On 08 December 2022, the University of Pretoria, in collaboration with Leicester University, convened a hybrid TB meeting to strengthen the partnership between the two institutions to accelerate the progress to end Tuberculosis. The meeting was followed by the Inaugural Professor Anton Stoltz Memorial lecture on 09 December 2022. 

Led by Professor Veronica Ueckermann, Acting Head of Infectious Diseases in the Department of Internal Medicine at the University of Pretoria, and Dr. Caroline Williams, an Infectious Diseases/Microbiology Clinical lecturer at the University of Leicester, the meeting brought together participants, comprising key international partners, researchers, and stakeholders interested in TB.  

The meeting aimed to strengthen collaboration and provide an update on TB in the post-COVID-19 landscape. "We are hoping that this meeting can rekindle everyone interested in TB that maybe got diverted during the last very recent pandemic, and I think we should start focusing back on old endemics and pandemics, so hopefully, we can get some great ideas going forward," said Dr. Williams. 

Farzana Ismail, from the National Institute for Communicable Diseases and senior lecturer in the Department of Medical Microbiology at the University of Pretoria, explored the landscape of TB in South Africa post covid-19 to set the tone for the meeting. "We need to understand what is happening in our country to align our research questions appropriately and work together towards ending TB," she said. She called for continuous engagements with the national and provincial departments to optimise interventions and decrease the burden of TB. 

"In 2020, we introduced the urine LAM, but the Covid pandemic hit, and the implementation was then halted. What is next for us is the implementation of the Xperts XDR cartridge, which we hope to start by the end of January 2023". She added, "South Africa has improved in its TB testing Xpert exceeding the forecast." 

"Covid-19 pandemic had a negative impact on the national TB programme (NTP), including globally, but despite that, South Africa has achieved NTP 2020 milestone for the reduction in TB incidence rate". 

Prof Rein Houben, a TB Epidemiologist, and Mathematical Modeler from the London School of Hygiene & Tropical Medicine acknowledged the prevalence of TB. "It is important to consider the TB Disease Threshold in detecting the prevalence of TB disease to help measure the burden of TB. There is a lot more TB Disease out there than we currently think. However, identifying this group's symptoms might be of limited use to get a full overview, which means we need new tools and treatments," he said.

He concluded, "Overall, this is an exciting and important time to be in TB as we switch from the classic way of thinking about TB; we need new ideas and energy to keep moving this field forward and prevent the disease burden." 

Dr. Lauren Ahyow, a consultant in communicable disease control and TB Prevention at UKHSA, National TB Unit, gave an overview of the global incidence of TB and the impact of the Covid-19 pandemic, highlighting that TB remains a global health emergency affecting a quarter of the world's population. She said inequalities remain an important feature of TB epidemiology in England, with disparities in geography, country of birth, ethnicity, and social risk factors. 

Speaking about TB diagnostics, Dr. Adam Penn-Nicholson, Deputy Director of the TB Programme at the Foundation for Innovative New Diagnostics, said there are new instruments and sampling strategies to bring diagnostics closer to patients. "Many new diagnostics can be partnered with communities, treatment regimens, and digital solutions for a comprehensive package to support patient care." 

Professor Graeme Meintjes, Second Chair and Deputy Head of Medicine at the University of Cape Town and the DST/NRF SARChI Chair of Poverty-related Diseases, presented the Inaugural Professor Anton Stoltz Memorial lecture. His talk was titled "Addressing mortality due to HIV-associated TB" and focused on the reasons for the high mortality experienced in southern and east African countries and explored potential solutions.

 In his talk, he described the epidemiology of HIV-associated TB and examined the advances in TB screening and diagnostics. He also focused on studies his research group has done in Cape Town, highlighting disseminated HIV-associated TB.

He noted that "Anti-retroviral therapy has been a game changer in driving down the mortality as it reduces the risk of TB disease by 60 to 80 percent. However, it is not just the number of cases that decreases. It is the severity of TB disease that reduces as well. However, TB risk remains elevated despite successful Anti-retroviral therapy compared to HIV-negative people in this population".

"We have strategies that effectively prevent HIV-associated TB such as Anti-Retroviral Therapy, Isoniazid Preventative Therapy, and the scale-up rifapentine". 

He acknowledged that while diagnostics have improved, there are still challenges in obtaining sputum samples of patients with advanced HIV admitted to the hospital and proposed a combination of sputum and urine testing as the best strategy for those patients. 

"There is a huge need for improved innovations in diagnostics, to have more rapid patient diagnostics in these patients when they are admitted to hospital to prevent the hospitalisation". 

Professor Meintjes explained that the nature of the TB disease in HIV-infected people is not only the amplification of the risk of developing TB. Instead, it is an accelerated form of TB with a high mortality risk, particularly if treatment is delayed. He noted that patients deteriorate from being healthy to bed-bound, hospitalised, and dying in weeks. 

He emphasised that disseminated TB is frequent and almost characteristic of TB in patients admitted to hospitals with HIV-associated TB. 

"Globally around 40 percent of deaths in HIV infected people TB disease was present. Of those deaths in hospitals, 90 percent of the cases were disseminated TB, disseminated to multiple organs such as the lung, liver, spleen, and lymph nodes. And this is the characteristic feature of TB among patients with HIV in hospitals", he said.

"We need to conduct research that aims to improve treatment strategies for this patient population, but that needs to be underpinned by an improved understanding of the pathogenesis, so we can direct treatment strategies specifically for this patients population and not borrow the strategies from other types of TB." 

He concluded that addressing the epidemiological burden of HIV-associated TB deaths requires a multi-pronged strategy that involves putting measures to access TB in communities, improved diagnostics, prevention strategies, and treatment approaches. To impact HIV-associated TB, he said these tools must be underpinned by optimal health system performance.