TB and NTM Research Programs

Observing patients taking their TB medications is an effective strategy for improving medication adherence.  However, some patients find it difficult to attend a clinic every day to receive TB therapy.  Working with eMocha Mobile Health, Inc. and the Center for Clinical Global Health Education (CCGHE), Dr. Maunank Shah and colleagues have developed, miDOT, an innovative platform to allow video-based directly observed therapy of TB treatment.  This platform allows Health departments to perform DOT in difficult to treat patients or marginalized groups in whom in person DOT is too logistically feasible or affordable.  Ongoing pilot studies continue in a variety of settings both domestically and internationally, with the goal of leveraging this technology to improve patient outcomes for a variety of infectious and chronic diseases.

Tuberculosis (TB) is the single most important public health problem in the Tibetan community today.  Rates of TB in the Tibetan population living in exile in India are nearly three times higher than rates in India as a whole and more than 150 times higher than rates in the Unites States.  Tibetan refugees are at particular risk for TB transmission because more than half of this population resides in congregate settings such as boarding schools, monasteries and nunneries.  The epidemic of tuberculosis among the Tibetan population is largely driven by TB disease in youth, especially schoolchildren.

The government of Tibet has been headquartered in Dharamsala, India since 1959.  Several thousand exiled Tibetans, including His Holiness the Dalai Lama, reside in and around Dharamsala.  The Tibetan community is a unique population bound by deep cultural, spiritual, political, and historical ties, and the high concentration of Tibetans living in this relatively small area presents an ideal opportunity to fight TB.

The objective of the Zero TB in Tibetan Kids project is to reduce the rates of TB in this population through the implementation of a model system of TB care.  Project activities will include community awareness building, active TB case finding, TB case management and a preventive therapy program.  The long-term goal of the project is to eliminate TB disease in Tibetan children. Kunchok Dorjee, MD, PhD implemented the Zero TB in Tibetan Kids project.

Increasing market and public health outcomes through scaling up affordable access models of short course prevention therapy for TB.  IMPAACT 4TB is a four-year project introducing a new way to tackle latent TB in order to slow and ultimately stop the flood of new TB cases occurring every year.  We are doing this by identifying and providing new, shorter treatment options for people with latent TB infection.  To eliminate TB, we must focus on prevention.  As part of the consortium, Johns Hopkins University is responsible for the scale up of 3HP in Brazil and conducting the demonstration project in the Pune site in India.

Unitaid is an international organization that invests in innovations to prevent, diagnose, and treat HIV/AIDS, TB, and malaria more quickly, affordably, and effectively.  They also work to improve access to diagnostics and treatment of HIV co-infections such as hepatitis C and human papillomavirus (HPV).  Unitaid is a hosted partnership of the World Health Organization (WHO).

The Johns Hopkins University Fogarty AIDS International Training and Research Program (Hopkins AITRP) is a campus-wide program involving faculty and trainees in both the Bloomberg School of Public Health and the School of Medicine.  AITRP provides training in support of collaborative research between JHU faculty and their developing country partners, to foster lasting research partnerships, and to assist developing country scientists in establishing their own and their countries’ capacity in independent HIV/AIS research.  The program has expanded to include tuberculosis.  Among the Johns Hopkins University Faculty Directors are Robert Bollinger, MD, MPH, Jonathan Golub, PhD, MPH, and Richard Chaisson, MD

In 2002, the Tuberculosis Animal Research and Gene Evaluation Taskforce (TARGET) was formed in response to a request from the National Institute of Allergy and Infectious Disease (NIH/NIAID) to enable the modeling of human tuberculosis in multiple animal species using defined protocols and testing defined mutants of M. tuberculosis.  Since no single animal model reproduces all features of human tuberculosis, TARGET will evaluate M. tuberculosis and M. tuberculosis mutants in mice, guinea pigs, and rabbits to assess their virulence and capacity to induce, for example, acute, latent, or cavitary tuberculosis.  TARGET will accept proposals for mutant testing in validated mouse, guinea pig, and rabbit models.

Tuberculosis (TB) remains one of the most significant infectious causes of mortality and morbidity worldwide and is the number one cause of death among those infected with HIV.  Major research needs span from basic research to identify biomarkers that accurately predict outcomes of active and latent TB to clinical research to measure efficacy and effectiveness of new tools and strategies for TB.  To meet this need, the National Institute of Allergy and Infectious Diseases (NIAID) has created the Regional Prospective Observational Research in Tuberculosis (RePORT) international program to support the establishment of regional RePORT consortia in cooperation with host countries.  This platform sets the stage for future combined or comparative data analyses and is an invaluable resource for in-country and cross-national collaborations between bench and clinical researchers.

Alliance for a Healthier World is a Johns Hopkins University initiative that integrated university-wide expertise and diverse perspectives to unlock groundbreaking knowledge addressing unresolved global health challenges.  The Alliance serves as an enterprising partnership and resource hub to stimulate and support innovation around health equity via multidisciplinary events, funding grants, mentorship, and strategic communication that bring the Hopkins community together.

The BWI-CTU works with patients from two diverse, urban U.S. communities with high burdens of and high risks for HIV and Hepatitis C (Baltimore and Washington, D.C.) as well as one of the largest HIV/infectious diseases clinical care and clinical research units on the Indian subcontinent.  The BWI-CTU brings together expertise in TB, Hepatitis, HIV Cure, HIV Prevention, Clinical Pharmacology, Pediatric & Adolescent Research, Inflammation & End Organ Complications, Antibiotic Resistance, and Training & Mentorship.  The committees are highly creative in developing new study proposals, identifying and prioritizing studies for site implementation, and encouraging early career and international investigators to contribute to novel scientific concepts valued by the networks we support.