Kharitode TB is a cluster-randomized implementation trial of TB case finding activities across 56 clinics in rural Limpopo Province, South Africa. Performed in collaboration with the Perinatal HIV Research Unit (PHRU) under the direction of Dr. Neil Martinson, we are comparing household contact investigation, incentive-based contact tracing, and facility-based screening in terms of impact on TB case finding and treatment initiation. The study also includes components of qualitative research, cost-effectiveness analysis, and population-level modeling. We began recruiting participants in 2016 and plan to complete the project in 2020. (Funded by NIH: R01AI116787)
K-WaTTS is a study of TB transmission in two well-defined districts of Kampala, Uganda. In this study, we seek to identify and characterize all prevalent cases of adult pulmonary TB in Kisugu and Wabigalo. We will then use information about those cases -- including their risk factors for TB, their connections to other cases as defined by social relationships and M. tuberculosis whole genome sequencing, and their willingness to engage with preventive and case-finding activities -- to design feasible, scalable interventions for efficiently reducing TB prevalence and transmission in similar settings. We plan to begin participant recruitment in 2018 and complete analysis in 2022. (Funded by NIH: R01HL138728)
In addition to K-WaTTS, our team actively participates in other studies under the umbrella of U-TIRC, a 10-year partnership between Makerere University (PI: Achilles Katamba), the University of California San Francisco (PI: Adithya Cattamanchi), Johns Hopkins University (PI: David Dowdy), Yale University (PI: Luke Davis), and the London School of Hygiene and Tropical Medicine (PI: Dave Moore). Within U-TIRC, we are engaged in a study of mHealth-facilitated TB contact investigation (R01AI104824, PI: Davis) and XPEL TB, an implementation trial of Xpert Omni, a point-of care molecular diagnostic test for TB (R01HL130192, PI: Cattamanchi).
In collaboration with the Division of Tuberculosis Elimination (DTBE) of the U.S. Centers for Disease Control and Prevention (CDC), we are part of a broad consortium dedicated to using infectious disease models to improve public health in the United States. Our team is responsible for development of models of TB transmission in the four states that contribute >50% of all TB cases in the US each year. Our current areas of active effort include investigation of the potential impact and cost-effectiveness of such interventions as targeted testing and treatment and enhanced contact investigation.
We collaborate with Interactive Research and Development (IRD) to model the potential impact of TB case finding initiatives in Karachi, Pakistan. Our models are being used to inform policy related to targeted case finding interventions in the city and to support scale-up of TB case detection on the country level (funded by the Global Fund to fight AIDS, TB, and Malaria). Web interface in development here.
In collaboration with the Bill and Melinda Gates Foundation and World Health Organization (WHO), we are constructing a series of models to inform target regimen profiles (TRPs) for new TB drug regimens, and also to inform strategic planning related to the emergence of drug-resistant TB. Our models are being used to develop global plans with respect to funding and prioritization of new drug regimens. (funded by the Bill and Melinda Gates Foundation, Work Order 10)
Our group is responsible for leading the Modeling Research Group of TB-MAC, the leading international organization responsible for coordinating TB modeling activities on a global level. In this capacity, we organize annual meeting related to key topics of interest to the scientific TB modeling community; our 2017 meeting focused on the epidemiological and economic modeling of TB case detection. (Funded by the Bill and Melinda Gates Foundation through the London School of Hygiene and Tropical Medicine)
In collaboration with Dr. Jonathan Golub of the Center for TB Research and Dr. Neil Martinson of the Perinatal HIV Research Unit in South Africa, we are constructing a suite of models to project the potential population-level impact of injectable or other long-acting formulations of preventive therapy for TB in HIV-endemic settings. (Funded by the NIH: R01AI095041)
We are collaborating with Dr. Bob Gilman at JHU and Dr. Alvaro Proaño of the Universidad Peruana Cayetano in Lima, Peru, to develop mechanistic models that can link individual-level data observed in the laboratory (for example, TB growth rates) to clinical data observed at the population level (for example, duration of illness and case-fatality). We are using these models to investigate potential transmission impacts of interventions that operate on the individual level but are designed for population-level effect.
We collaborate with the Center for Tuberculosis Research (PI: Richard Chaisson) as part of the global RePORT consortium that is funded by the NIH to develop a common protocol for observational research in tuberculosis.
UnivART Rio aims to assess the impact of universal antiretroviral therapy for all people living with HIV on patient outcomes and the community burden of HIV and HIV-related comorbidities in Rio de Janeiro, Brazil. Randomized controlled trials have proven the efficacy of early antiretroviral therapy for reducing morbidity and mortality for HIV-infected individuals and limiting HIV transmission among serodiscordant couples. However, the effectiveness and impact of universal ART has not yet been quantified. In this project, we are using comprehensive, large scale surveillance and patient monitoring databases maintained by the Rio de Janeiro Health Secretariat to explore the long-term effects of universal ART in a high HIV burden setting. We aim to determine the patient- and community-level impact of universal ART in Rio de Janeiro, Brazil, a city with more than 60,000 HIV-infected individuals and high rates of HIV/TB co-infection. Results of this study will help determine the potential for universal ART to help end the global AIDS epidemic.