Bangladesh/ Brazil/ Ethiopia/ India/ Indonesia/ Nepal/ Philippines
Erythema Nodosum Leprosum International STudy (ENLIST) Group
ENLIST is a collaborative network of leprosy centres across a number of countries. The group has published on the clinical features of ENL, is analysing data on quality of life of individuals with ENL and is currently conducting a validation study of a clinical severity scale for ENL.
Benin/ Guinea/ Kenya/ Senegal/ Uzbekistan/ South Africa/ Swaziland
Treatment trials for drug-sensitive and drug-resistant TB
A recently completed trial in adults with drug-sensitive pulmonary TB in five countries in Africa showed that a four-month experimental treatment with the drug gatifloxacin was not as effective as the standard treatment with ethambutol for six months. These results were published in the New England Journal of Medicine in 2014, and we are now working with Médecins Sans Frontières on a new trial using bedaquiline and pretomanid.
TB/HIV Co-infection in Brazil
A two-year clinical trial with individual randomisation led by epidemiologists from the Oswald Cruz Foundation in Recife, Brazil and the School started in March 2014. The objective is to estimate the incremental cost-effectiveness of a protocol for screening and diagnosis of TB in HIV patients. The study includes screening by clinical algorithm, followed by diagnosis with gene Xpert MTB/RIF, sputum smear microscopy and chest X-ray.
Research Programme on TB control
In a five year collaboration between the School, Saw Swee Hock School of Public Health, University of Singapore, the Cambodia National Institute of Public Health and TB Programme, and Phnom Penh University of Health Sciences, researchers are conducting a series of linked projects in qualitative methods, epidemiology, genomics, transmission dynamics modelling and health economics. The overarching goal is to define a variety of options to reform Cambodia’s TB Programme and interventions, and to assess their likely impact and costs over the next 15 years.
Improving Adherence to Treatment for Drug-sensitive TB
Mobile text messaging and medication monitors have the potential to improve adherence to TB treatment and reduce the need for directly observed treatment. Researchers from the School and the National Center for Tuberculosis Control and Prevention in China conducted a cluster randomised trial in four provinces in China, to assess the effectiveness of these interventions.
Patients either received text message reminders, an electronic medication monitor, both, or no reminders for their six month treatment period. Patients receiving no reminders missed 30% of their medication doses and patients receiving text messages missed 27%. However, patients with an electronic medication monitor box – which beeps if not opened at the agreed time – only missed 17% of doses, and those who received both text messages and medication monitors missed just 14%, clearly demonstrating effectiveness. A second study is now underway, using a more robust medication monitor and examining clinical outcomes. These studies are funded by the Bill & Melinda Gates Foundation.
Clinical Trials Looking at Immunological Reactions in Leprosy
Work in Ethiopia on leprosy has involved clinical trials looking at ciclosporin as a treatment for immunological reactions in leprosy, assessing reaction severity scale and quality of life tools, as well
as observational studies in patients coinfected with HIV and leprosy. This work has contributed towards an important project with the Ministry of Health in Ethiopia mapping leprosy.
Leprosy projects in India
Patients with leprosy and neuropathic pain report a poor quality of life and psychological wellbeing. In a project looking at nerve damage characteristics and somatosensory profiles of leprosy patients in lowresource settings, School researchers have identified a novel profile of sensory loss to thermal and mechanical sense, combined with preservation of vibration sense. They have also shown that adding azathioprine to leprosy immune-suppression does not improve patient outcomes,an important negative result.
TB/HIV in Malawi: Case-finding/Diagnosis, Treatment and Outcomes
A number of projects based in Blantyre, Malawi are addressing TB/HIV-related issues such as the provision of sustainable household contact tracing and screening in TB patients and families including perceptions and barriers to these; the development of a new electronic app (ePAL – electronic PArticipant Locator) to integrate accurate collection of TB patient place of residence into routine registration by the NTP for identifying hotspots and assisting participant follow up; the prevalence of TB, HIV and Hepatitis C among health care workers; investigating mortality, HIV and TB in individuals presenting with chronic cough and symptoms of TB; the evaluation of loop-mediated isothermal amplification (LAMP) assay for point of care diagnosis of pulmonary tuberculosis; the impact of a new molecular TB test on TB/HIV outcomes among HIV-infected Malawians and early diagnosis of TB in the community including the short and long-term impacts of an active case-finding intervention.
Malawi Epidemiology and Intervention Research Unit The Karonga Prevention Study, now part of the Malawi Epidemiology and Intervention Research Unit, is using traditional epidemiology and whole genome sequencing on long-term population-based data to find out how and where TB transmission occurs, whether some strains are more transmissible or virulent than others, and how TB interacts with HIV.
Liz Corbett (email@example.com), Marriott Nliwasa (firstname.lastname@example.org), Emily Webb (email@example.com), Rebecca Harris (firstname.lastname@example.org), Augustine Choko (email@example.com)
Interlinked Projects in Myanmar and Yunnan Province, China
This is a project of 30 months funded by USAID in collaboration with FHI360, Myanmar NTP and Yunnan CDC. In Myanmar the research focus is, through a case control study, to determine risk factors associated with MDRTB generation. In Yunnan, qualitative research is addressing questions of access and stigma amongst patients with TB and the role of gender in health seeking behaviour. We are also analysing the costs and cost-effectiveness of community-based MDRTB treatment programmes in Yunnan.
Pakistan and South Asia
Health Systems and Policy Research in South Asia
Members of the TB centre have collaborated on two important studies in South Asia, and are engaging in further research with policy makers. In Pakistan we collaborated with the National TB Programme on an important cohort study which showed that treatment outcomes were similar for MDR-TB patients treated using locally procured drugs and international quality assured (GLC) drugs (Qadeer et al, PLoS ONE, 2015). We also conducted a multi-country analysis of private sector engagement in TB management across South Asia (Khan et al, Health Policy and Planning, 2015).
MDR-TB and TB/Diabetes Mellitus in Peru
In addition to ongoing diagnostic, epidemiological and genomic studies largely focussed on multi-drug resistant TB in Peru, Centre researchers are working with partners at Universidad
Peruana Cayetano Heredia (UPCH) in Lima on the EUfunded TANDEM consortium project. The association between TB and diabetes mellitus is being investigated using established laboratory and community-based research platforms here and at partner sites in Indonesia, Romania and South Africa. Both the School and UPCH are core partners in the global TB genomics programme known as CRyPTIC, the Comprehensive Resistance Prediction for Tuberculosis International
Consortium, led by the University of Oxford and funded by the Bill & Melinda Gates Foundation
Africa Centre TB programme
The Africa Centre, KwaZulu-Natal, has a demographic surveillance area whose population has very high TB incidence, and the highest prevalence of MDR-TB in South Africa. Africa Centre is developing a multidisciplinary TB research programme, whose goal is to understand TB transmission, and develop interventions to interrupt TB transmission. Projects in development include TB case surveillance in the demographic surveillance area population; a cohort of people starting MDR-TB treatment; and a cohort of adolescents to estimate the incidence of TB infection.
The Immunology of TB in Adults and Infants
We have several funded projects around the immunology of TB in both adults and infants. In adults, we have a particular interest in the B cell response to TB, and also in clinical trials of new TB vaccines. In infants, we have two projects looking at whether the latent TB infection status of pregnant mothers affects their infants’ response to BCG following birth. Our second project is a randomised controlled trial of delayed BCG, to determine whether BCG non-specifically stimulates the infant innate immune system, as a mechanism of protection from heterologous infection. Projects are funded by the MRC, The Wellcome Trust and the EU.
TB Programmes in Zambia
Zambart is a major research collaboration between the School and the University of Zambia. Current Zambart studies include a TB vaccine trial with Aeras and GlaxoSmithKline, diagnostics studies of Quantiferon plus, a TB and meningitis study, and a study of the relationship between TB, HIV and diabetes, as well as HPTN071/ PopART which looks at TB in the context of universal test and treat for HIV.
Helen Ayles (firstname.lastname@example.org)