The TBPod

How does stigma impact treatment in tuberculosis? Has the COVID-19 pandemic enabled high income countries to commiserate with lower middle income countries who have high infectious disease burden? Are antimicrobials impacting the way some countries treat tuberculosis? Dr Paul Mason explores these questions while addressing other ethical issues in tuberculosis.

Dr Paul Mason is an anthropologist who has conducted community-based research in Indonesia, India and Brazil, behaviour change research in Vietnam and Brazil, and laboratory research in Australia and France.  Paul’s research interests include a deep fascination with biological and cultural diversity, social and multispecies justice, and interdisciplinary and cross-cultural efforts towards establishing long-lasting planetary health.

Tuberculosis is a global health priority and a major cause of child and adolescent morbidity and mortality.  Approximately 1.5 million children and adolescents are infected with tuberculosis each year. Tuberculosis in children and adolescence is often overlooked by health providers and can be difficult to treat and diagnose. Professor Steve Graham will provide an overview of the current state of play in child and adolescent tuberculosis including the scale of the problem and our progress in reaching global targets.

Prof Graham is a Paediatrician with 20 years' experience in international child health including African and Asia-Pacific regions. He is a founding member of the Child Tuberculosis (TB) subgroup of World Health Organization (WHO) Stop TB Partnership, as well as being a member of the Strategic Technical Advisory Group on TB for the WHO, as well as research committees for Wellcome Trust, UK, and National Institutes of Health, USA.

Philipp is the co-head of the Burnet Institute Tuberculosis Elimination and Implementation Science Group. He is an infectious diseases specialist with more than 15 years of extensive clinical and public health experience, and over 10 years’ experience in the management of TB/HIV programs. He has worked as a TB/HIV advisor, and supported program implementation and research in a range of settings. He has worked with MDR TB programs across Tajikistan, Uzbekistan, India, Myanmar, Uganda, Swaziland and Zimbabwe. A current project is the TB Practecal Study.

The TB Practecal study is a phase two, phase three study that aims to improve the treatment of multidrug resistant tuberculosis by reducing the time and using shorter treatment and less toxic regiments. Trial sites have been established working in conjunction with national health ministry's and national TB programs in Uzbekistan, Belarus and South Africa. Using new drugs, bedaquiline, delamanid, and pretomamandid the treatment for TB lasts for 6 months and does not include injections. The Practecal study also carries out public outreach programs for tuberculosis and how the public can seek effective treatment. 

Dr Andrew Burke and Dr Ramdeep Bajwa discuss clinical cases consisting of rheumatoid arthritis, the risk of tuberculosis reactivation and management of tuberculosis. 

What are the broader issues for TB control at present? How has COVID-19 impacted TB programs? What are the longer term prospects for TB control over the coming decade in the post pandemic era? Dr James Trauer and Professor Guy Marks answer these questions and discuss the areas requiring focus.

Guy Marks is a respiratory physician and epidemiologist and a public health physician. He is the President of the International Union Against Tuberculosis and Lung disease and has led the Respiratory and Environmental Epidemiology group at the Woolcock since 1997. The major focus of his research interest is lung health with specific focus on airways disease, air pollution and tuberculosis. He also has a strong commitment to capacity building for lung health research. 

What are the broader issues for TB control at the moment? How has COVID-19 impacted TB programs? What are the longer term prospects for TB control over the coming decade in the post pandemic era? Dr James Trauer and Professor Guy Marks answer these questions and discuss the areas requiring focus.

Guy Marks is a respiratory physician and epidemiologist and a public health physician. He is the President of the International Union Against Tuberculosis and Lung disease and has led the Respiratory and Environmental Epidemiology group at the Woolcock since 1997. The major focus of his research interest is lung health with specific focus on airways disease, air pollution and tuberculosis. He also has a strong commitment to capacity building for lung health research.

Molecular testing in Tuberculosis (TB) is broad and complex.  Dr Andrew Burke and Dr Chris Coulter discuss the utility/ advantages of Ultra GeneExpert, different types of line probe assays and WGS/ NGS in the future. Dr Chris Coulter uses his expertise to explain these diagnostic tools for physicians, nurses, policy makers and public health professionals.

Dr Chris Coulter is a Microbiologist, the Chair of TB Expert Advisory Group for Tuberculosis in QLD, and the Director of the Queensland Mycobacterium Reference Laboratory.

What are the issues with active case finding? What is the trajectory and the way forward to obtain tangible differences in reducing TB globally? Professor Greg Fox and Dr Kavi Velen explore the answers to these  questions and discuss why active case finding has not shown the anticipated level of progress predicted by the literature and the World Health Organisation.

Associate Professor Greg Fox a respiratory physician, epidemiologist and clinical trialist committed to using research to improve health care among disadvantaged populations. He is clinical Academic Lead (Research) for the Faculty of Medicine and Health at Cumberland Campus.

TB clinical presentation is complex. This is because TB may involve any tissue or organ, the severity of symptoms range from none to overwhelming, the tempo of the illness ranges from indolent to rapid, symptoms/ findings may be local or systematic, the presentation varies in immunocompromised and diagnostic tests such as TST or IGRA cannot provide an official diagnosis alone. Due to the complexity of TB, clinician’s may find difficulty in recognising. TB presentation. Dr Hazel Goldberg provides an insight into understanding TB clinical presentation.

 Dr Hazel Goldberg is a Respiratory Consultant who runs the Tuberculosis clinic at the Prince of Wales Hospital in Randwick, Sydney. She oversees services which include diagnosing and managing active TB, screening for latent TB infection (LTBI) among health care workers, those exposed to TB, migrants and the immune suppressed and treating LTBI, organising radiology surveillance as well as BCG vaccination service. 

COVID-19 and TB respiratory illnesses share both significant similarities and differences. At first glance, the viruses appear to be very different infections. However, perhaps one of the most important similarities is how the infections affect communities epidemiologically. Dr James Trauer and Dr Anna Coussens discuss the similarities and differences between the two infections.

Dr Anna Coussens is an infectious disease immunologist with a keen interest in host-pathogen interaction in tuberculosis (TB), the interaction with HIV-1, and other non-communicable diseases, including vitamin D deficiency and diabetes. Anna was the 2014-2015 Sydney Brenner Fellow, awarded by the Academy of Science of South Africa. In 2014 she was elected to the Global Young Academy, where she now sits on the Executive Board and is the southern Africa lead on a project to investigate the Global State of Young Scientists.