Education played a key role in our IGEM journey due to the nature of TB's perception in different countries. It is generally perceived as an old issue that has been overcome in high-income countries and as something that carries many social stigmas in low-income countries. As illuminated by our stakeholders from the general public, although the majority of people may have basic knowledge of TB as a dangerous disease, most of them don't know much about it beyond that. Additionally, there is a lot of misinformation about TB circulating in many communities. We wanted to use our platform to raise awareness and promote education about TB, as well as to encourage younger people to get involved in synthetic biology. We did this by making and distributing a selection of educational materials and giving talks about our project and synthetic biology to diverse audiences.
Project Poster
We designed this poster to educate the passersby about latent TB and also introduce our project to the public. We used majority black text on a white background to make it as reader-friendly as possible to people with visual impairments. We picked blue as a primary colour for our educational materials as it conveys trust and is associated with the medical field. We provided QR codes to our social medias where people could find out more information about our project and latent TB. We distributed this poster around our university campus, in some public areas in North Finchley and in Guy's and St Thomas' hospital. We wanted to dispel the myth that TB does not exist in the UK and is an isolated issue in developing countries.
Stigma Poster (for the Dominican Republic)
TB is not the same as HIV
Tuberculosis
Caused by a bacteria
Can be treated with antibiotics
Spread through the air when a patient with active TB coughs or sneezes
HIV
Caused by a virus
Treated with antiretroviral drugs
Spread through exchange of bodily fluids with someone infected with HIV
We designed this leaflet for the Dominican Republic (DR) after a stakeholder meeting with a Dominican doctor who informed us that there is a big stigma associating TB with HIV in the DR. Due to this, many people (particularly women) actively avoid diagnosis and treatment of TB. This false association also exists in many other countries. We made this poster to be displayed in doctors' offices and health clinics in the DR to challenge both the association between TB and HIV and the demonisation of HIV. We did so by stating simple facts on the differences between the two. We wrote in Spanish (the primary language of the DR) and kept it brief to hold people's attention with a clear slogan that will stick in people's minds. Again, we used dark text on a white background to make it legible and we kept the blue colour with all of our educational resources for continuity. We added an eye-catching graphic to capture the reader's attention and plan to ask our stakeholder Dominican doctors to display our posters around their place of work, where they could be of comfort and education to patients coming in.
Educational Leaflet (for the United Kingdom)
We made this educational leaflet about TB for the UK to teach the average person about TB treatment and prevention. We were inspired by a similar government-certified NHS leaflet and wanted to recreate it in a format that would be engaging and easy to understand for the general public. We made sure to include information implicated in our quiz as being less widely known, such as the distinction between latent and active TB. We opted for fast bullet points and easy steps to follow that would be memorable for readers. Like with our other educational resources, we kept the black text on a white background with blue accents. We also added related visuals to break up the text and facilitate understanding. We plan to distribute these in waiting rooms at our local hospital and around campus, where there is high traffic of people and ample opportunity for them to engage with this resource. We also provided online translations of our leaflet in different languages so it could be more accessible to immigrant communities in the UK.
Translations:
Educational Leaflet (for the Dominican Republic)
Tuberculosis can be cured
What is TB?
TB is a mostly respiratory bacterial disease caused by Mycobacterium tuberculosis. It it transmitted via the air (through coughs and sneezes) from a person with active tuberculosis to a healthy person.
What is HIV?
HIV is the virus that causes AIDS. AIDS is the most advanced part of a HIV infection. This disease can be transmitted through sexual relations without protection, during breastfeeding or during direct contact with blood contaminated with HIV. People with HIV are 30x more likely to contract TB than a healthy individual.
Which people have the greatest risk of contracting TB and should have regular checkups?
People with HIV
People with Diabetes Miletus- this is treated as a lifelong disease that is characterised by high levels of sugar in the blood.
Symptoms of TB
Coughing blood
Fever
Weakness
Chest pain
Decreased appetite
Night sweats
*Tuberculosis generally affects the lungs but can also affect the brain, kidneys and spinal column. However, only people with pulmonary TB are infectious.
What to do if you are worried and present symptoms?
Visit your closest GP
This leaflet functions the same way our British leaflet does for the UK, but for the Dominican Republic (DR). We included red to differentiate this leaflet from our one designed for a British audience and to match the flag colours of the DR. The government-certified information released about TB was slightly simpler than the UK's guidance, thus the easier to comprehend language and the lack of mention of latent vs active TB. This could be to account for the lower average level of education in the DR compared to the UK. Another discrepancy between the information released by the UK and the DR is that the DR's information has more of a focus on HIV; this could be due to the more pronounced stigma associating TB with HIV in the DR. As our leaflets promote government education, these trends are also reflected in our two leaflets. As with our stigma poster, we hope to distribute this leaflet in the clinics and offices of the Dominican doctors we used as stakeholders. We made the leaflet in Spanish as it is the national language of the DR, but also made a Haitian Creole version because there is a large Haitian minority in the DR who use the healthcare system, and they face extensive linguistic discrimination.
Educational Instagram Posts
During our IGEM journey, we made numerous posts on our project instagram account to reach a wider audience we could educate about our project and TB. We focused on spreading information about TB epidemiology and diagnostics, but also tried to bring attention to social issues intersected with TB that we researched.
Post 1
We created this post in order to inform the general population on what tuberculosis is, which symptoms it showcases, and to highlight the differences between latent and active TB. This is especially important information to share as 1 in 4 people have the disease. Hence, such a widespread illness should be caught as soon as possible and the best way for this is for the public to be aware of the symptoms it causes and get tested. It is also worth noting that latent TB can turn into active TB, which is both dangerous and contagious. Therefore, we believe this post will encourage people to get tested for TB even if they do not present active symptoms.
Post 2
We created this post to highlight the severity and urgency of the TB situation worldwide. We wanted to show this through statistics to make a statement using figures so the general population would understand the necessity of having a test for TB. Nonetheless, we also said that it is preventable in order for the population to realise that although it is a big problem, we can make a big impact in reducing the TB cases worldwide. This gives us a good entry to introduce our project and talk about its importance.
Post 3
We created this post to inform the public on the different methods that are used to diagnose TB. This is extremely important as we want the public to be aware of the disadvantages of different methods available to highlight the strengths of our particular diagnostic tool. Therefore, we believe that this post will serve as a guideline for a comparison between available tests.
Post 4
We created this post as part of our inclusive approach to creating a TB test. We wanted to highlight vulnerable communities most at risk of contracting the disease and inform the public about it. These people are some of the most at-risk for developing TB, but frequently receive the least sympathy and help from governments and the public alike. This way, more awareness is brought to the issue at hand and hopefully, more resources are given to mitigate TB spread in homeless shelters and prisons.
Mini Jamboree
The mini jamboree was held by Imperial 2025 IGEM team and was an opportunity for UK-based IGEM teams to come together and present their findings, whilst also listening to experts and networking. This was a good chance for our team to practice our presenting skills in preparation for the real jamboree in Paris. We received useful feedback about our project and aimed to address it moving forward.
The presentation we gave was not well-rehearsed because it was more reading from our notes and people could tell we did not have confidence, so we would like to improve on our confidence when presenting and presenting without any notes.
The content of the presentation seemed to be understood, but we didn't stress the importance enough of diagnosing LTB, as many people were more concerned of the therapeutic side (questions asking about treatment courses and multi-drug resistant) , we should improve on this by addressing the reasons we chose LTB and Diagnostics. We didn't go into depth into our test - how it would work , why it's a good diagnostic test and what it's improving on, because we weren't as confident on the research and lab side, but now seeing there is more progress in the modeling and lab side of things, we can showcase this in our next educational event. Lastly, we need to think about how our project will be implemented, as we did not talk about this except for its target audience being those in the Dominican Republic. So we should emphasise the human practice and entrepreneurship side a lot more.
miRNA Detection Method
Interactive Educational Booklet
Myth-Busting Session with Ms Collins
How TB is transmitted?
How a mother with TB can easily spread it to her newborn baby?
How TB affects foetuses in pregnancy?
What the children will have when they grow up (symptoms)?
What are the side effects of TB medication on pregnant women?
TB and pregnancy
Research shows that new mothers and pregnant women are at an increased risk of developing active TB. Pregnancy has no negative impact on the success rate of TB diagnosis, but as with TB in general, late diagnosis can hinder the effectiveness of treatment and pregnancy can often result in this. Symptoms of active TB during pregnancy may be less identifiable as they may be mistaken for the typical physiological changes experienced in pregnancy, e.g., heavier breathing, loss of appetite and tiredness. Pulmonary TB is the most common in pregnant women, along with lymph node TB. (1)
The likelihood of an unborn baby being infected with TB is very low and complications can be reduced through early diagnosis and appropriate treatment. Without swift intervention (e.g., late diagnosis and lack of proper treatment) complications can arise: neonatal morbidity, prematurity, growth retardation and low birth weight. A mother with untreated TB can also infect her baby. Late diagnosis of TB can also increase the risk of obstetric morbidity (death of the mother in childbirth), which accounts for 6-15% of all maternal mortality.(1)
Governments of multiple countries (e.g., Uganda and Brazil) are attempting to introduce TB screening specifically for pregnant women, but it is not yet a widespread or routine thing. It is a routine thing in South Africa.(2)
After a positive IGRA or TST, mothers should do a chest X-ray with abdominal shielding to distinguish if their TB is active or latent. (The shielding is used to reduce the radiation to the foetus).
The BCG vaccine should not be administered to pregnant women to avoid side effects and if required, should be given after birth. Untreated TB poses a greater risk to the woman and her unborn child than the medication used to treat the disease.
Recommended TB treatment for pregnant women: course of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol (usually for about six months). In the last four months of treatment (the continuation phase), medication is usually reduced to rifampicin, isoniazid and pyridoxine. Anti-TB drugs can cross the placenta and reach the baby, but no adverse effects of these drugs on the foetus have been shown. *Streptomycin (an anti-TB drug) should not be given to pregnant women because it can damage the foetal 8 cranial nerve (responsible for hearing and balance).(1)
Pregnant women with latent TB should be treated with TB prophylaxis (a preventative drug that is isoniazid and rifampicin or a combination) if they are HIV positive or have recently caught the disease. Isoniazid and Rifampicin are generally safe for the baby and mother, but in rare circumstances, they can result in liver damage (this more commonly occurs in the third trimester).(1)
A mother can still breastfeed in spite of being treated for TB because the concentrations of the anti-TB drugs in the breast milk are too low to be toxic to the newborn. Breastfeeding as a treated mother and offering specific TB treatment to the baby can provide protection against the disease. Breastfeeding women taking isoniazid should also take pyridoxine.(2)
Only women with TB in their lungs and/or larynx are potentially infectious to their baby. Patients typically stop being infectious 2 weeks after treatment. Sometimes mothers with TB need to be separated from their newborns to prevent transmitting it to them (this usually only occurs in incidents of TB diagnosis just before birth or resistant forms of TB).(1)
Infants who have been exposed to mothers with active TB should be treated prophylactically to prevent progression of the disease to active. Contact tracing should also be done among the family and close contacts. After 3 months, a TST should be done and following a negative result, another one or an IGRA test should be done and then if they're all negative, treatment can be stopped and the BCG vaccine can be provided.(1)
The BCG vaccine is 70-70% effective in preventing serious cases of TB in infants and children.(2)
Potential side effects on infants
A paper recorded the outcomes of 5 women who were treated for drug-resistant TB whilst pregnant in South Africa. The drugs used were: bedaquiline, delamanid and linezolid. The main findings were: no significant impact on birth outcomes- suggesting pregnant women should not be denied novel treatments for resistant TB.
Studies have shown pregnant women with drug-resistant TB may be offered substandard care and face a high degree of discrimination in healthcare. A study in Ukraine showed that women with DR-TB were more likely to have pregnancy complications. These women were also given conflicting advice on precautions to take postpartum due to the lack of training of healthcare workers.
New and repurposed TB medications such as bedaquiline, linezolid and delamanid aim to improve the lives and health of pregnant women with TB because they decrease sputum conversion time (time taken for sputum to change from positive for TB to negative)- decreases infectiousness, better treatment outcomes and decreased mortality. They are safer than current drugs for DR-TB, such as aminoglycosides, which cause maternal and foetal ototoxicity (problems with hearing and balance) and ethionamide, which causes severe vomiting, hypothyroidism and development of neural tube defects.
A key problem is that pregnant women are excluded from drug trials, so there is little progress on pregnancy-safe drugs for TB.
A small cohort of pregnant women in South Africa with DR-TB were treated with either delamanid, bedaquiline and linezolid. All 5 of their babies were born alive and were developing normally at their follow-up visits. ⅗ had successful treatment outcomes, whilst the other 2 were lost to follow-ups.(3)
Transmission of TB
TB is an airborne disease, spread through droplets from coughs and sneezes, primarily through prolonged close contact with an individual with infectious active TB. Once released into the air, TB bacteria can remain for several hours and are most efficiently transmitted in crowded indoor places with poor ventilation. It is not a waterborne disease and is not typically spread through sharing drinks.
(TB is transmitted from mother to child in the same way. Mothers are particularly likely to spend increased periods of time around their newborns and infants inside the house as they don't go to school and may sleep in the same bed/room- increasing likelihood of transmission.)(4)
Association of TB treatment with pregnancy complications
Latent TB is treated using Rifampicin, Isoniazid, pyridoxine (vitamin B) and Rifapentine. Isoniazid and Rifapentine are not recommended for pregnant women or women expecting to conceive for safety reasons. Active TB is typically treated with Isoniazid, Rifampin (responsible for killing TB bacteria in non-resistant forms), ethambutol, Streptomycin and Pyrazinamide. Streptomycin and Pyrazinamide are not recommended during pregnancy because streptomycin has harmful effects on the foetus and Pyrazinamide has unknown effects.
Estimates claim up to 11% of pregnant or postpartum women develop TB. Pregnant women with TB are even more vulnerable in the post-partum period. During pregnancy, T-helper cells are reduced, increasing risk of reactivation of TB. TB in pregnancy is linked to intrauterine growth restriction and hyaline membrane disease (respiratory distress syndrome- when a baby needs extra oxygen and help breathing after birth).
TB accounts for 35% of maternal deaths, but is most common in mothers with both HIV and TB.
Pregnancy triggers physiological changes that have major impacts on absorption, distribution, renal or hepatic clearance and metabolism of TB drugs. Azithromycin has been linked to pregnancy-induced cholestasis (when bile flow from the gallbladder to the liver is reduced and can leak into the blood and cause inflammation). Isoniazid TB therapy during pregnancy can cause birth defects like talipes equinovarus (club foot- the foot points inwards and downwards) in infants.(5)
Following up on the previous account of her experience with TB during pregnancy, we organised an educational session with Ms Collins, where we went over some of her questions and concerns regarding the disease and her treatment. In preparation for this meeting, I had multiple meetings with her daughter Scarlett to clarify details of Ms Collins' experience with TB, read through her medical records regarding TB that she provided me and did my own research into her questions using reputable sources. As part of the session, we clarified how TB is spread. She previously believed she initially caught the disease from sharing drinks, but this is very unlikely, as TB is an airborne disease. I explained to her the details of TB transmission, giving examples of other potential ways she could have contracted the disease. I ensured the session was interactive and frequently recapped what I'd said to facilitate understanding. We also discussed the possibility that she had contracted TB previously from her friend's dad, which she had mentioned in our last meeting. We weighed up the likelihood of this with the two negative TSTs and antibiotic resistance strain, ultimately concluding that it was still indeed a possibility, but not something we could say for definite. Also regarding transmission, I clarified that it was unlikely she gave her son TB in-utero whilst pregnant and latent (something she had expressed previous concern over), as this is a very uncommon phenomenon and latent TB bacteria cannot cross the placenta.
It is essential to spread awareness and promote education surrounding TB in pregnancy, as it is an underrepresented issue despite estimates of up to 11% of mothers having TB and estimates of up to 35% of maternal deaths attributed to TB. It is important to reassure patients of positive outcomes and provide the necessary education they need to continue productively with their lives with peace of mind.
There is limited research into TB and pregnancy, especially regarding the treatment of drug-resistant TB (like Mrs Collins had) during pregnancy. This is because many pregnant women are systematically excluded from clinical trials and the lives of their unborn babies are prioritised over their own.
LBT Sixth Form Educational Workshop
"By learning, you will teach; by teaching, you will learn." - Phil Collins
Teaching Format
This year, our team delivered a 75-minute session at a local sixth form to a Year 13 biology class. We wanted to engage students who are about to enter higher education and give them exposure to research methods in a way that could inspire them to pursue STEM. The lesson was structured around three main learning objectives:
- Learn about infectious diseases from a medical and social perspective
- Learn about diagnostics and their components
- Apply science to real life contexts
Our plan aligned well with their existing curriculum, as they had previously studied infectious diseases as part of their coursework.
Student Engagement
The session was designed with lots of images, minimal text, and interactive activities. We incorporated Mentimeter questions to gauge prior knowledge and were encouraged to see that students already had a broad awareness of tuberculosis and its symptoms. Throughout the lesson, students were engaged, asked questions, and responded enthusiastically to the games.
By the end of the session, students had learned about:
- The difference between active and latent TB
- The current diagnostic tools for latent TB
- The 4 components of a diagnostic
- The role of samples, biomarkers, and their different types
- The key differences between diagnostic tools such as LFTs, PCR, and ELISA
- Different readout methods
They also explored the challenges of implementing diagnostics in low-resource settings, encouraging them to think about the broader societal and global health context of scientific innovation.
Reflection and Outcomes
This activity not only strengthened student understanding but also aligned with our own iGEM goals by fostering public engagement with synthetic biology. The session:
- Improved student awareness of tuberculosis as a modern global health issue, countering the misconception that it is a "disease of the past."
- Encouraged critical thinking by connecting science with human practices (e.g., stigma, cost, and accessibility).
- Inspired future STEM engagement by showing that high-impact science can be broken down into accessible, real-world applications.
One limitation we faced was timing - we had overprepared content, meaning the human practices discussion was shorter than intended. To address this, we designed a second session with undergraduate students condensed into 45 minutes, refining our delivery while keeping the core interactive elements. In this session, we put an emphasis on our human practices to make sure this is also covered.
References
- Public Health England . Pregnancy and tuberculosis (TB) Information for clinicians [Internet]. 2019 Dec. Available from: https://assets.publishing.service.gov.uk/media/5df2563740f0b6094e25ac3c/RA_Pregnancy_TB_Clinicians.pdf
- WHO. TB and pregnancy [Internet]. Who.int. 2018. Available from: https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024/featured-topics/tb-and-pregnancy
- Acquah R, Mohr-Holland E, Daniels J, Furin J, Loveday M, Mudaly V, et al. Outcomes of Children Born to Pregnant Women With Drug-resistant Tuberculosis Treated With Novel Drugs in Khayelitsha, South Africa: A Report of Five Patients. The Pediatric Infectious Disease Journal [Internet]. 2021 May 1;40(5):e191. Available from: https://journals.lww.com/pidj/fulltext/2021/05000/outcomes_of_children_born_to_pregnant_women_with.21.aspx#:~:text=Recent%20data%20from%20a%20cohort
- Centers for Disease Control and Prevention. Tuberculosis: Causes and How It Spreads [Internet]. Tuberculosis (TB). 2025. Available from: https://www.cdc.gov/tb/causes/index.html
- Kgathi MA, Phoswa WN. Association of tuberculosis treatment with pregnancy complications. Medicine. 2021 Nov 19;100(46):e27849.