:
thank you
10:29:32 From Judy Machuka to Everyone:
Thank you for the rich discussion
10:29:37 From Jerphason Mecha to Everyone:
Thank you
10:34:11 From ANIBAL VILCA to Everyone:
hello
10:35:18 From Robert Rousseau to Everyone:
Has The Cameroon ministry of health rolled 3HP?
10:35:19 From Tah Rene Mih to Everyone:
I’m interested in infectious diseases, that’s the reason I enrolled in this course
10:57:32 From Yvette Rodriguez to Everyone:
@Gabriella Jackson and John. It was great talking with y’all!
10:57:52 From Sarah Jbara to Everyone:
Thank you
10:58:10 From Gabriella Jackson to Everyone:
@Yvette and John – thank you me too!
10:58:15 From John Enzama to Everyone:
Thanks Yvette and Gabriella
10:58:20 From Tah Rene Mih to Everyone:
@Ronald, Roseau glad to chat with you
10:58:51 From matovu Sande to Everyone:
my friends from Kenya, thanks, it has been a great talk
10:58:59 From Dra Laura Lagrutta to Everyone:
Thank you

From Isabel Chin to Everyone:  07:29 AM

Good morning!

From Emmanuel Biryabarema to Everyone:  07:30 AM

Good evening from Uganda

From Me to Everyone:  07:30 AM

Good morning everyone!

Good evening!

From Paul K. Drain to Everyone:  07:30 AM

Welcome everyone!  Last day of the Advanced TB Research Course!  Please give us a greeting and let us know where you are located.

From Andrea Nansereko to Everyone:  07:31 AM

Goodmorning from Uganda!

From Melanie Goth to Everyone:  07:31 AM

Good Morning from New York

From Andrea Nansereko to Everyone:  07:31 AM

Goodevening i meant, sorry from Uganda

From Cinthya Ruiz-Tagle to Everyone:  07:31 AM

Good morning from Chile!

From Emmanuel Biryabarema to Everyone:  07:31 AM

Emmanuel Biryabarema from Makerere University Uganada.

From Judy Machuka to Everyone:  07:32 AM

Greetings from Kenya. The past 4 days have been a great learning experience

From Rafaella Osores Urday to Everyone:  07:32 AM

Hello! From Peru

From Harriet Namyalo to Everyone:  07:32 AM

Good evening everyone Harriet Namyalo form Uganda MUJHU

From Carla Achiro to Everyone:  07:32 AM

Greetings! Carla Achiro From Makerere University School of Public Health

From Tah Rene Mih to Everyone:  07:32 AM

Greetings from Cameroon 🇨🇲

From elizabeth Mwangi to Everyone:  07:33 AM

Greetings everyone

Elizabeth Mwangi from Kenya

From Bashir Ssuna to Everyone:  07:34 AM

Hi Everyone, Bashir here from Makerere University-Uganda

From anibal_medicina@hotmail.com to Everyone:  07:34 AM

Good Morning.

thank you for the presentation of the topics … and for the work that is done to present them.

From Lubega Jason to Everyone:  07:34 AM

Heyllo, Lubega Jason

from School of Biomedical Sciences Makerere University Uganda.🇺🇬

From florence mwangwa to Me:  (Direct Message) 07:34 AM

Hi Ksenia, I missed Thursday due to competing priorities , do you have a recording you can share please?

From Rose Mary to Everyone:  07:34 AM

Hi everyone. Rosemary Namwanje

From anibal_medicina@hotmail.com to Everyone:  07:35 AM

ANIBAL VILCA- CITBM . PERU

From Lubega Jason to Everyone:  07:36 AM

#Question:

Hello Paul and Chris, How do we access the recordings? When will they be available?

If you would like to see any of the recorded presentations or access the chat, we will have everything uploaded sometime early next week: https://courses.washington.edu/tbresearchcourse/curriculum-schedule/ In the drop down agenda, simply hover and click on the talk title you wish to view.

From Lubega Jason to Everyone:  07:38 AM

Thank you @Ksenia

From matovu — to Everyone:  07:38 AM

good evening to you all, from Uganda

From Me to Everyone:  07:38 AM

Please take a moment to complete the course evaluation. Your results are anonymous and extremely helpful to us in planning future programs: https://catalyst.uw.edu/webq/survey/kkoon1/412679

From IVAN IBANDA to Everyone:  07:39 AM

Ivan Ibanda from Uganda. A warm evening here.

Hi everyone

From Sarah Jbara to Everyone:  07:39 AM

Good morning from Costa Rica

From elizabeth Mwangi to Everyone:  07:39 AM

Thanks Ksenia p.Koon

From simon walusimbi to Everyone:  07:39 AM

simon walusimbi, Uganda

From florence mwangwa to Me:  (Direct Message) 07:39 AM

hi Florence from Uganda,

From Ngonie Dube to Everyone:  07:39 AM

Cold evening from Swaziland

From Valeria Guzman Luna to Everyone:  07:39 AM

Good morning from Madison, Wisconsin

From Zuweina Kondo to Everyone:  07:40 AM

Hi I am Zuweina from Tanzania currently in MD

From Abdou Fofana to Everyone:  07:40 AM

Abdou, from Togo currently in Boston

From Isabelle Munyangaju to Everyone:  07:40 AM

Hello. Isabelle from 🇲🇿 Mozambique

From Daniel Waiswa to Everyone:  07:41 AM

Hi everyone,

Am Daniel Waiswa from Makerere University Kampala, Uganda

From Josephine Victo Namugga to Everyone:  07:41 AM

thank you all, this has been a great training.

I’m Josephine from Uganda

From simon walusimbi to Everyone:  07:48 AM

Hi. Can you share a link for the article/publication on the Styblo rule. Thanks.

From Teniola Lawanson to Everyone:  07:49 AM

Hello there. Teniola Lawanson, from Nigeria 🇳🇬

From Paul K. Drain to Everyone:  07:51 AM

Good questions from Dr. Chang – perhaps audience can put responses in the chat box.

From Charlotte Barungi to Everyone:  07:59 AM

Hello, Charlotte Barungi, MUJHU Uganda

From Lomonyang Victor to Everyone:  07:59 AM

Victor Lomonyang Uganda; Good evening!

From nassozi rashidah to Everyone:  08:00 AM

hello Rashidah Nassozi from Uganda mujhu

From IVAN IBANDA to Everyone:  08:00 AM

What are some of the modeling tools available for TB

From Paul K. Drain to Everyone:  08:22 AM

If you have question for Dr. Iribarren – please write in the chat box.

From Charlotte Barungi to Everyone:  08:22 AM

Thank you Sarah for you presentation.

From STEPHANIE ANOVER-SOMBKE to Everyone:  08:23 AM

Would use of DATs need training for users? This can be a challenge in itself?

From Wilson Mangeni to Everyone:  08:24 AM

Is Patient confidentiality and privacy assured with DATs?

From Lubega Jason to Everyone:  08:24 AM

One of the recent 99DOTs studies in Uganda,

you can check it out here

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755538/

low cost smartphones were provided but still this intervention heavily relies on Patient reporting

From Sarah Iribarren – she, her to Everyone:  08:40 AM

@Stephanie Yes, I agree there is a need for training. Particularly for the more interactive tools. The aim is to design/tailor tools to be easy to use but there is certainly a learning cure and variation in how the tools are used.

From Paul K. Drain to Everyone:  08:40 AM

Questions for Dr. Weiner?   Please type in Chat box.

From Sarah Iribarren – she, her to Everyone:  08:42 AM

@wilson. Privacy and confidentiality is a critical component. There are standards in app and tool development to safeguard privacy and confidentiality but it is still a risk. Can design to improve.

From Wilson Mangeni to Everyone:  08:43 AM

@ Sarah. Thanks

From Sarah Iribarren – she, her to Everyone:  08:43 AM

@Daniel  we have had good success when many patients using an app at the same time. Each person should have individual logins.

From Felipe Santana-Gomez to Everyone:  09:05 AM

What is the current average cost of a geneXpert cartridge?

From Tah Rene Mih to Everyone:  09:07 AM

@Santana, I saw $2.95-$4.64

From Felipe Santana-Gomez to Everyone:  09:09 AM

I think that was estimated cost of production, I’m curious to what they charge clinics or diagnostic labs per cartridge.

From Paul K. Drain to Everyone:  09:10 AM

We’ll see everyone back at 15 minutes past the hour.

From Emma Mudrock to Everyone:  09:11 AM

Protestors Demand Cepheid Halve the Price of GeneXpert TB Tests to US$5

this article on the TAG website says as of 2012 the price is $9.98

that is reduced from $16.86 because the Bill and Melinda gates foundation gave Cephid $11.1 million to reduce the price

From Felipe Santana-Gomez to Everyone:  09:12 AM

Thanks!

From David Branigan to Everyone:  09:19 AM

Hi all, regarding the price of GeneXpert tests, Cepheid prices these at between $9.98 (TB) and $19.80 (COVID-19, Ebola). But the estimated COGS across diseases are between $2.95 and $4.64. Here is a link to the MSF analysis: https://msfaccess.org/time-for-5

From Emma Mudrock to Everyone:  09:20 AM

Thanks for the clarification David!

From David Branigan to Everyone:  09:20 AM

Here is a link to the TAG analysis that found the public invested more than $250 million in the research and development of GeneXpert technology: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256883

From @WaiteRobyn to Everyone:  09:28 AM

stop tb Canada 🙂

Alex and Lena made it and published it here: https://www.healthaffairs.org/do/10.1377/hblog20210503.703348/full/

From Felipe Santana-Gomez to Everyone:  09:34 AM

So based on a 9.98 cartridge cost and 10 million cartridge sales per year, they gave up 68.8 million USD gross profit for 11.1 million USD when they dropped the price from 16.86 to 9.98. Their profit margin is definitely huge.

From Tah Rene Mih to Everyone:  09:34 AM

Thanks for the clarification

From Lubega Jason to Everyone:  09:37 AM

Great Points @Rhea👏

From Valeria Guzman Luna to Everyone:  09:37 AM

Thanks @Rhea Lobo, it is very inspiring lo listening to you.

From David Singini to Everyone:  09:38 AM

Thanks for sharing your experience Rhea.

From florence mwangwa to Everyone:  09:41 AM

thank you Rhea that was inspiring

From Judy Machuka to Everyone:  09:41 AM

Excellent sharing Rhea. Thanks

From Charlotte Barungi to Everyone:  09:41 AM

Thank you so much Rhea, for sharing your experience.

From Sarah Jbara to Everyone:  09:41 AM

Thanks for sharing. It was a very inspirational talk

From Mbulaka Remmy to Everyone:  09:42 AM

Interesting

From Daniel Waiswa to Everyone:  09:43 AM

Thanks Rhea, it was quite inspirational experience.

From Chishala Mirriam Kapambwe to Everyone:  09:43 AM

A Big Thank you Rhea for saying it the way it is…TB needs to get the attention and recognition  it deserves, otherwise we will talk and talk for decades without making headway in its eradication. Kind regards

From David Branigan to Everyone:  09:44 AM

Regarding the Xpert MTB/RIF buy-down, here is a TAG brief with background info and lessons learned: https://www.treatmentactiongroup.org/publication/advancing-access-through-market-interventions-lessons-learned-from-the-genexpert-tuberculosis-test-buy-down/

From Nkirote Mwirigi to Everyone:  09:45 AM

Thanks Rhea for sharing. That was insightful

From Paul K. Drain to Everyone:  09:50 AM

If anyone has questions for our panelists – please raise hand or write in chat box.

From Chetan Seshadri to Everyone:  09:59 AM

On Monday Willem Hanekom pointed out that TB vaccine develop is slow compared to COVID because we are not prepared for success.  How can advocates help us prepare?

From Rhea Lobo to Everyone:  10:04 AM

Thank you everyone for your kind messages, means a lot to me.

From Lubega Jason to Everyone:  10:06 AM

This is a great discussion. We need a course too on how to build Political will😂, it is one major factor for making things happen.

From David Branigan to Everyone:  10:08 AM

FIND Global Access Policy: https://www.finddx.org/wp-content/uploads/2021/07/FIND-Global-Access-Policy_PL-02-08-07_V1.1_JUL2021.pdf

From Ethan Bustad to Everyone:  10:10 AM

@Robyn, what you say makes sense wrt changing our language from a “disease of poverty”. But… poverty is a huge risk factor for acquiring TB, and highly correlated with TB burden globally (https://pubmed.ncbi.nlm.nih.gov/19394122/). How can we be honest about this reality while also avoiding the stigma of our current language?

From @WaiteRobyn to Everyone:  10:11 AM

I think talking in terms of social determinants of health – rather then putting “TB is a disease of poverty” front in center across messaging is the way we need to go

does that make sense?

From Premanshu Dandapat to Everyone:  10:13 AM

Prevalence of animal TB varies significantly across regions, although unlike for M. tuberculosis, data are sparse. The reduction in incidence and prevalence and control of both human and bovine TB is must to control TB across the world. Other than zoonotic TB in human, lots of M. tuberculosis cases are being reported in animals. Then, what are we thinking towards implementation of one health approach for END TB?

From Renée Codsi UW Seattle to Everyone:  10:13 AM

@Rhea – Very good point about the need to destigmatiz TB and change the language we use to talk about TB. Can you please share the link to the advising guidelines of how to talk about TB?

From Ethan Bustad to Everyone:  10:15 AM

@Robyn yes… I think so. Do you simply mean, “poor health in general is associated with poverty, so why single out TB”? And, “why make that such a talking point if it isn’t constructive”?

From Rhea Lobo to Everyone:  10:17 AM

Stigmatising language guide: http://www.stoptb.org/assets/documents/resources/publications/acsm/LanguageGuide_ForWeb20131110.pdf

From Ethan Bustad to Everyone:  10:17 AM

@Rhea thank you!

From @WaiteRobyn to Everyone:  10:17 AM

no we can talk about it in the specific content of TB too – just as one of many social determinants of TB

From Rhea Lobo to Everyone:  10:18 AM

For everyone who asked about the link to the video in my presentation: https://youtu.be/Y_8OdZXx9Fw

From Lubega Jason to Everyone:  10:19 AM

TB is an infectious disease capable of crossing borders eradicating it is the only way to protect yourself

Just like COVID

From Charlotte Barungi to Everyone:  10:19 AM

thank you

From Lubega Jason to Everyone:  10:22 AM

We can package it that way

Are there TB-FREE countries??

From Ethan Bustad to Everyone:  10:26 AM

(which was surprisingly high to me). I’m curious where can realistically expect more TB funding to come from?

From Rhea Lobo to Everyone:  10:34 AM

GIVE US NEW VACCINES… AND NEW TOOLS… AND NEW DRUGS WITH SHORTER REGIMENS!!! PLEASE!

From @WaiteRobyn to Everyone:  10:37 AM

https://www.stoptbcanada.com/join-us

From Valeria Guzman Luna to Everyone:  10:38 AM

Thank you ALL!

From @WaiteRobyn to Everyone:  10:38 AM

By everyone! Thank you

From Lubega Jason to Everyone:  10:59 AM

IT WAS GREAT MEETING YOU ALL.

LEARNT ALOT FROM THIS COURSE

From Tah Rene Mih to Everyone:  11:00 AM

Thanks so much for the opportunity

From Carla Achiro to Everyone:  11:00 AM

thank you for this training opportunity.

From Sarah Jbara to Everyone:  11:00 AM

Thank you very much to everyone, especially to the organizers. It was a great opportunity.

From Qader Ghulam to Everyone:  11:01 AM

It was a great course. I have learned a lot and will apply it into my day to day work that will lead to saving more lives.

From DANIEL OKUTU to Everyone:  11:01 AM

thank you very much

From Lucía Loy to Everyone:  11:01 AM

thank you!

From Martial Sonkoue Pianta to Everyone:  11:01 AM

It was awesome. Thank you very much

From matovu Sande to Everyone:  11:01 AM

thanks for giving us this

From Yvette Rodriguez to Everyone:  11:01 AM

Thank you!

From Dra Laura Lagrutta to Everyone:  11:01 AM

Thank you !