Epidemiology
Evaluating the Tuberculosis Epidemic in South Africa Using a Novel Ten Year National Cohort
- Investigator: Karen Jacobson, Helen Jenkins
- Funding Source: National Institute of Allergy and Infectious Diseases
- Investigator: Tyler Brown
- Funding Source: National Institute of Allergy and Infectious Diseases
This project aims to improve surveillance and early detection of emerging or re-emerging strains of drug-resistant Mycobacterium tuberculosis (Mtb) in South Africa. The project will use genomic data, mathematical modeling, and mobility data to study the spread of Mtb. The research will focus on identifying origin locations and transmission hubs, developing a computational model incorporating human mobility and Mtb evolution, and evaluating surveillance strategies.
Geospatial Clustering and Molecular and Social Epidemiology of Drug Resistant TB
- Investigator: Karen Jacobson
- Funding Source: NIH Fogarty International Center
Phenotype, Progression and Immune Correlates of Post-Tuberculosis Lung Disease
- Investigator: Akshay Gupte
- Funding Source: National Institute of Allergy and Infectious Diseases
Pulmonary tuberculosis (PTB) is associated with lung injury which can persist despite successful therapy. Lung sequelae of treated PTB are increasingly recognized as an independent risk factor for chronic obstructive pulmonary disease (COPD) and, an important contributor of excess morbidity and mortality. This project aims to: 1) characterize the early natural history of post-TB lung disease (PTLD) and provide rationale for long-term monitoring and bronchodilator therapy in affected cases, 2) characterize the functional and morphological phenotype of PTLD by serial pulmonary function testing and multi-detector computed tomography, 3) identify immune profiles measured during early, late and post-therapy associated with PTLD.
Optimal Targeting for Individual and Population-Level TB Prevention
- Investigator: C. Robert Horsburgh
- Funding Source: National Institute of Allergy and Infectious Diseases
Within the same community, TB risks can differ by several orders of magnitude due to differences in infectious exposure and immune competence, and TB control depends heavily on targeting services to those most at risk. Priority groups described by the CDC and other agencies capture major TB risk factors, but these broad categories include many individuals with low TB risk, and exclude others who would benefit from screening. Our long-term objective is to provide individually- and locally-tailored evidence on TB risks and intervention effects, to optimize TB prevention services. In Aim 1, we will create granular estimates of TB risk for the US population, via a Bayesian evidence synthesis combining time series data on TB cases and population size, prevalence of latent infection (LTBI), and the fraction of cases due to recent infection. This analysis will allow us to produce individually-tailored risk predictions to better target preventive services, and provide patients with quantitative information on the risks they face. Aim 2 will create highly-disaggregated estimates of the costs, harms, and benefits of LTBI testing and treatment, using a Markov microsimulation model of LTBI screening and treatment to estimate long-term patient-level outcomes, including changes in TB risk, survival, costs, and adverse events. Based on these analyses we will develop a user-friendly web tool to provide patients and clinicians prompt, validated, and individually-tailored information on possible treatment outcomes. We will also conduct analyses and develop a companion tool that will report the impact and cost-effectiveness of LTBI screening for user-defined target. To increase the reach and impact of these tools we will adapt them for other countries with TB incidence below 20 per 100,000. In Aim 3, we will develop a transmission-dynamic simulation model to predict long-term outcomes for a broad set of TB control options (including but not limited to LTBI treatment) and risk factor trends. The model will be calibrated for multiple jurisdictions, and a web-based interface will allow users to specify scenarios and visualize outcomes.
RePORT-India Lung Health Study
- Investigator: Akshay Gupte
- Funding Source: CRDF Global
Pulmonary tuberculosis (PTB) is the most common form of TB disease and is characterized by granuloma formation, necrosis, and cavitation in the lung tissue. This lung injury in PTB may affect tuberculosis treatment outcomes. Granulomatous lesions, fibrosis, and cavitation impair drug penetration in affected lung tissue and may lead to persistent foci of bacterial replication and drug resistance. The overall goal of this project is to identify clinical and imaging markers of lung injury that are associated with unfavorable treatment outcomes in PTB.
Tracking Drug-Resistant Tuberculosis Patients Through Time in South Africa
- Investigator: Helen Jenkins
- Funding Source: National Institute of Allergy & Infectious Diseases
- Investigator: Helen Jenkins
- Funding Source: National Institute of Allergy & Infectious Diseases
Tuberculosis Infection and Disease Progression in Pregnant, Postpartum, and Non-Pregnant Women of Childbearing Age
- Investigator: Meredith Brooks
- Funding Source: National Institute of Allergy and Infectious Disease
Little information is known about rates of TB disease and infection progression among pregnant and postpartum women. We aim to describe a cohort of women of childbearing age living with and exposed to a person with TB disease. We compare rates of TB disease and infection progression among pregnant and postpartum and non-pregnant women at baseline, six-, and 12-months after exposure, and explore uptake of TB disease and infection treatment.