Global Health Research Projects.
Global Health research spans a wide range of interrelated and complex public health topics. Please explore our current projects by their primary theme listed below. Be sure to investigate more detailed descriptions of projects that have hyperlinked project titles. Many project areas overlap, so please explore them all.
Academic Interests of the DGH Faculty
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Point of Care Diagnostics
Technology to Improve Decision Making and Neonatal Outcomes in Special Neonatal Care Units (SNCUs) in India
There have been major improvements in childhood mortality around the world over the last 20 years, but it has been more difficult to reduce mortality of babies in the first month of life. The study is evaluating how to optimize design and use of medical equipment and point of care diagnostics to improve care of newborns in India.
India
Diagnostic and Prognostic Biomarkers for Bacterial Infection in Pediatric Clinical Pneumonia
Bacterial pneumonia is one of the leading causes of childhood mortality, particularly in resource-limited countries. The disease burden can be partially attributed to the lack of an accurate and reliable diagnostic test to allow promptly starting antibiotic therapy. Lack of a diagnostic test also results in accelerated resistance to available antibiotics. Previously, we identified a combination of blood inflammatory proteins that could accurately diagnose bacterial infection in Mozambican children with clinical pneumonia. We are currently validating and improving upon this combinations in Gambian children with clinical pneumonia to further start development of a point-of-care diagnostic test with partners.
The Gambia
Emerging Infectious Disease Surveillance and Research
GeoSentinel – The Global Research and Surveillance Network of the International Society of Travel Medicine in Partnership with the CDC
This is an emerging infectious global surveillance and research network consisting of 72 sites in 30 countries, which uses travelers, immigrants, and refugees as sentinel indicators of disease outbreaks worldwide. GeoSentinel research major projects include studies of fever etiology and outcomes among travelers, artemisinin resistance, mpox, neurocognitive impact of malaria, and COVID-19.
Global
BU-UL Partnership to Enhance Emerging Epidemic Virus Research in Liberia (BULEEVR)
This grant supports a training program is for Liberian Researchers to combat emerging infectious disease outbreaks, such as Ebola. Faculty at BUMC/BUSPH and the University of Liberia co-mentor trainees.
Andrew Henderson
Liberia
Global Health Research Training
Fogarty Global Health Training Fellowship
This program provides mentored research opportunities to train and prepare a new cadre of health professionals in the US and LMICs in global health research by enhancing the trainees’ ability to independently plan, implement, and assess innovative clinical or operations research focused on reducing mortality and morbidity associated with HIV/AIDS and associated co-infections, NCDs including cardiovascular disease and diabetes, mental health, and MCHN. Academic partners include Harvard University (Harvard T. H. Chan School of Public Health, Harvard Global Health Institute), Boston University (Schools of Public Health and Medicine), Northwestern University (Center for Global Health, Feinberg School of Medicine) and the University of New Mexico (School of Medicine, Center for Global Health).
Bangladesh, Botswana, Ghana, India, Kenya, Nigeria, Mali, Peru, South Africa, Thailand, Uganda, Zambia
Health Services Research
Indlela: A nudge unit to build capacity in behavioral economics and increase HIV program effectiveness in South Africa
Indlela is the first-of-its-kind unit focused specifically on improving the effectiveness of the public sector in delivering health care and achieving better health outcomes in South Africa. In the unit’s first 3 years it will focus specifically on building capacity to expand the use of behavioral economics within HIV prevention and treatment programs in South Africa and strengthen the ability of health service delivery providers and key research institutions to develop and test contextually appropriate interventions that are informed by behavioral insights. In future years, the scope will expand beyond HIV to include other public health issues in South Africa.
South Africa
HIV
Providence/Boston Center for AIDS Research (CFAR)
The major goals of this project are to foster HIV Research and collaborations between Brown and Boston University Developing young investigators.
US, Ukraine, Kenya, South Africa, the Philippines
Dartmouth-Boston University HIV-TB Research Training for the Infectious Disease Institute at Muhimbili University of Health and Allied Sciences (MUHAS)
The major goals of this project are to train Tanzanian citizens in clinical HIV/AIDS research and to estaqblish san Infectious Dsieases Institute at MUHAS.
Tanzania
Boston University’s Contributions to the Enhanced Mentor Mother Program (EMMA) Study for USG FY2021-22.
During 2014-2019, BU collaborated with the Walter Reed Project and the Kenya Medical Research Institute to complete a study titled: “Evaluating the effectiveness of implementing Option B+ under routine conditions with and without the PMTCT Patient Coordinator Program: A site-randomized impact evaluation among maternal and child health centers supported by the South Rift Valley PEPFAR program in Kenya.” The focus of this additional grant is to complete final data extraction and analysis for infant HIV testing outcomes (testing and HIV status at 18 months of age).
Kenya
AMBIT: Alternative Models of ART Delivery: Optimizing the Benefits
Many high HIV-prevalence countries are scaling up differentiated service delivery (DSD) models for providing antiretroviral treatment for HIV. DSD models adjust the location, frequency, provider cadre, and other aspects of service delivery to make HIV treatment more patient-centric and more efficient. Little is known about the true impact of DSD models on the health system or patients, however. AMBIT is a research project in sub-Saharan Africa comprising synthesis of existing data, new data collection, data analysis, and modeling activities aimed at generating information for near- and long-term decision making for scaling up DSD models in Malawi, Zambia, and South Africa.
Malawi, Zambia, South Africa
Evaluating the Cost of Scaling PrEP Access through Novel Delivery (EXPAND).
Blurb: This is an economic evaluation of three demonstration projects that are testing different service delivery approaches for PrEP in South Africa. Each of the demonstration projects uses a different delivery model to reach populations at increased risk for HIV acquisition to offer them oral PrEP. These models will also be adapted for the delivery of long-acting injectable PrEP as soon as this becomes available in South Africa. The economic evaluation includes qualitative work, baseline assessment, patient costs, and the cost of delivery PrEP from the provider perspective. We also include a cross-cutting component focused on local capacity building in costing and economic evaluations.
South Africa
Retain6: Models of care for the first 6 months of lo treatment
For HIV-positive patients in sub-Saharan Africa and globally, the first six months after initiating lifelong antiretroviral therapy (ART) pose the greatest risk of loss to follow up. Patients who make it through the first six months have a good chance of being retained on ART for the long term, but many drop out before reaching the six-month point. The Retain6 project aims to develop new models of differentiated service delivery for patients in their first six months on ART, in an effort to improve retention in care during this period.
Zambia, South Africa
CAB-RPV LA Implementation Strategies for High-Risk Populations.
This will be an evaluation of a new injectable antiretroviral treatment for HIV-positive individuals receiving care at the Boston University Medical Center and its associated community-based outreach clinics. It includes qualitative research on preferences of patients and providers and a randomized controlled trial to assess feasibility and impact.
Mari-Lynn Drainoni (BMC)
Boston
The SUpporting Sustained HIV Treatment Adherence after INitiation (SUSTAIN study)
Early detection of poor adherence to antiretroviral treatment (ART) and linkage to support for new patients is critical. The objective of this study is to improve ART adherence, retention and viral outcomes in people commencing ART in the South African public sector, a low-resource setting, over 24 months using five evidence-based adherence strategies to enable rapid identification and management of people with poor adherence. We will test the combinations of these components using a Multiphase Optimization STrategy (MOST) design, which allows us to explore the benefit of various combinations of these five effective and feasible ART adherence monitoring or support components.
Faculty/PI: Lora Sabin (PI), Nafisa Halim (Co-I), Bill MacLeod (Co-I), Allen Gifford (Co-I)
Location: South Africa
Zambia Infant Cohort Study 
The ZICS study will determine if antiretroviral regimens used to successfully prevent mother to child transmission of HIV have also decreased morbidity and mortality among the children born to these mothers but who, themselves, have escaped infection with HIV. If not, then further investigation of the cause of poor outcomes in these children will be necessary. We will also determine if the mother’s immune status is a determinant of poor health outcome in their uninfected children, and in their infants early immune status.
Zambia
Zambia Infant Cohort Study: Brain Optimized to Survive and Thrive (ZICS-BOOST)
Children exposed to HIV in-utero but uninfected (CHEUs) number 14.8 million globally. In Zambia, an estimated 56,000 CHEUs are born annually, a staggering fraction of the national birth cohort. Multiple studies establish that CHEUs are more neurodevelopmentally vulnerable than HIV-unexposed peers. In Zambia, there are existing effective early childhood developmental (ECD) interventions that target other vulnerable populations, but never trialed specifically for CHEUs. GAP: Research is needed to evaluate the effectiveness of a scalable early childhood development (ECD) intervention for CHEUs. Zambia is scaling up ECD as part of its national strategy, but CHEUs are not currently targeted. There is need to better understand the scope and mechanism of HEU-related neurodevelopmental differences and what interventions are most effective. HYPOTHESIS #1: An ECD intervention delivered by community health workers via bi-weekly home visits will improve neurodevelopmental outcomes in CHEUs. HYPOTHESIS #2: CHEUs have significantly worse neurodevelopmental outcomes than unexposed peers at 24 months, mediated by preterm birth, disease stage or ARV exposure. METHODS: In order to observe differences in neurodevelopment between HIV-exposed and HIV-unexposed children, we will build upon an existing Zambian birth cohort by extending follow-up from 6 months to 2 years (n=450). Neurodevelopmental assessments will be measured by multiple context-validated tools at 12 and 24 months. In addition, a randomized control trial of a bi-weekly community health worker-delivered ECD intervention for CHEUs will be conducted to assess its impact on CHEU neurodevelopment. RESULTS: Pending. IMPACT: Despite growing evidence, HIV-exposure is not currently prioritized as a risk factor for poor development by policy makers or ECD programs. By capitalizing on the wealth of prenatal and infant data collected in our ‘parent’ study, we can investigate the mechanism that links HEU to neurodevelopment and test a potential therapy. Addressing developmental vulnerability in CHEUs is paramount to ensuring that future generations of children are school ready, and able to reach their full developmental potential.
Zambia
EVIDENCE: Evaluation to Inform Decisions using Economics and Epidemiology
EVIDENCE is a 5-year HIV/AIDS project funded by PEPFAR through USAID. With the project lead in South Africa, the Health Economics and Epidemiology Research Office (HE2RO), we conduct health economics and epidemiology evaluations and provide technical assistance in support of the goals of the South African National Strategic Plan for HIV, TB and STIs (NSP) and the PEPFAR Country Operational Plan. BU faculty and staff work closely with HE2RO on project evaluations, cost modeling, outcomes research, and financial management to improve guidelines, policies, programs, and resource allocation.
South Africa
Economic Impact of HIV Policy Briefs
This project synthesises the evidence on the economic impact of HIV into a series of 17 policy briefs that can help decision-makers in ministries of finance and health in low- and middle-income countries (LMIC) decide on the future financing of their country’s HIV programme. The project incorporates a series of seminars with an academic and LMIC government staff audience aimed at refining the content and presentation of the briefs, the presentation of the evidence base to LMIC decision makers during a comprehensive workshop, and the publication of the briefs on a website and in peer-reviewed journals.
South Africa
infectious disease
Vaccine Impact Modelling Consortium (VIMC) 2.0
VIMC is an international community of modelers providing high-quality estimates of the public health impact of vaccination to inform and improve decision making. This project contributes to the estimation of cervical cancer disease burden and human papillomavirus (HPV) vaccine impact in low- and middle-income countries. In addition, this project examines policy-relevant research questions for HPV vaccines in order to advance the research agenda in the field of vaccine impact modeling.
Low- and middle-income countries worldwide
INSECT: Implementing Novel Strategies for Education and Chagas Testing
This project, funded by a CDC cooperative agreement, aims to increase Chagas knowledge in the medical community and to roll out screening programs for high-risk populations (such as women of childbearing age from endemic areas) nationwide.
Boston, Massachusetts
Chagas disease biorepository
We have developed a biorepository using biological samples from a cohort of Chagas disease patients at Boston Medical Center. The primary goal of the biorepository is to develop and maintain a large, geographically diverse collection of well-characterized samples to be used as a resource for future Chagas diagnostics research.
Boston, Massachusetts
Incorporating Behavioral Feedback in the Infectious Disease Transmission Modeling
Transmission dynamic modeling is a powerful tool to understand the epidemiology of infectious diseases and evaluate the impact of control measures. However, the lack of empirical data on human behavior and its temporal variation has hindered the progress and application of these models. Therefore, this project aims to 1) understand how people experiencing acute infections change their social contact patterns over the course of their illness and 2) develop mechanistic models that incorporate these data to generate more reliable estimates of key transmission parameters and intervention impacts. Our project aims to provide policy makers and public health officials with more informed decision-making tools to develop interventions, ultimately leading to improved health outcomes.
United States
EPISTORM: Real-time Evaluation of Vaccine Effectiveness and Safety
Real-time monitoring of the effectiveness and safety of vaccines is essential for controlling infectious diseases. However, there are both practical and methodological hurdles. Our project aims to address two key challenges: 1) issues with linking public health data from different sources, and 2) analytic challenges associated with evaluating multi-dose vaccines, using causal inference techniques. Boston University has been selected to be part of the national network for outbreak and disease modeling led (CDC Insight Net), and this project will be conducted through this network.
United States
Cryptococcal Meningitis Screening in South Africa
Cryptococcal meningitis (CM) is a fungal infection that causes infection in the brain and spinal cord. CM is a leading cause of AIDS-related deaths globally, mainly among patients with low CD4 cell counts. Through screening HIV patients with low CD4 cells counts for cryptococcal antigen (CrAg), it is possible to identify CrAg-positive patients before they develop meningitis. Treating these patients with antifungal medications can then substantially reduce risks of progression to CM and death. Through support from the CDC Foundation (May 2015 – June 2021), the purpose of this program of research has been to evaluate costs and effectiveness of alternative CrAg screening strategies and CM treatment regimens.
Kenya
Using Behavioral Economics to Improve the Uptake of and Persistence on Pre-exposure Prophylaxis in Men Who Have Sex With Men to Prevent HIV Infection
South Africa’s HIV incidence remains high, in particular amongst populations such as men who have sex with men (MSM) who may be at increased risk. HIV pre-exposure prophylaxis (PrEP) is considered key to reducing incidence in these populations, yet pilot studies show sub optimal uptake and poor persistence amongst those most at risk. This research will focus on understanding why PrEP uptake and persistence amongst MSM in South Africa is low and how the delivery of PrEP to this population could be altered to encourage those most at risk to start treatment using behavioral insights.
South Africa
Impact of Undernutrition on Immunity Elicited by Vaccines in the Gambia
Moderate and severe undernutrition are highly prevalent in several resource-limited countries. There is conflicting evidence on the impact of undernutrition on the immunity elicited by childhood vaccines, as well as the specific supplements that could be used to overcome vaccine hypo-responses associated with undernutrition. In a pilot project in The Gambia, we are comparing antibody vaccine responses against a panel of EPI vaccines of children with severe wasting and stunting with well-nourished children. Furthermore, through a metabolomics assay, we will assess whether specific amino acid deficiencies are associated with decreased responses in undernourished children.
The Gambia
IPV (intimate partner violence)
Testing the Effectiveness of an Evidence-based Transdiagnostic Cognitive Behavioral Therapy Approach for Improving HIV Treatment Outcomes among Violence-affected and Virally Unsuppressed Women in South Africa
This study will evaluate the impact of the Common Elements Treatment Approach (CETA), an evidence-based intervention comprised of cognitive-behavioral therapy elements, at improving HIV treatment outcomes among women with HIV who have experienced intimate partner violence (IPV) and have an unsuppressed viral load on HIV treatment. To evaluate CETA, we will conduct a randomized controlled trial of HIV-infected women, with or without their partners, who have experienced IPV and have an unsuppressed viral load to test the effect of CETA in increasing viral suppression and reducing violence.
South Africa
Malaria
The Intransigence of Malaria in Malawi: Understanding Hidden Reservoirs, Successful Vectors and Prevention Failures
Under the aegis of the Malawi International Center of Excellence of Malaria Research (ICEMR) program, several cohort studies have been conducted focused on studying malaria control measures and understanding why measures such as bed nets have failed to control malaria in Malawi. Examples of these studies are the one led by Dr. Valim aiming to identify the transmission reservoir group(s) for malaria in Malawi and to assess the impact of current interventions on these human reservoirs. Another study conducted under the aegis of ICEMR aims to assess the effectiveness of the RTS,S malaria vaccine in conjunction with other malaria prophylactic measures.
Malawi
Maternal and Child Health
Global Network for Women’s and Children’s Health Research
The Global Network conducts observational studies and clinical trials in 8 locations in low and middle income countries in Asia, Africa and Central America. The goals of the research are (1) to evaluate whether low-cost, sustainable interventions improve maternal and child health; and (2) build local research capacity and infrastructure. Whenever possible common protocols are implemented in all 8 locations. The Boston University site works with the Lata Medical Research Foundation in Nagpur, India. The grant funds several studies.
Global
Technology to Improve Decision Making and Neonatal Outcomes in Special Neonatal Care Units (SNCUs) in India
There have been major improvements in childhood mortality around the world over the last 20 years, but it has been more difficult to reduce mortality of babies in the first month of life. The study is evaluating how to optimize design and use of medical equipment and point of care diagnostics to improve care of newborns in India.
India
Synbiotics for the Early Prevention of Severe Infections in Infants (SEPSIS)
SEPSIS, a collaboration between icddrb (Dhaka), Hospital for Sick Kids (Toronto), and BU consists of a few related studies including an observational cohort of severe infections and the intestinal microbiome in young infants in Dhaka, Bangladesh and a phase II randomized, placebo-controlled trial of the efficacy, safety, and tolerability of neonatal administration of Lactobacillus plantarum ATCC 202195 with or without fructooligosaccharide for one or seven days
Bangladesh
Antimicrobial Resistance
A-PLUS Trial: Multi-site Efficacy and Safety Trial of Intrapartum Azithromycin in LMICs – AMR Sub-study and Effect of Azithromycin on the developing microbiome.
The Global Network is conducting a trial to evaluate whether Azithromycin given during labor reduces maternal and neonatal infections and mortality. This grant supports studying the effect of azithromycin on development of antimicrobial resistance and the gut and airway microbiome.
Global
Sequencing of Klebsiella pneumoniae isolates from Zambia
Bloodstream isolates (K. pneumoniae and E. coli) from the Sepsis Prevention in Neonates in Zambia study are being sequenced to determine serotypes and antibiotic resistance characteristics.
Zambia
Non-communicable Diseases
World Health Organization. Global NCD Reporting Mechanism.
Veronika Wirtz & Peter Rockers
Global
In 2021, the World Health Organization introduced the Global Diabetes Compact, targeting equitable and affordable access to diabetes care, particularly in low- and middle-income countries. Acknowledging the support from the private sector, WHO formulated a list of 31 asks to prioritize expansion of access to essential insulin and related health technologies. Boston University is now supporting WHO in developing a Global Reporting Mechanism (GRM) to encourage the reporting and tracking of industry commitments aligned with the 31 WHO Asks.
Noncommunicable Disease Management in South Africa: Insights from the National Health Laboratory Services (NHLS) Multi-morbidity Cohort.
The K01 Award (K01DK116929) addresses the growing challenge of Type 2 Diabetes Mellitus (T2DM), focusing on care disparities and treatment efficacy, particularly among populations living with and without HIV in low- and middle-income countries. Central to this project is the innovative application of a probabilistic record-linking algorithm to develop a patient cohort from the National Health Laboratory Services (NHLS) database in South Africa, which contains over 68 million laboratory records from more than 30 million individuals and covers conditions like HIV, tuberculosis, diabetes, kidney disease, and cardiovascular disorders from April 1, 2004, to March 31, 2017.
The creation of the NHLS Multi-morbidity Cohort has facilitated in-depth analysis of data including anonymized patient identifiers, demographics, test specifics, and geographic information. This cohort is instrumental for the project’s aims to examine examining the T2DM care cascade in populations with and without HIV, evaluate the Integrated Chronic Disease Management (ICDM) model’s impact on diabetes care using quasi-experimental methods, studying chronic kidney disease progression, and evaluating compliance with national diabetes guidelines. These efforts aim to enhance understanding and improve management of noncommunicable diseases in South Africa.
South Africa
World Bank Global compendium of primary care service delivery models for non-communicable diseases
(link to report should be available in June 2024)
Addressing the challenges within non-communicable disease programs and primary healthcare centers, the World Bank embarked on a project to gather a comprehensive collection of primary care service delivery models for non-communicable diseases. This initiative highlighted the critical need for a cohesive approach to primary healthcare, which includes the promotion, prevention, and management of non-communicable diseases, aiming to improve care across the entire spectrum, from reducing risk factors to managing chronic conditions at the primary care level effectively. The project’s goal was to develop an online, action-oriented collection for the World Bank, filled with innovative design solutions and digital enhancements to boost access, efficiency, effectiveness, and the quality of care for non-communicable diseases. This collection intended to present a wide array of primary healthcare models designed for chronic conditions, supporting countries in their shift towards integrated, chronic care services and moving away from a reliance on acute, episodic care.
The project culminated in a comprehensive matrix featuring 158 models, alongside 60 concise two-page case reports and 15 detailed five-page case reports. These documents collectively highlight a diverse range of primary care service delivery models for non-communicable diseases, spanning various geographic regions and income categories. Sub-Saharan Africa was prominently featured, accounting for 26.6% of the models, with East Asia and the Pacific at 22.8%, and South Asia at 20.2%. Most of these models were found in upper-middle-income and lower-middle-income countries, making up 45.6% and 42.4% of the implementations, respectively. Diabetes stood out as the most common focus, being the target of 50.0% of the models, followed by hypertension at 41.8% and mental health disorders at 38.0%. The main strategies highlighted in these models were task-shifting/task-sharing (40.5%), the integration of new services or conditions (35.4%), and educational or training initiatives (33.5%). The implementation settings varied, with mixed areas being the most common at 41.8%, and rural and urban areas following at 24.7% and 22.1%, respectively. The scale of implementation predominantly ranged from small to medium, accounting for 55.1% of the models, but there were also notable instances of large-scale and national-scale projects at 20.2% and 10.1%, respectively, highlighting the extensive reach and potential impact of these initiatives.
Alana Brennan, Nancy Scott, Sydney Rosen
low-and middle-income countries
Opportunistic screening for hypertension and type 2 diabetes mellitus using COVID-19 infrastructure
South Africa continues to grapple with a substantial burden of non-communicable diseases, particularly type 2 diabetes and hypertension. However, these conditions are often underdiagnosed and poorly managed, further exacerbated by the strained primary healthcare system and the disruptive impact of the COVID-19 pandemic. Integrating non-communicable disease screening with large-scale healthcare initiatives, such as COVID-19 testing and vaccination campaigns, offers a potential solution, especially in low- and middle-income countries. We investigated the feasibility and effectiveness of this integration in two separate cohorts.
In a prospective cohort study at the Germiston taxi rank in Johannesburg, South Africa, we assessed the integration of screenings for type 2 diabetes mellitus and hypertension with rapid antigen tests for COVID-19. The study involved 1,169 participants and included measurements of blood glucose, blood pressure, waist circumference, smoking status, height, and weight. Participants showing elevated blood glucose levels (fasting levels equal to or greater than 7.0 or random levels equal to or greater than 11.1 millimoles per liter) and/or elevated blood pressure readings (diastolic pressure equal to or greater than 90 and systolic pressure equal to or greater than 140 millimeters of mercury) were directed to receive clinical follow-up. Our results indicated an overall diabetes prevalence of 7.1%, incorporating both previously diagnosed individuals and those newly identified with elevated blood glucose measurements. We also observed a hypertension prevalence of 27.9%, which included both known cases and new detections of elevated blood pressure during the study. However, the rates of connecting these individuals to subsequent medical care were low, with only 30.0% of those with elevated blood glucose and 16.3% with elevated blood pressure engaging in follow-up care. This opportunistic approach to screening helped identify potential new diagnoses in 22% of participants, yet it also underscored the necessity for better strategies to ensure these individuals receive the necessary ongoing care, highlighting the critical need for additional research to determine the feasibility and effectiveness of such integrated screening programs on a larger scale.
In a prospective cohort study at four health facilities in Johannesburg, South Africa, we screened 1,376 participants for hypertension and type 2 diabetes mellitus during COVID-19 vaccination campaigns. This integration aimed to address the significant problem of undiagnosed conditions in a strained healthcare system. We measured blood glucose, blood pressure, waist circumference, smoking status, height, and weight, referring individuals with elevated blood glucose (fasting levels equal to or greater than 7.0 or random levels equal to or greater than 11.1 millimoles per liter) and/or blood pressure (diastolic pressure equal to or greater than 90 and systolic pressure equal to or greater than 140 millimeters of mercury) for further medical evaluation. Our findings showed a 4.1% prevalence of diabetes, combining known cases and new detections of elevated blood glucose levels. The hypertension prevalence was 19.4%, including both existing and newly identified cases of elevated blood pressure. Notably, 46.1% of participants exhibited waist circumferences indicative of metabolic syndrome, more frequently observed in females. Additionally, 7.8% of the screened individuals were potentially newly diagnosed with diabetes or hypertension, emphasizing the importance of integrated screening initiatives. Approximately half of the individuals with newly identified risk factors successfully sought follow-up care within a month, highlighting the effectiveness of using routine healthcare interactions for extensive screenings, particularly vital in settings with limited resources, and underscoring the need to improve linkage to care for efficient management of non-communicable diseases.
Alana Brennan, Gesine Myer-Rath
South Africa
Assessing the effects of HIV disease on dysglycemia in a cohort of tuberculosis patients in South Africa’s Western Cape
Our planned research will focus on compare rates of dysglycemia (both hyperglycemia and hypoglycemia) in people living with HIV (PLWH) and HIV-uninfected persons receiving tuberculosis (TB) treatment using pilot data from the The Impact of Alcohol Consumption on TB Treatment Outcomes (TRUST) Study. HbA1c’s were only collected at enrollment the TRUST. As such, we will collect blood samples to measure HbA1c and blood glucose levels at patients 18-month study visit. This will allow us to assess changes in blood glucose levels from study enrollment by HIV status. Second, we will assess the role stress and inflammation play in relation to blood sugar levels in PLWH and HIV-uninfected individuals. Research suggests that the hosts immune response to active TB and/or HIV disease results in a prolonged state of systemic inflammation which can have negative metabolic effects. We will collect samples to measure markers of stress and inflammation at the 18-month study visit when all patients will be one year post TB treatment completion and when transient hyperglycemia due to TB infection should be resolved. This will be preliminary data to assess if there are differences in these specific stress and inflammatory markers post TB treatment amongst PLWH and HIV-uninfected individuals and potentially identify underlying mechanism(s) causing abnormal blood sugar levels.
South Africa
Programme Evaluation of Timor-Leste PEN-HEARTS Intervention
This project will evaluate early implementation in Timor-Leste of PEN-HEARTS, a community-based intervention supported by the WHO designed to improve health outcomes among individuals with non-communicable diseases such as diabetes. Building on a similar evaluation in Bhutan, a BU team of faculty and students will design and implement the evaluation with WHO and Ministry of Health officials in Timor-Leste. The evaluation will use mixed methods and involve data collection in both intervention and comparison sites in four districts of Timor-Leste.
Timor-Leste
Pharmaceutical Policy
Medicines, Technologies, and Pharmaceutical Services
The Medicines, Technologies and Pharmaceutical Services (MTaPS) project aims to strengthen pharmaceutical systems in low and middle income countries. Boston University is a core partner of the USAID funded MTaPS project led by Management Sciences for Health. The objectives are (1) to generate evidence on the development, implementation and strengthening of data management that can support decision-making in pharmaceutical systems; (2) to develop, implement and evaluation accountability mechanisms in pharmaceutical systems.
Tuberculosis
Methods to estimate the impact of interventions on the transmission and incidence of tuberculosis
The major goals of this project are to develop models that can be used to monitor the success of TB interventions. This project is a collaboration with Dr. Helen Jenkins and Dr. Leo Martinez and is led by Dr. Laura White of the BUSPH Department of Biostatistics
Global
Intensified patient-finding intervention to increase the detection of children with tuberculosis
Children with tuberculosis are vastly under detected and under diagnosed. An intensified patient-finding intervention using systematic verbal screening at health facilities was undertaken in two locations to increase the detection of children who may be at high risk for tuberculosis disease. These projects aim to identify gaps along the pediatric tuberculosis care cascade; understand age-specific clinical presentation and risk factors for tuberculosis disease, extrapulmonary presentations, and poor treatment outcomes; refine clinical algorithms to expedite decision-making for treatment initiation; and explore other topics related to pediatric tuberculosis epidemiology.
Pakistan and Bangladesh
SAIA-TB: Using the Systems Analysis and Improvement Approach to Prevent TB in rural South Africa
Description: South Africa estimates 80% of their population has TB infection, and 14% of the population lives with HIV, with an estimated 5-15% of South Africans at high risk of developing TB disease from recent infection or immunocompromised status. Therefore, utilization of routinely collected data to optimize the comprehensive TB care cascade – screening, evaluation, diagnosing, linkage to care, treatment, and TB-free survival – is important to assess at the clinic level to improve clinic flow and patient outcomes. This study—funded by NINR/NIH—will leverage an evidence-based implementation science strategy, the Systems Analysis and Improvement Approach (SAIA), and recent TB cascade analyses piloted in the proposed site, to adapt and evaluate the effectiveness of SAIA-TB using a stepped wedge crossover cluster randomized trial across 12 clinics in rural Eastern Cape, South Africa.
South Africa
Improving Childhood Tuberculosis Treatment Outcomes and Post-TB Lung Functioning and Quality of Life in Rural South Africa
Description: We will assess the TB care cascade in children, expanding it to include a child-specific definition of post-TB lung disease (PTLD), among children in a high TB/HIV burden setting in Eastern Cape South Africa, and identify risk-factors for completing each step of the newly expanded TB care cascade. Additionally, we will collect rich data regarding nutritional status, air pollutant exposure, lung capacity, and quality of life to estimate their effect on TB disease outcomes and PTLD in children. Funded by the Charles H. Hood Foundation.
South Africa
Household Contact Tuberculosis Preventive Therapy Programs in Rural Eastern Cape, South Africa (KWIT-TB)
Description: We will assess the geospatial components, including access to care and population-level characteristics to gaps in the TB preventive therapy care cascade.
South Africa
Adaptive Design to Aid in the Planning of community-based Tuberculosis screening services (ADAPT-TB)
Description: Community-based screening via mobile units can close gaps in missed diagnoses by bringing screening services into communities, making screening more convenient for individuals with limited access to appropriate services. Questions remain, however, about how to efficiently operate these mobile units. Leveraging longstanding relationships in Lima, Peru, including existing collaborations involving mobile screening units, I will collect data from health facilities and mobile screening units to [Aim 1] establish spatial and temporal trends of the local tuberculosis burden and [Aim 2] build neighborhood-level models reflecting local risk of tuberculosis. I will then [Aim 3] develop a baseline decision model via a restless multi-armed bandit framework to make data-driven decisions about where, when, and how long to place the mobile units in the community. The overall goal is to optimize the real-time movement of these units throughout a community to increase the detection of individuals with TB and allocate resources more efficiently. Funded by a Carlin Foundation Award for Public Health Innovation and a Population Health Data Science (PHDS) Seed Funding Award.
Peru
Optimizing tuberculosis elimination initiatives for high-risk populations
Certain populations are at increased risk of tuberculosis infection and progression to tuberculosis disease. In Mexicali, Mexico, we are assessing the impact of novel diagnostics for tuberculosis infection testing in three high-risk populations–people who use drugs, household contacts of people with tuberculosis, and people confined to a penitentiary setting–to inform tailored algorithms for tuberculosis testing and initiation of tuberculosis preventive treatment. We also assess gaps identified along the tuberculosis comprehensive care cascade to guide local tuberculosis prevention and management guidelines.
Mexico
Tuberculosis in teens: a geospatial approach to predict community transmission
Description: Adolescents are a unique population that have been routinely neglected from tuberculosis guidelines. However, due to their ability to spread tuberculosis and their high number of social contacts, adolescents may be a key node fueling cycles of local community tuberculosis transmission in high incidence settings. Through a K01 Award from NIAID, NIH, we use geospatial and genotypic analyses to complete the following objectives: (1) To characterize the spatial heterogeneity of tuberculosis transmission events in adolescents. (2) To predict the spatial distribution of tuberculosis transmission events in adolescents. (3) To estimate and compare, through simulation, the impact of adolescent-tailored screening and treatment interventions on reducing community tuberculosis transmission.
Peru
Predictors of Resistance Emergence Evaluation in MDR-TB Patients on Treatment.
Dr. Horsburgh and Dr. Tim Sterling of Vanderbilt are leading a prospective cohort study of patients with MDR-TB. The aims of the study are to determine if decreased TB drug levels predispose to the development of additional drug resistance on treatment and to develop early indicators of such emergence of resistance.
US, India, Brazil
RePORT India Consortium
The major goal of this project is to collaborate with partners in India in clinical studies of tuberculosis infection and disease.
US, India
Transmission of Tuberculosis among illicit drug use linkages
The goal of this project is to assess the risk for TB transmission between persons who smoke drugs. This is a prospective cohort study of persons with and without drug use in South Africa.
US, South Africa
Prevention Policy Modeling Lab
The Goal of this Project is to develop cost-effectiveness models for TB prevention. This project is a collaboration with Dr. Nick Menzies at Harvard School of Public Health and Dr. Josh Solomon at Stanford School of Medicine.
US
DRAMATIC Phase 2 Duration Randomized MDR-TB Treatment Trial
The major goal of this project is to identify a shorter, less toxic treatment for MDR-TB. This project is a collaboration with Dr. Payam Nahid at University of California, San Francisco. It is randomizing patients with fluoroquinolone-susceptible MDR-TB in Vietnam and the Philippines to four different durations of a 5-drug regimen.
US, Vietnam, the Philippines
Phenotype, Progression and Immune Correlates of Post-Tuberculosis Lung Disease
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.
India
RePORT-India Lung Health Study
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.
India
Multiomic signatures of Lung Injury in Tuberculosis
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. Furthermore, PTB is characterized by granuloma formation, necrosis, and cavitation in the lung tissue which can impair drug penetration in affected lung tissue leading to persistent foci of bacterial replication, drug resistance and poor treatment outcomes. The overall goal of this study is to explore host metabolomic and genetic signatures associated with lung injury in PTB patients with and without diabetes and HIV.
India
Point-of-care Questionnaire and mHealth Assisted Diagnosis of Post-TB Lung Disease
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. Spirometry is the gold standard for diagnosing lung function defects, however it is technically challenging and expensive to perform, and may not be available at the point-of-care in many TB-endemic settings. The overall goal of this project is to develop and validate a questionnaire-based screening algorithm, assisted by machine learning analysis of cough sounds and lung auscultation data, to identify individuals with a high probability of having Post-TB Lung Disease for referral and confirmatory testing.
India
Effectiveness of Anti-Fibrotic Therapy for Preventing Pulmonary Impairment in COVID-19
COVID-19 is associated with persistent pulmonary impairment despite successful management of acute disease. Of particular interest is pulmonary fibrosis, with several studies reporting reduced FVC, DLCO and anterior reticulation on chest CT. The overall goal of this project is to conduct a retrospective analysis of medical records to measure the association between receipt of antifibrotic therapy (Pirfenidone and/or Nintedanib) and lung impairment following hospital discharge among adults with COVID-19.
India
Veterans health
Bridging the Care Continuum for Vulnerable Veterans across VA and Community Care (BridgeCC) QUERI Program
Led by investigators at the Bedford VA, this project is implementing three evidence-based practices (EBPs) that aim to improve coordinated care between VA and non-VA providers to improve the health of veterans. The EBPs focus on 1) homeless overdose prevention expansion; 2) maintaining independence and sobriety through systems integration and outreach; and 3) post-incarceration engagement to increase social support. Dr. Sabin is guiding the costing components for each EBP.
Boston