From studies of new medicines and a mask used to diagnose TB, there was no shortage of interesting findings presented at the recent Union World Conference on Lung Health, held in Copenhagen, Denmark. Spotlight rounds up six studies that stood out.

1. People do better if we dispense all TB prevention pills at once

Researchers have found that dispensing all the pills in a three-month course of TB preventive therapy (TPT) at once, instead of asking people to collect pills at the clinic every few weeks, led to many more people completing the treatment course.

“Multi-month delivery of TPT is safe and person-friendly. Approaches improving the convenience of TPT should be adopted to decompress health facilities and improve TPT coverage to meet TB prevention goals,” said Dr Adrienne Shapiro, assistant professor of global health and infectious diseases at the University of Washington.

2. A new medicine might help shorten TB treatment

One of the big talking points at this year’s conference was data on an experimental new drug called sorfequiline. It is thought that sorfequiline could be a replacement for bedaquiline, arguably the most important TB drug developed in recent decades. This is because sorfequiline appears to be more potent than bedaquiline and because of worries over TB strains that are resistant to bedaquiline.

3. Comorbidities are really important when people have TB

The more comorbidities a person has, the higher their risk of dying if they get ill with TB. This risk was 19% if they had three or more comorbidities compared to 16% if they had two and 11% if they had none. The key conditions driving mortality in some people with TB are HIV and undernutrition. Undernutrition was found to be responsible for around one in five TB deaths in people under the age of 40.

4. Point-of-care testing leads to people starting treatment faster

The details of how TB services are delivered can make a significant difference to TB outcomes. One such study, led by researchers from the University of Cape Town, explored whether it made a difference if someone had a TB test done at a mobile van or had their sputum sample collected and sent off to a lab. The study was indirectly testing whether it makes a difference if someone gets a test result right after testing versus having to wait a day or two to be contacted with a result.

5. Promising signs for a portable TB test

Tessa Mochizuki, a research scientist at the University of California, presented results from a multi-country study evaluating how accurate a portable, battery-operated testing device, called MiniDock MTB, was at diagnosing TB from sputum swabs and tongue swabs.

“The test is run on a small device about the size of my hand, and results are available in under 30 minutes, often even faster for positive results,” Mochizuki said.

6. A mask that can help diagnose TB

An even more interesting idea that some researchers have been working on is to use a diagnostic mask to diagnose TB.

At this year’s conference, Dr Rouxjeane Venter, a researcher based at the Clinical Mycobacteriology and Epidemiology research group at Stellenbosch University, presented a proof-of-concept study testing whether a mask, called the Avelo Mask, can be used to diagnose whether TB bacteria are present in the air a person breathes out.

Fifty-eight adults, across four clinics in Cape Town, who had TB symptoms and tested positive for TB on a molecular test were given the mask to wear for 45 minutes. The filter in the mask is able to trap viruses and bacteria. This filter is then pushed into a buffer tube using a sample stick — where it can be stored or tested directly.

The mask as well as the stick and buffer tube, is part of the Avelo mask kit developed by Avelo Diagnostics. For this study, the researchers used a qPCR test — a rapid test that looks for TB DNA — to detect TB bacteria.

Pilani (Supplied)

When the mask filters were tested, 34 people were found to be negative for TB bacteria and 24 were positive. When compared to their Xpert Ultra sputum results, it was found that there were two false positives.

Overall, according to Venter, the mask had a sensitivity of 71% when compared to GeneXpert Ultra and 65% when compared to the Microbiological Reference Standard and a specificity of about 92%.

These numbers aren’t nearly as good as those for the MiniDock MTB, but it is positive that masks like these are showing promise. A long-standing problem in TB diagnosis is that not everyone can produce sputum samples. The more alternatives we have, be it tongue swabs or masks, the better.