Umesh G Lalloo talk

Political instability interrupts treatment, facilitates disease spread e.g. strikes in South Africa, post election violence in Kenya, refugees from Syria.
Paradoxical IRIS-like reactions in HIV-negative TB patients.
Why can we not shorten the course of treatment despite the best drugs?
Why do some people not get sick despite similar exposure?

Focus on TB in HIV patients in South Africa research may be confounding picture of disease in immunocompetent patients.
Ultra short course phase 3 failure- was based on phase 2 results but phase 2 was underpowered.
Primate models may be more relevant than mouse.
Protection vs exposure- he has not gotten TB but several of his colleagues has. Healthcare workers may be a good cohort to study.
Diagnostic solutions: giant pouched rat (he misspoke as mouse)
Worst case scenario: may have to reopen sanatoria in the absence of effective drugs.

Q&A:
INH prophylaxis lead to resistance?
Ans: if you put a huge cohort of HIV positive patients on prophylaxis, the benefit may outweigh the risk.

GeneXpert does not detect INH resistance, is this a problem?

do you know of any plans to introduce UV in South Africa?
Problem is that it requires good engineering to implement effectively- if not, ineffective, UV burns, etc.
However it could help in combination with other measures e.g. masks. Church of Scotland Hospital study.

What is the fundamental problem of TB in South Africa?
It’s behaviour because we have worse TB rates than poorer African countries like Tanzania.
I am using behaviour in a broad sense – we are doing something wrong. Need to discuss with politicians.

What do u think is the “real” number of people latently infected?
There has not been enough evidence eg strong postmortem study to recover AFB from tissue.

Do u think us in Durban and KZN have some difference from rest of country?
Rest of country is not doing so well either! CPT produces a huge number of TB cases.

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