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DR highest in foreign born. No age difference. But more INH-R in elderly? Implications for DR after LTBI treatment.
Approach could be retrospective data collection by someone who speaks Korean going through clinical notes.  Can do this without consent. From 2011. Relapse data would be good, but cannot trace without government involvement (unless within same hospital). Can get phenotypic resistance levels.

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Potential to meet relevant people in the autumn (note Korea has really good people already in this field!). Put on hold

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1. Prospective study through hospitals. Private hospitals more useful for this, probably.
2. Are we seeing a difference in levels of exposure or toxic results of the drug? Literature to be mined.
3. Elderly currently not being tested for LTBI unless contacts. Even the latter only started a few years ago, before that elderly family members not tested during contact tracing for LTBI.

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Training programmes and capacity building

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Training programmes and capacity building

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1. ERS short (Apr/Oct deadline) and long term (Jan deadline).

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PPM programme- evaluation and outcome measurement

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PPM programme- evaluation and outcome measurement

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Jusang to send draft paper for review.
Further data update over next year. Has resource

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of value to modelling for economic analysi
look at defaulters/lost to follow up as a sentinel group.
Do this in next 12 months

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Are the elderly transmitting among themselves or all reactivation?

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LTBI biomarkers for progression (subclinical disease)

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LTBI biomarkers for progression (subclinical disease)

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1. Biorepository of remaining blood from IGRA test. Or extra blood. Needs to be hypothesis-driven (otherwise expensive).
2. Elderly high LTBI prevalence BUT test looks at risk for next couple of years, so really want cross-section of pop to look at immediate risk. Two options- clinical trial (sample size ~1000-1500 contacts) or large scale observational study nested into another study.
3. Also can use within the context of an observational study of how people respond to treatment (how do the biomarkers change?)
4. Can freeze the blood samples pre-testing.
5. Data needed prior to (observational) study of testing every year- incidence of TB among LTBI positive and risk factors for this. Comes from data linkage study.

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Healthcare systems and choice- public health and satisfaction implications

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Healthcare systems and choice- public health and satisfaction implications

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customer satisfaction - for the future

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Latent TB treatment and development of DR (plus transmission of this)

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Latent TB treatment and development of DR (plus transmission of this)

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1. Make sure collecting right data now! Rough measure of adherence per person.
2. Want more evidence for treatment in 35-65s, rather than elderly.

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1. Meeting in Korea in the autumn, where prelim results of LTBI work will be presented. This work can inform 2.
2. Apply for LTBI-linked work in early 2019.
3. Discrete grant idea A) modelling of testing and treating for LTBI in the elderly.
4. MN to write a short brief of a proposal to go into our feedback report in May. And write a brief summary of other things that can be done with the biomarkers.
5. FK to look at pharmacology of TB drugs in the elderly.
6. Find funding to start storing bacterial samples beyond 6 months in preparation for WGS.

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1. Korean sources- wait until next year. One international expert to meeting in the autumn.
2. MRC. Any more joint calls? Go back to MRC, say we have built a collaboration and ask where they want us to go next. Flag research ideas in our end-of-grant report.
3. Joint Heath Systems Research Initiative (Wellcome)

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1. Storage of bacterial isolates from culture for 6m (baseline) in hospitals. Can sequence in Korea.
2. Korean Institute of Tuberculosis (KIT) is the over-arching reference lab with ~70% of TB cultures (do not have the epi data). ~5 labs that do the DSTs (private). Best way in through KIT?

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1. Should the elderly be screened for LTBI and treated?

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Being done this year- the linkage takes 3-5 months
6 months of follow up after LTBI testing. Who is progressing?
Results of this can be used to inform a funding application
Currently looking at what % start and complete treatment. Korean CDC  has information on public hospital pple, claim data for private hospital pple
Translation into the highest impact policy possible for TB control