The hallmark of TB disease is the necrotising granuloma, a site where the live mycobacteria reside amidst necrotic cell death. For TB drugs to be effective, drugs have to be delivered to the infection site which may pose a challenge in granulomas. This talks will describe the immunopathology of TB, the process of dysregulated angiogenesis and how the process can be augmented to improve drug delivery.

Optimising tuberculosis (TB) treatment requires ensuring appropriate drug exposure to maximise efficacy, minimise side effects, and prevent drug resistance. However, blood-based therapeutic drug monitoring (TDM) remains largely inaccessible in resource-limited settings due to the need for specialised laboratory infrastructure.
Alternative approaches such as saliva- and urine-based TDM offer practical solutions. Saliva sampling enables non-invasive prediction of plasma drug concentrations, while urine testing provides qualitative or semi-quantitative assessments with minimal technical requirements.
Despite these innovations, important challenges remain, including the need for standardised sampling protocols, validation of alternative matrices against clinical outcomes, acceptance of patients and healthcare workers as well as integration into programmatic care. Opportunities exist to leverage mobile health platforms, point-of-care technologies, and collaborative networks to support the adoption of simplified TDM frameworks. In this presentation, we will discuss the current landscape, highlight key research findings from saliva and urine-based TDM, and outline the critical steps needed to move from innovation to implementation in resource-constrained environments.

In high burden countries, TB treatment mainly done in the primary health care (PHC) within the National TB Program. Even with successful programmatic treatment, people treated for TB may experience severe side effects, respond slowly to treatment, or develop antimicrobial resistance. It is imperative that TDM is available for those people. This session will discuss feasibility of implementation of TDM in TB programs, different type of TDM service in different settings, what are the challenges, what technology & innovation can help us, and how to move forward including to face the barriers.

After diagnosis, providing each tuberculosis (TB) patient with the right drugs at the right dose for the right duration in the right combination is important to effectively reduce transmission, prevent relapse and control the risk of development of drug resistance. A better understanding of the relationship between drug exposure and antimicrobial kill and acquired drug resistance has helped to design more appropriate dosing regimens for antituberculosis drugs. Despite the success of TB treatment programs, patients still experience side effects, slow response to treatment, or acquire drug resistance. Therapeutic drug monitoring (TDM) is intended to optimize treatment efficacy and reduce side effects by performing drug concentration guided dose adjustments. Such individualised strategy clashes with current programmatic TB treatment which recommends general dosing strategies. Identifying patients receiving programmatic TB care who are at risk for suboptimal treatment is key to improve treatment outcomes. The use of new technology and new approaches to TDM can help overcome hurdles for implementation of TDM. In this presentation a TDM framework feasible to be implemented in programmatic care will be presented as well as the evidence required for uptake of TDM in TB treatment guidelines.