 Thank you very much. I'm very happy to have been invited to chair this session. I have worked in HIV and TB in South Africa and in Malawi, and I'm very happy that we start off with a TB topic and then we are going into very special populations within the HIV field. So I would like to welcome Esther Kazas, a medical doctor who has worked for MSF for a long time to lead us through the nine-month short-course MDL TB treatment. Yeah, good morning to everybody and good day to everybody online. Yeah, well, this morning I'm going to share with you the interim results of these two prospective studies that are looking at implementation of short-course to treat multidirect-resistant TB into settings in Swaziland and Uzbekistan. So why is this relevant? If today any of you is diagnosed with multidirect-resistant TB, your physician will give you a cocktail of drugs for at least 20 months, and amongst these eight of these ones are going to be on injectables. So we had results a couple of years ago from Bangladesh challenging that and letting us know that actually it might be possible to treat multidirect-resistant TB for a shorter duration with also a cocktail of drugs shortening the intensive phase with injectables and with still the same drugs that we are classically using first and second line drugs. These people they showed from an observational court analysis that after nine months of treatment the success rate was 88%. So MSF chose to look at that a bit more in depth and to increase the evidence in the specific populations in settings where there is high prevalence rate of second line drug resistance and in settings where the HIV prevalence is also very high. So we go to Uzbekistan where MSF is working since 2003 supporting comprehensive TB care in Karakal-Pakstan and with the rates of MDR TB prevalence. I'm not going to go through all these numbers but you can see that they are quite high, quite impressive. And in Swaziland we are working there since 2010. Swaziland is a small country bordering Mozambique and South Africa has also the highest HIV prevalence rates in the world and not only that the highest TB incidence rates in the world as well. And not only that, more than 80% of the cases that we are going to see with TB are HIV co-infected. So we are going to look how we can improve the treatment for these patients with multi-drug resistant TB. The objective, both the studies, they share the same objective. We aim to describe effectiveness and safety following treatment completion of this regimen in patients with MDR TB with and without HIV co-infection. Any patient that is diagnosed with MDR TB and that consented is included in the study. If patients they had any contraindications to the drugs, XDR TB or other resistant patterns, severe renal insufficiency, abnormalities in the electrocardiogram, or in the case of Uzbekistan, additional exposure or previous exposure to second-line drugs were excluded from the study. So in summary, these are two independent prospective single-arm cord studies. Uzbekistan is aiming at including 147 patients in three sites. Swaziland is looking at including 120 HIV-co-infected patients in two sites. The study in Uzbekistan started in September 2013. The study in Swaziland in January 2014. They both got approval from the ERBs in country and in MSF and they are both working with independent drug safety monitoring boards. So the time of the analysis, the moment of the analysis at the end of December 2014, we see that in Uzbekistan we enrolled 119 patients. Of them 14, we'd drawn a posteriori from the study. In Swaziland, 61 were enrolled in the study. Four of them were drawn later on. Why were we drawn or we had to withdraw patients from the study? Mostly because they showed different patterns of resistance from the criteria. So we saw some patients that had confirmed drug-sensitive TB, patients with poly-drug-resistant TB, patients that showed additional second-line drug resistance with XDR TB or extreme drug-resistant TB. And in Swaziland, one patient withdraws consent. We have a look quickly at the baseline demographic data. I put them together just for the sake of the presentation. We do not aim to compare results. In Uzbekistan, out of the 105 patients we can see 50% male and the median age was 30 years old in Swaziland. Out of the 57 patients enrolled at that moment, 40% were male, 35 years old. The BMI body mass index median was around 20 in both cases and to highlight, three out of four patients in the Swaziland court were HIV-co-infected. To also note that amongst the registration group more than 70% of the cases in both courts were new cases. And having a look at the closer look at the HIV subgroup, we can see basically that the baseline demographic data is the same in the HIV subgroup than in the overall group in Swaziland. And looking at the interim outcomes at the end of 2014, in Uzbekistan there were still on treatment 66 patients out of them 35 were still on intensive phase that means on injectables. 24 patients had documented successful outcomes. Two died, three patients failed and 10 patients were documented lost of follow-up. In Swaziland, out of the 57 patients enrolled 39 at the moment of the analysis were still on treatment 21 of them on intensive phase 10 patients were cured, six died, two failed. And again, having a look closely at the HIV subgroup analysis what this revealed to us is that all the patients that died in Swaziland were HIV-related deaths. So why do patients die? In Swaziland, as I said, we had HIV-related deaths advanced HIV-TV with a case suspected of Cryptococcal meningitis encephalopathy related to late stage of HIV-H. Two cases related to advanced MDR-TV and two cases with liver failure. In Uzbekistan, one of the deaths were related to the MDR-TV process, another one not. Let's have a look at the culture conversion and we see that in all the groups in Uzbekistan and in Swaziland and including the HIV subgroup court at four months we have more than 90% of the patients converting culture. A closer look at the analysis at month two in Uzbekistan we saw that already 73% of the patients had culture converted as I said at month two. In terms of toxicity, we see a number of site events the most of them in Uzbekistan are mild grade one mostly nausea and vomiting and headache and dizziness and in Swaziland also a number of adverse events the most of them mild also grade one mostly also nausea and vomiting and arthritis and minor auto toxicity and a few number of cases documented with severe adverse events. Another one of the concerns or one of the main concerns of this regimen is the cardiotoxicity and the prolongation of the interval QT in the electrocardiogram that eventually might lead to very severe arrhythmias. So we looked at that and in both studies there were monitoring with electrocardiogram in a regular basis for all patients. So what we see is that at two and four weeks the median increase of this corrected QT was less than 20 milliseconds in all cases in both programs I mean and then there is a number of patients that had an increase of more than 60 milliseconds and in one case in Swaziland we documented an absolute QTC of more than 500 milliseconds at two weeks. This patient had also documented electrolyte abnormalities corrected and he could resume treatment. So in conclusion, we know that we need I'm not saying anything new probably we need shorter, safer and more tolerable regimens to treat multidirect resistant TB. These outcomes indicate that there is early culture conversion in this regimen as expected we have some failures we have a challenge in terms of loss to follow-up and age-related day indicating that there are components of the program that we have to improve and to work on further there is still, this is not yet a regimen that is toxic-free and then we have to think about the next steps. Obviously when it comes to the studies we want to look at the final outcomes of these regimens in these two settings we want to look at relapse rates as part of the effectiveness assessment and when it comes to TB it seems that there is some light at the end of the tunnel with new drugs becoming available and we have the MSF commitment to continue on the fight against tuberculosis and this is actually great news and I have the pleasure to show you a couple of very nice initiatives I can only give a couple of hints but this is related to randomized clinical trialing several new regimens that combine new drugs. With all that I would just like to thank the teams in the field the Ministries of Health mainly the patients and to you all for your attention, thank you very much. Thank you very much for keeping to time we are going to take a couple of questions they are all going to be technical questions because there is a discussion at the end so if anybody wants any questions of clarifications then Nathan. Hi, thanks Esther, Nathan from WHO did you have any information on antiretroviral therapy status or immune status of the patients? For the... For the HIV court in Swaziland it's included in the protocol also and in the management of treatment all the patients they are either on antiretrovidals or they start soon after treatment antiretroviral treatment and we are looking also at response of the treatment baseline if they have already been there this analysis I cannot yet share. Thank you, any other questions? Thank you very much.