The Union World Conference on Lung Health 2023 - Saturday 18 November press release
- Research breakthroughs presented at The Union World Conference for Lung Health include how drones tackling the threat of TB in Himalayan communities;
- Impact of COVID-19 pandemic on notification of TB in prisons revealed
- ‘Urgent need’ to reduce stigma-based depression for adolescents with TB
- Embrace new technology to fight major global health threats, scientists say
- Focus on adolescent recuperation necessary for building stronger future for healthcare
Paris; 18th November 2023: Leading voices in tuberculosis (TB) have presented research on how drones are securing crucial diagnoses and supplying patients with life-saving medicines in Himalayan communities, on the fourth day of The Union World Conference on Lung Health.
India-based public health officials in Himachal Pradesh have discovered that using drone (unmanned aerial vehicles) services could provide the answer to securing crucial TB diagnoses of patients in Himalayas, where the annual risk of catching the disease sits at double the Indian national average.
World leading TB researchers shared how technological innovation is rising to meet the monumental challenge of eradicating the critical global health issue.
This study found that drones were able to reduce transportation distance by nearly three times while halving its operational cost, leading researchers to recommend the scaling-up of drone services in similarly hard-to-reach locations across the globe.
Using these cost-effective drones, researchers were able to retrieve test samples from and transport life-saving medicines to patients in hard-to-reach areas of Himachal Pradesh, in Northern India.
Their findings suggest that the future of TB diagnosis and treatment will be technologically driven, with innovation providing scientists with the clear opportunities to eradicate the disease in hard-to-reach areas.
IMPACT OF COVID-19 PANDEMIC ON DIAGNOSIS AND TREATMENT IN PRISONS REVEALED
At The Union World Conference on Lung Health, researchers demonstrated that the impact of the COVID-19 pandemic led to disruptions in TB notifications for persons deprived of liberty in Europe and the Americas.
This study was the world’s first academic research investigating the impact of the pandemic on the prison populations across multiple continents.
Persons deprived of liberty and people who work in prisons are known to be especially vulnerable to the disease. According to the World Health Organisation, TB case rates among inmates are between five and 50 times higher than the national averages across both the developed and the developing world.
The researchers found that, during the pandemic, TB notification rates dropped amongst almost all countries in Europe and in most countries in the Americas.
The team concluded that COVID-19 substantially impacted TB notifications in prisons across Europe and the Americas and was especially notable among countries with larger TB epidemics in prisons.
These findings highlight the importance of identifying vulnerable, high-risk populations especially impacted during the pandemic and how TB is a global disease which requires global collaboration to combat its effects.
THE IMPORTANCE OF AI TO FINDING COMMUNITY CASES OF TB
A presentation by a team of Nigeria researchers showcased the potential of artificial intelligence (AI) in early detection of TB, encouraging the uptake of this new technology to address lung diseases. The team are staff of KNCV Nigeria, that introduced the use of portable digital x ray with AI in Nigeria after a successful pilot project in 2020.
AI has been adopted by scientists across a wide range of disease areas, with scientists drawn to the advantages offered by the precise technology over human-led disease detection.
Nearly 15,000 people in Nigeria’s Delta State were screened for TB using AI (from January to December, 2022) with results indicating the technology’s substantial ability to detect the presence of the disease.
The researchers were satisfied that their study indicated AI’s capability to drive early, effective detection of TB as well as its potential for enhancing therapy and preventing the spread of TB and other diseases.
Thanks to the equipment’s ability to be moved between communities, bringing TB screening services to the doorsteps, and improving access.
The scientists urged the importance of embracing new technologies as tools to facilitate early TB detection and treatment to prevent the spread of TB within the communities.
They stressed that scaling up the new technology to more communities would play a key role in eradicating TB in Nigeria.
‘URGENT NEED’ TO REDUCE STIGMA AND DEPRESSION FOR ADOLESCENTS WITH TB
Peruvian and South African researchers highlighted that TB infections impact more than just a patient’s physical health, as they discussed the urgent need to reduce stigma, treat depression, and improve support systems for adolescents with TB.
The research showed the importance of putting individual patient needs at the centre of treatment, especially when these young people are socially or psychologically vulnerable.
The results built on earlier academic work which had identified links between TB cases and poorer mental health, particularly as a result of young people being instructed to self-isolate following diagnosis.
Chelsie Cintron, Senior Research Study Coordinator, Boston Medical Center: “Adolescence is a challenging stage of life due to dramatic physical, emotional, social, and psychological changes. Our work illuminates the unmet needs of adolescents living with TB in two very different settings. These unmet needs may negatively impact TB treatment outcomes, as well as overall well-being. Our findings underscore the importance of implementing youth-centered care to improve TB outcomes.”
The Union World Conference on Lung Health is convened by The International Union against Tuberculosis and Lung Disease, the world’s first global health organisation, committed to eradicating tuberculosis and lung disease.
These scientific discoveries come at a crucial moment for the TB community after world leaders pledged funding and agreed targets for the next five years towards ending the global TB epidemic at UN High-Level meeting on health in New York in September.
Professor Guy B. Marks, President and (Interim) Executive Director, International Union Against Tuberculosis and Lung Disease (The Union) said: “Making new discoveries and utilising new technology for how we diagnose and treat TB and other lung disease is a vital step for improving the lung health across the world.
“The Union World Conference on Lung Health has been a fantastic forum for achieving this, with the globe’s most impressive scientists coming together to share their crucial and innovative research.”
The Union
Established in 1920 as the world’s first global health organisation, the International Union Against Tuberculosis and Lung Disease is committed to eradicating tuberculosis and lung disease, leading to a healthier world for all. Its members, staff, and consultants work in more than 140 countries globally.
The Union aims to improve the world’s lung health by prioritising prevention and care, through bringing together clinicians, patients, survivors, policy makers, scientists, and managers to disseminate and implement knowledge in practice. The Union’s work is exemplified by its core values of quality, transparency, accountability, respect, and independence.
ENDS
Notes to editors:
This is a press release issued by Lexington on behalf of the International Union Against Tuberculosis and Lung Disease. For more information, please contact theunion@lexcomm.co.uk. You can find more press releases from The Union here.
The Union social media:
Twitter: @TheUnion_TBLH
Facebook: The Union Lung Health
LinkedIn: International Union Against Tuberculosis and Lung Disease (The Union)
Overview of Each Abstract:
The role artificial intelligence in community active TB case finding: a review of PDX-CAD activities in Delta State, Nigeria
- Background and challenges to implementation: The organization of population screening with artificial intelligence (AI), particularly for socially important diseases, is one of the promising areas in the era of global digitalization of medicine. In endemic areas, the prevalence of undiagnosed TB may rise as a result of insufficient community-based case detection. For efficient and effective approach, there are a variety of screening methods that can be used in a mobile device with various technologies, such as Potable Digital X-Ray with Computer-Aided Detection (PDX-CAD). Hence, this study is aimed at determining the role of AI in community active TB case finding.
- Intervention or response: KNCV Nigeria have is implementing community active case search in Delta state Nigeria using PDX-CAD. In 2022, clients were screened, and presumptive clients were identified using PDX-CAD. Identified presumptive TB clients are further evaluated using molecular WHO recommended rapid diagnostic tests (mWRD). Data from KNCV Nigeria intervention data base was obtained. Information on number of Persons screened, number Presumptive identified, number of presumptive evaluated and number of diagnosed TB cases was extracted and used for this study. Analysis was done using descriptive statistics.
- Results/Impact: A total of 14280 clients were screened for TB using PDX-CAD. Presumptive clients identified were 1426 (10%) and all were evaluated. The total Clients that were confirmed to have TB were 19% (n=1426; 270), of which 76% (n=268; 204) were confirmed by expert evaluation of X-Ray film, 1% (n=268; 2) were diagnosed by Trunat MTB-RIF assay and 23% (n=268; 62) were diagnosed using Xpert MTB-RIF assay.
- Conclusions: In the result, a 19% TB yield out of 1426 presumptive yield using PDX-CAD shows a substantial potential of the PDX-CAD to detect TB if more number of the machine is deployed. Targeted ACF and support services improve health by promoting early, effective detection, enhancing therapy, and preventing the spread of TB and disease.
Drone (Unmanner Aerial Vehice) - a new vehicle for TB drugs and sputum sample transportation in Himachal Pradesh, India
- Background and challenges to implementation: The mountainous terrain of district Mandi in Himachal Pradesh, India has several hard-to-reach areas where timely transportation of sputum samples and TB drugs remains a challenging task. The present study was conducted to assess the impact of use of drone (Unmanned Aerial Vehicle) services in ensuring early case detection in hard-to-reach areas of Himachal Pradesh.
- Intervention or response: Based on the recommendations of a feasibility study, Himachal Pradesh government deployed drones (UAV) for transportation of sputum samples and TB drugs. In January2023, five peripheral health institutions (PHIs) in hard-to-reach areas of district Mandi were identified for drone services. Use of drones in service delivery was analyzed in terms of early diagnosis of TB cases, reduction in transportation distance and operational cost.
- Results/Impact: Total 32 transportations were completed by the drone from Feburary2023-March2023 across five most hard-to-reach PHIs of district Mandi. Drones transported 53 drug boxes from district store to these PHIs and 169 sputum samples in a return flight to NAAT site. Flights were conducted daily on a rotation basis. Prior to deployment of drones, sputum samples were transported once a fortnight to NAAT site and TB drug boxes once a month. This led to delays in TB diagnosis and treatment initiation in hard-to-reach areas. With drones in operation, early case finding, and treatment initiation was made possible. During the study period, drones travelled cumulative aerial distance of 318 Kilometer (km) (average distance of 10 Km/flight) in comparison to road transportation distance of 835 Km (average distance of 26 Km/travel), thus reducing transportation distance by 2.8 times and reducing operational cost of transportation by 2.4 times.
- Conclusions: Deployment of drones (UAV) ensured early detection of TB cases in high-altitude hard-to-reach areas. The study strongly recommends scaling-up of drone services in similar hard-to-reach geographies.
Psychosocial needs of adolescents living with tuberculosis in Peru and South Africa
- Background: Adolescents (people 10-19-years-old) account for 11% of the global tuberculosis (TB) burden. Studies on chronic disease in adolescence have shown that psychosocial factors are key aspects in disease management and can impact treatment adherence and completion. Yet, there is a paucity of data regarding psychosocial needs of adolescents living with TB. We examined the psychosocial profile of adolescents with TB to better understand their needs, to improve the care of this population.
- Design/Methods: We analyzed data from two prospective cohort studies of adolescents on TB treatment, one in Peru (n=249) and the other in South Africa (n=48). Surveys were conducted between the third and fifth weeks of therapy in Peru and prior to treatment initiation in South Africa. We compared variables between the Peruvian and South African cohorts using Chi-squared and t-tests.
- Results: There were no differences in age (median 17 years) between the cohorts. Males represented 63.9% of the sample in Peru compared to 39.6% in South Africa. 38.7% of adolescents reported being sexually active, though this is driven mainly by 18-19-year-olds (51% sexually active). Adolescents at both sites had high scores on a depression screening tool, with most reporting moderate or severe scores. In both countries, but especially in South Arica, many participants reported experiencing TB-related stigma, low levels of family support and incomplete TB knowledge. In South Africa, there was some evidence of problematic alcohol use.
- Conclusions: There is an urgent need for interventions aimed at reducing stigma, treating depression, and strengthening family and social support systems for adolescents with TB. The observed variation in psychosocial characters between sites further underscores the need for setting-specific evaluations of the psychosocial needs of this vulnerable population. Further, rifampicin and other rifamycins diminish the effectiveness of hormonal contraceptives highlighting the need to improve sexual healthcare for this patient population.
Impact of the COVID-19 pandemic on incarceration and TB notification rates among individuals who are incarcerated in Europe and the Americas
- Background: The COVID-19 pandemic has led to major disruptions in diagnosis, treatment, and care for tuberculosis programs globally. However, the impact of the pandemic on incarceration and tuberculosis notification rates among people who are incarcerated, a high-risk, vulnerable group, is unknown.
- Design/Methods: In collaboration with the Pan American Health Organization (PAHO), European Centre for Disease Control and Prevention, and European World Health Organization Regional Office, we collected tuberculosis notification and incarceration data from pre-pandemic (2019 and prior) and pandemic years (2020-2021). Autoregressive integrated moving average time-series models were conducted to predict the number of persons who are incarcerated and tuberculosis case rates for 2020 and 2021. We subsequently compared these predicted estimates to observed trends to evaluate the impact COVID-19 had on incarceration and tuberculosis notification rates.
- Results: Of the 101 countries in European and PAHO region, 79 and 41 countries were included for incarceration and notification rate outcomes, respectively. In Europe, most countries reported lower incarceration and tuberculosis cases per 100,000 persons in 2020 (28/40 and 17/19 countries) and 2021 (25/36 and 17/21 countries) than expected. The mean percent change between observed/predicted tuberculosis notification rates in 2020 and 2021 was -37%. Whereas, in the Americas, trends in incarceration and tuberculosis rates in prisons were highly heterogeneous; 9 (53%) countries had reduced notification rates in prisons in 2020 while 8 (47%) had higher notification rates (Figure). The mean percent change between the observed/predicted tuberculosis notifications rates for the Americas was -6% in 2020 but decreased to -16% in 2021. Countries in the Americas with elevated notification rates during the pandemic were more likely to be countries with a high tuberculosis burden in prisons (e.g., Haiti, Venezuela, Peru, Paraguay).
- Conclusions: Our findings suggest that the COVID-19 pandemic has substantially impacted tuberculosis notification rates in prisons, with especially substantial decreases throughout Europe.
- Summary: The COVID-19 pandemic led to major disruptions in diagnosis, treatment, and care for tuberculosis programs globally. However, the impact of the pandemic on people who are incarcerated, a high-risk group, is unknown. We conducted time-series modelling to evaluate the impact of COVID-19 on incarceration and tuberculosis notification rates.