Spotlight On…Karen Jacobson

Karen Jacobson, MD, MPH, Co-Investigator of the ADEPTT study and Assistant Professor of Medicine, Boston University School of Medicine

As told to URBAN ARCH Admin Core staff, June 2017

Tell us more about your background. What led you to TB and how did you become involved in alcohol research?

I am a clinician by training. During my Internal Medicine residency and Infectious Diseases fellowship, I cared for clinical TB cases in the US and also when working in South Africa. Earlier in medical school, I did a pediatrics clinical rotation in Cape Town and was struck by how much TB we saw in kids. It made me realize TB is a disease that I find clinically interesting and also a disease that has a substantial impact globally. I felt there was still room to grow in the field of TB, so as a junior investigator I chose Megan Murray as my mentor, as she also had TB as her disease focus.

In terms of alcohol, I was inspired by my work in South Africa. My fellowship research site was in the town of Worcester (pictured below)– about 90 minutes outside of Cape Town in the wine region. This region has some of the highest rates of problem alcohol use (and, subsequently, fetal alcohol syndrome) among both men and women in the world. What I found was that in the TB hospital I worked in, many of the most difficult to treat patients were those with a co-morbid alcohol use disorder. I became very interested in understanding why these particular patients were so hard to treat, specifically, if it was really all behavioral or if beyond whether a patient was good about taking their medications or not, there was a residual biologic impact. These real world cases made me recognize this was an issue I could explore on many levels. karen location

You’ve conducted research with Stellenbosch University in Cape Town, South Africa. How did that partnership come about and what have you learned from collaborating with them?

That relationship began during my fellowship in 2009 when I was looking for an opportunity to examine drug-resistant TB. Stellenbosch’s Robin Warren and Tommy Victor, who had previously collaborated with my mentor, graciously offered to host me as a trainee to do primary data collection in Cape Town and also in a gold mining clinical setting near Johannesburg. For anyone who wants to pursue research in another country, finding mentors willing to welcome you and integrate you into their work is not something to take lightly. I was thrilled to find that, with repeated visits, I was able to develop my own primary and productive collaboration with them.

How does your research in Africa impact you as a clinician in Boston?

I now do most of my clinical work at the Boston Public Health Commission TB clinic where I treat both latent and active disease. My TB research experience has in no small part enabled this opportunity for me, and I believe that the high volume of drug-resistant cases I saw in South Africa have made me more comfortable and confident in treating the handful of cases we see in Massachusetts each year. In turn, I think my clinical work also makes my research stronger. My research and clinical work are, without a doubt, synergistic.

You recently joined Uganda ARCH as a co-investigator. What are you most looking forward to in the ADEPTT study?

It’s thrilling to join such an established research site. As I work to establish a new research site in Worcester, I am learning from seeing how a more “mature” study performs. I am also excited about bringing TB questions to a group that already has so much knowledge on alcohol and HIV. There’s space for information sharing both ways. Our study aims to demonstrate how to safely deliver TB preventive therapy to a HIV-infected population that has otherwise been overlooked. I like that our research question has tangible clinical impact.

Karen team

Karen Jacobson and her research team

What’s the most exciting thing happening in the field of TB research right now?

In recent years the TB field has acquired new diagnostics, drugs, and tools to help us understand the full scope of the disease: everything from infection through outcomes. It’s exciting to be looking at an ancient disease with new tools. We have an increasing understanding that even drug resistant TB is highly transmissible, underscoring a new urgency to look upstream and focus on effectively preventing TB transmission rather than solely on diagnosis and treatment adherence. I also believe that TB research continues to benefit from progress made in the field of HIV with regards to figuring out how to deploy research techniques that lead to rapid and impactful outcomes.

Tell us something surprising about yourself.

My interest to pursue global health is rooted in living and traveling overseas as a child. I was fortunate to live with my parents in Israel for periods of time during their sabbaticals. I think these opportunities to see cultures other than my own set me up for wanting to have that experience again as an adult. Full immersion in a school where few others spoke English fluently and classes were in Hebrew taught me how to work outside my comfort zone and gave me skills for the international work that I do now.