UCL World TB Day Event 2013

Targeting zero deaths from TB: progress, reality and hope

This year's World TB Day event featured speakers from around the globe - this selection of photographs from the day gives a flavour of a highly successful meeting.


The highest mountain in Africa is not Kilimanjaro but the TB mountain – and it’s more difficult to scale. Steve Lawn

Blog by Dr Santino Capocci, Mr Aidan Hanrath and Dr Isobel Honeyborne, Faculty of Medical Sciences, UCL

The annual World TB Day marks the announcement by Robert Koch in 1882 of the discovery of the infectious cause of tuberculosis (TB). This was commemorated by UCL on Monday 25th March with a meeting of experts from London and around the world at the Royal Free Hospital. ‘Targeting zero deaths from TB: progress, reality and hope’ was hosted by UCL Professors Ali Zumla and Tim McHugh, and Dr Marc Lipman, North Central London TB lead and UCL Senior Lecturer. The global theme picked up on series of articles launched[1] by The Lancet Infectious Diseases at the event.

The day was introduced by Provost Prof Malcolm Grant with a theme that ran through the whole meeting – the need for an ‘integrated strategy’ to tackle tuberculosis. He highlighted UCL’s interdisciplinary strengths and important role in the global TB research effort.

Professor Ben Marais (University of Sydney) showed that tuberculosis has the strongest socioeconomic gradient of any infectious disease, and talked of the importance of not just dealing with the infectious organism but fighting the vulnerability of individuals, and the conditions of poverty in which TB thrives.

Dr Gill Craig linked this to UCL’s Lives on the Line[2] project which showed how social inequality and life expectancy change from west to east on a London tube map. She discussed how new initiatives, such as dedicated tuberculosis link workers, might halt the rise of TB in London by approaching the social factors and often chaotic lives of individuals living with TB. She also showed how a mobile screening unit has been introduced, similar to the style of that used in the 1950’s to try to improve access for socially marginalised groups to tuberculosis services in London. Dr Marc Lipman presented striking figures of one in five homeless people having evidence of latent TB infection and the high risk they have of then developing active TB disease. The importance of political will and commitment to tackling all aspects of TB was emphasised by Simon Logan of the All Party Parliamentary Group on TB.

The global response to the rise of multi-drug resistant tuberculosis (MDR-TB) was a second theme of the meeting. Although so far, the UK has been largely spared, in resource-poor areas of the world, drug resistance is an increasingly urgent crisis. Difficulties in reliably identifying MDR-TB and the high cost of second line drugs means patients are often unaware and not treated appropriately: they continue to be infectious and risk spreading MDR strains to those around them including their families at home and healthcare workers in the clinic. New tools for diagnosis and susceptibility testing are gradually being introduced in resource constrained settings.

Dr David Moore described a relatively simple and low cost test called MODS (Microscopic Observation Drug Susceptibility[3] test) with which someone with MDR TB can know within a week of submitting a sputum sample and be started on appropriate treatment within a fortnight. The ideal situation for tuberculosis would be to have a simple test like a urine dipstick for detection of drug sensitive disease.

Dr Steve Lawn (University of Cape Town) opened with a thought provoking comment that ‘the highest mountain in Africa is not Kilimanjaro but the TB mountain!’. He described how a urine assay exists, which looks a little like a pregnancy test, but is based on a lipid found in the tuberculosis bacterial cell wall. It isn’t as sensitive as hoped, but has shown some utility at diagnosing TB, especially in individuals with advanced stage HIV-1 infection, and may well be lifesaving by preventing the delay in diagnosis in those with the highest risk of dying from TB.

Steve also discussed GeneXpert (Cepheid), a DNA based near-patient test (mostly for sputum). South Africa has embraced this automated molecular test, famously described as being as simple to operate as a coffee machine. One of the key parts of the test is detection of resistance to rifampicin, one of the frontline tuberculosis drugs. However, the impact of the machine is still waiting to be seen as in less well resourced settings where TB is endemic, tuberculosis is often treated with first line drugs, without knowing that the strain is sensitive. However, the test is still too expensive for some areas of Southern Africa, although it is now being rolled out in parts of Mozambique and rural Uganda. With both of these technologies, the limitations seem to be in implementation: costs of setting up labs, having a constant source of electricity and then the availability of drugs to treat MDR-TB in the developing world.

[1] Link to http://www.thelancet.com/series/tuberculosis-2013

[2] Link to http://life.mappinglondon.co.uk/

[3] Link to http://www.nejm.org/doi/full/10.1056/NEJMoa055524

Presentations delivered (some downloadable):

Dr Marc Lipman, UCL:
TB in the UK - practical challenges of effective TB clinical service delivery.

Dr Gill Craig, City University:
Bio-social determinants of TB in the UK & Europe.

Dr David Moore, London School of Hygiene & Tropical Medicine:
Interrupting MDRTB transmission - turning off the tap in Peru.

Dr John McConnell, The Lancet Infectious Diseases:
World TB Day 2013: Launch & summary of the LID TB Series.

Professor Markus Maeurer, Karolinska Institutet:
Host directed therapies for MDR/XDR-TB

Dr Stephen Lawn, London School of Hygiene & Tropical Medicine/University of Cape Town:
The Xpert MTB/RIF assay and future prospects for a point-of-care test.

Professor Robert Wallis, Pfizer/Case Western University:
Tuberculosis biomarkers discovery:  recent developments, needs and challenges.

Mr Simon Logan, All Parliamentary Group on Global TB:
The rising tide of drug resistant tuberculosis - time for a visionary political leadership.

Dr William Wells, Global Alliance for TB Development:
Alignment of new tuberculosis drug regimens and drug susceptibility testing: a framework for action. (slides, PDF)

Professor Ben Marais, University of Sydney:
TB co-morbidity with communicable and non-communicable diseases: integrating health services and control efforts.

Professor Andrew Nunn, MRC-CTU/UCL, and Professor Denny Mitchison:

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