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Dr Alice Sawka, adult respiratory and TB physician in Adelaide, is joined by Dr Victoria Grey, infectious diseases physician in Brisbane, and Dr Jack Callum, respiratory physician in London, to explore the evidence behind the 12 month treatment duration for TB meningitis. Together, they discuss the limited evidence underpinning current guidelines, the challenges of treating TB within the central nervous system, and emerging research examining whether shorter treatment regimens may be safe and effective.  This episode concludes the TB Origins series, exploring the evidence and history behind long-standing TB clinical practices. Show Notes Jullien S, Ryan H, Modi M, Bhatia R. Six months therapy for tuberculous meningitis. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD012091. DOI: 10.1002/14651858.CD012091.pub2.Donovan J et al. A clinical practice guideline for tuberculous meningitis. Lancet Infect Dis. 2026 Feb;26(2):e96-e111. doi: 10.1016/S1473-3099(25)00364-0. Epub 2025 Aug 18. Erratum in: Lancet Infect Dis. 2025 Dec;25(12):e684. doi: 10.1016/S1473-3099(25)00660-7. PMID: 40840485; PMCID: PMC12419961.Sulis G et al. Comparative Effectiveness of Regimens for Drug-Susceptible Tuberculous Meningitis in Children and Adolescents: A Systematic Review and Aggregate-Level Data Meta-Analysis. Open Forum Infect Dis. 2022 Apr 9;9(6):ofac108. doi: 10.1093/ofid/ofac108. PMID: 35673608; PMCID: PMC9167638.

Dr Alice Sawka is joined by Dr Jack Callum, respiratory physician in London, and Dr Victoria Gray, infectious diseases physician in Brisbane, to explore the origins of the widely used “eight-hour rule” in TB contact tracing. Together, they examine the evidence behind this commonly used threshold, trace its roots to early studies of TB transmission during air travel, and discuss how clinicians and public health teams assess exposure risk. They also explore the practical challenges of contact tracing and the “stone in the pond” approach used to identify those at greatest risk of TB infection. This episode is the second in the TB Origins series, exploring the evidence and history behind long-standing TB clinical practices. Show Notes Tuberculosis and air travel: guidelines for prevention and control – 3rd ed. “WHO/HTM/TB/2008.399” Available at: https://www.who.int/publications/i/item/9789241547505 Driver CR, Valway SE, Morgan WM, Onorato IM, Castro KG. Transmission of Mycobacterium tuberculosis associated with air travel. JAMA. 1994 Oct 5;272(13):1031-5. PMID: 8089885. Kenyon TA et al. Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight. N Engl J Med. 1996 Apr 11;334(15):933-8. doi: 10.1056/NEJM199604113341501. PMID: 8596593. Migliori GB, et al. Reducing tuberculosis transmission: a consensus document from the World Health Organization Regional Office for Europe. Eur Respir J. 2019 Jun 5;53(6):1900391. doi: 10.1183/13993003.00391-2019. PMID: 31023852.

Dr Alice Sawka, adult respiratory and TB physician in Adelaide, is joined by Dr Jack Callum, respiratory physician in London, and Dr Victoria Grey, infectious diseases physician in Brisbane, to explore the evidence behind delaying TNF-alpha inhibitor therapy after starting TB preventive treatment. Together, they discuss the risk of TB reactivation with biologic therapies, the origins of current guideline recommendations, and how clinicians balance urgent immunosuppression with TB prevention in everyday practice.  This episode is the first in the TB Origins series, exploring the evidence and history behind long-standing TB clinical practices.

Dr Alice Sawka, adult respiratory and TB physician in Adelaide, is joined by Courtney Murphy, a paediatric specialist TB nurse at Manchester University NHS Foundation Trust, to explore the challenges of diagnosing tuberculosis in children. They discuss innovative approaches such as induced sputum, improving diagnostic yield and reducing invasive procedures, and the importance of microbiological confirmation and multidisciplinary care in paediatric TB. Courtney also reflects on introducing new clinical pathways within her service and the impact on time to diagnosis, as well as the importance of engaging families in treatment decisions.

Dr Martin Allen, Consultant Respiratory Physician at the University Hospital of North Staffordshire and National Clinical Lead for Respiratory Medicine within the GIRFT programme, joins Dr Jack Callum to discuss the development and impact of the GIRFT tuberculosis report across England and Scotland. They explore how data-driven review and peer-led evaluations are uncovering gaps in TB care, from diagnostic delays to workforce challenges, and how these insights are driving local and national improvement. Dr Allen also reflects on translating recommendations into practice and the importance of shared learning across services as TB rates rise post-COVID.

Dr Padmasayee Papineni, Consultant and Co‑Clinical Director in Infectious Diseases at London North West University Healthcare NHS Trust, joins Dr Jack Callum to discuss the lived experience of tuberculosis care through narrative medicine. The conversation centres on her 2022 Lancet Wakley Prize–winning essay “Directly Observed Therapy,” which follows socially vulnerable patients navigating TB alongside poverty, migration, and precarious housing. Dr Papineni challenges narrow, paternalistic interpretations of directly observed therapy, arguing instead for a model grounded in compassion, social support, and multidisciplinary care, and reflects on how storytelling can restore humanity to statistics-driven global health narratives.

Dr Peter MacPherson, Professor of Global Public Health at the University of Glasgow, joins Dr Jack Callum to discuss his research on HIV–TB care and shifting TB epidemiology. He discusses findings from the SaDAPT trial, showing that same‑day ART initiation for people with HIV and TB symptoms is non‑inferior to waiting for TB results and carries similarly low IRIS risk, supporting flexible, program‑level decision‑making. He also highlights his urban–rural TB prevalence meta‑analysis, revealing substantial regional variation and a global trend toward urbanization of TB, with implications for targeted screening and policy. Dr MacPherson reflects on the need for better, low‑cost TB surveillance tools and describes ongoing work on MTB immunoreactivity–based transmission mapping and advances in CAD‑supported TB diagnosis.

Dr Joseph Donovan, clinical researcher at OUCRU Vietnam and Associate Research Fellow at the University of Oxford, joins Dr Angus Lane, medical registrar to discuss the global burden and diagnostic challenges of tuberculosis meningitis (TBM). He outlines key findings from major trials in Vietnam and Indonesia, including the ACT HIV trial of adjunctive dexamethasone, discusses global practice guidelines, and highlights existing and emerging evidence on antiretroviral timing, aspirin, and rifampicin. Dr Donovan also reflects on the severe neurological complications of TBM and the need for evidence-based critical-care strategies worldwide.

Catherine Berry, ACTnet Steering Committee member and ID physician at John Hunter Hospital, Newcastle, was joined by Dr Jodie Schildkraut and Dr Van Le Hong, key researchers in the global Unite4TB consortium, which is accelerating the development of new TB treatments. Dr Schildkraut, based at Radboud University Medical Center, leads the Phase 2B/C clinical trials work package and coordinates across multiple TB consortia. Dr Van Le Hong, a pulmonologist and clinical research fellow at OUCRU Vietnam, heads the multi-arm, multi-stage (MAMS) trial platform in Ho Chi Minh City. Together, they explore Unite4TB’s approach to transforming TB regimen development, strengthening trial platforms, advancing biomarkers, improving early-phase design, and harmonising global research efforts, while reflecting on the practical challenges of conducting trials in high-burden settings.

Associate Professor Nicolas Alan Menzies, from the School of Global Health and Population at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, joins Dr Andrew Burke to discuss his research on the contribution of post-TB sequelae to life-years and quality-adjusted life-years lost due to TB disease in the United States. Drawing on data from both U.S. and Brazilian cohorts, he explores how a significant portion of TB’s health burden, including elevated mortality and reduced quality of life, emerges after treatment completion with apparent cure. Together, they discuss the impact of delayed diagnosis, age-related risks, and the need for early detection and long-term care.

Dr Matthew Burman is a TB clinician and researcher from East London, Queen Mary University and the Blizzard Institute. Today he presents the data from the CATAPULT trial which randomised patients to either have their latent TB infection managed by a TB clinic in secondary care, or be managed in primary care by their GP in concert with a community pharmacist. This amazing trial re-evaluates how we think about TB preventative therapy and looks at new ways of approaching the burden of latent TB infection. REFERENCES Burman, M., et al. "Protocol for a cluster randomised control trial evaluating the efficacy and safety of treatment for latent tuberculosis infection in recent migrants within primary care: the CATAPuLT trial." BMC Public Health 19 (2019): 1-7. Goswami, Neela D., et al. "Predictors of latent tuberculosis treatment initiation and completion at a US public health clinic: a prospective cohort study." BMC public health 12 (2012): 1-8. Loutet, Miranda G., et al. "National roll-out of latent tuberculosis testing and treatment for new migrants in England: a retrospective evaluation in a high-incidence area." European Respiratory Journal 51.1 (2018). Alsdurf, Hannah, et al. "The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis." The Lancet Infectious Diseases 16.11 (2016): 1269-1278.

Dr. Stijn Deborggraeve is the Diagnostics Advisor Infectious Diseases at Médecins Sans Frontières (MSF) Access Campaign. In this episode we discussed GeneXpert technology including pricing, logistics, and future developments.

Dr Graeme Hoddinott is a Senior Lecturer in Global Health at the University of Sydney. He is also an Extraordinary Associate Professor in paediatrics at Stellenbosch University. Much of his research experience is on tuberculosis, especially among children, adolescents, and their families.  In this episode, we explore ground-breaking research on the preferences of children and adolescents in tuberculosis (TB) treatment and management, revealing surprising insights that could lead to better patient outcomes. We also discuss the hidden long-term effects of TB treatment in younger populations and highlight areas where further research is essential.

Associate Professor Sarah Bernays, co-director of the Masters of Global Health program at the University of Sydney, leads a social science research program focused on community engagement in infectious disease prevention, treatment, and care. Her work emphasizes understanding how individuals, households, and communities respond to health adversity, risk, and vulnerability while fostering resilience and hope. In this episode, we explored the perspectives of tuberculosis patients, the challenges they face in accessing and receiving clinical care, and methods to identify what truly matters to them. We also examined strategies for clinicians and researchers to enhance their approaches to interventions. Finally, we highlighted the importance of cultural contexts and the value of patient expertise in shaping effective care. 1. Person-centered and youth-oriented interventions to improve TB Care for adolescents and young adults: https://doi.org/10.1371/journal.pgph.0003659

Professor Guy Marks AO FAHMS is a distinguished respiratory and public health physician and environmental epidemiologist. Currently serving as the President and interim Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union), he has led the Respiratory and Environmental Epidemiology group at the Woolcock Institute since 1997. His research primarily focuses on lung health, with particular emphasis on airway diseases, air pollution, and tuberculosis. Additionally, he is dedicated to capacity building in lung health research.  In this episode, we delve into the essential factors for TB elimination, emphasizing the need for clinicians, researchers, and policymakers to focus on the infectious nature of TB. We explore the significance of large-scale active case finding, a strategy employed since the early 20th century, and discuss why targeted case-finding should be prioritized in middle- and low-burden countries where it proves most effective. Summary (Unfortunately not included in the audio)  Despite extensive eradication efforts comparable to malaria and HIV, TB remains a persistent public health issue. Guy indicated that current metrics suggest we are not on track to meet the 2030-2035 global TB eradication targets.  Professor Marks highlights the primary factors required for TB elimination, with emphasis that as clinicians, researchers, and policymakers, we need to centre our approach to TB eradication on the basis infectious nature of TB.  Since its use in the early 20th century in Western countries, large-scale active case finding remains a primary strategy in the management of TB. Guy indicates that targeted case-finding should be reserved for middle and low TB burden countries where it is more effective.    Professor Mark's Vietnam-Based Research on TB Transmission shows that in high-burden TB countries:  Most TB cases result from recent transmission, and are the largely responsible for driving the epidemic in these settings. Identifying and treating these recently diagnosed cases leads to a rapid reduction in TB incidence across the population.  Feasibility and cost remain as the prohibitive challenges for implementing molecular techniques widely in TB case identification. However, advances in radiographic technology are helping to bridge this gap, especially in high TB settings.   Professor Mark's suggests that the essential approach to achieving TB eradication will revolve around finding patients with TB and delivering efficient and effective healthcare. The Union World Conference on Lung Health 2024 is just a few days away starting on 12 November 2024 in Bali, Indonesia, but it is still not too late to register. Be sure to explore the comprehensive Programme, full of the latest scientific breakthroughs in tuberculosis and lung disease.  If you cannot make it to Bali, registered delegates have online access to most sessions as they happen or can watch at leisure.