Community randomised evaluation of socioeconomic intervention to prevent TB
Lead Research Organisation:
Imperial College London
Department Name: Dept of Medicine
Abstract
BACKGROUND. TB kills 1.5 million people each year, more than any other single infection. There is an urgent need to evaluate the impact of new interventions to strengthen TB control. Poverty is increasing globally in cities and urban areas, and is associated with factors that increase TB risk including crowding and malnutrition. Conversely, TB worsens poverty by increasing expenses and reducing income. In addition, those with TB and their families may experience stigma. Poor people have more TB and greater TB-related needs but they tend to have least access to TB care. This mismatch between need for and access to TB care undermines TB control and worsens poverty.
OBJECTIVE. We will evaluate the impact of socioeconomic interventions for reducing poverty, improving access to TB care and consequently reducing the risk of future TB.
SETTING. 24 peri-urban shantytowns in Northern Lima, Peru near the site of our TB control research since 2001. Peru has an acclaimed TB control programme but its levels of TB disease remain high and its rates of multidrug-resistant TB (MDR-TB) have doubled over the last decade to the highest levels in the Americas. The high TB and increasing MDR-TB rates are concentrated in "hotspots" such as poor peri-urban shantytowns surrounding Lima. It is these "hotspots" where we will work.
RELATED WORK. Since 2007, our on going pilot project has been "Innovative Socio-economic Interventions Against TB (ISIAT)" which involves developing and implementing socioeconomic interventions to fight poverty and increase equitable access to TB care. Early analysis of the pilot ISIAT project showed promising results with the interventions described below increasing the number of people to a) complete TB treatment b) complete preventive therapy to prevent them getting TB c) be tested for TB and d) be tested for HIV. These results were published in 2011. The improvement in awareness, prevention and treatment of TB that our work and subsequent article showed has attracted the attention of funding bodies, like the World Bank and The Bill and Melinda Gates Foundation, and policymakers such as the World Health Organisation (WHO) and its Stop-TB department. Our on going relationship and involvement of these organizations and the published results of the pilot ISIAT project are encouraging for future work. The proposed project will rigorously assess the impact of these interventions not just on poverty and access to TB care but also on actual TB control.
INTERVENTIONS AND STUDY DESIGN. The interventions will be inexpensive, involving a team of experts from different fields working with all TB-affected families. They will utilize household visit and fortnightly community meetings to implement an integrated program of social support for enhancing equitable access to TB-related healthcare and economic support to help people to afford TB care and to help them to become less poor.
We will include in the study all members of a household with a new diagnosis of TB, as assessed by the Peruvian national TB program, without age limit, who provides informed written consent.
TB-affected households in 12 intervention communities will be offered the socioeconomic intervention for 6-months whilst the TB patient is receiving TB treatment. TB-affected households in 12 other control communities will be offered no intervention (standard of TB care). We will then re-visit those households 2 years after recruitment to assess what happened to the people with TB and those people in the household exposed to TB, and if our interventions prevented TB and reduced poverty.
BENEFITS: These socio-economic 'structural' interventions will be assessed for their capacity to reduce poverty-related TB risk factors, improve access to TB care and for reducing TB treatment failure, recurrence and transmission. This has potential importance for focusing poverty reduction on those in greatest need and who have the most to benefit and preventing TB.
OBJECTIVE. We will evaluate the impact of socioeconomic interventions for reducing poverty, improving access to TB care and consequently reducing the risk of future TB.
SETTING. 24 peri-urban shantytowns in Northern Lima, Peru near the site of our TB control research since 2001. Peru has an acclaimed TB control programme but its levels of TB disease remain high and its rates of multidrug-resistant TB (MDR-TB) have doubled over the last decade to the highest levels in the Americas. The high TB and increasing MDR-TB rates are concentrated in "hotspots" such as poor peri-urban shantytowns surrounding Lima. It is these "hotspots" where we will work.
RELATED WORK. Since 2007, our on going pilot project has been "Innovative Socio-economic Interventions Against TB (ISIAT)" which involves developing and implementing socioeconomic interventions to fight poverty and increase equitable access to TB care. Early analysis of the pilot ISIAT project showed promising results with the interventions described below increasing the number of people to a) complete TB treatment b) complete preventive therapy to prevent them getting TB c) be tested for TB and d) be tested for HIV. These results were published in 2011. The improvement in awareness, prevention and treatment of TB that our work and subsequent article showed has attracted the attention of funding bodies, like the World Bank and The Bill and Melinda Gates Foundation, and policymakers such as the World Health Organisation (WHO) and its Stop-TB department. Our on going relationship and involvement of these organizations and the published results of the pilot ISIAT project are encouraging for future work. The proposed project will rigorously assess the impact of these interventions not just on poverty and access to TB care but also on actual TB control.
INTERVENTIONS AND STUDY DESIGN. The interventions will be inexpensive, involving a team of experts from different fields working with all TB-affected families. They will utilize household visit and fortnightly community meetings to implement an integrated program of social support for enhancing equitable access to TB-related healthcare and economic support to help people to afford TB care and to help them to become less poor.
We will include in the study all members of a household with a new diagnosis of TB, as assessed by the Peruvian national TB program, without age limit, who provides informed written consent.
TB-affected households in 12 intervention communities will be offered the socioeconomic intervention for 6-months whilst the TB patient is receiving TB treatment. TB-affected households in 12 other control communities will be offered no intervention (standard of TB care). We will then re-visit those households 2 years after recruitment to assess what happened to the people with TB and those people in the household exposed to TB, and if our interventions prevented TB and reduced poverty.
BENEFITS: These socio-economic 'structural' interventions will be assessed for their capacity to reduce poverty-related TB risk factors, improve access to TB care and for reducing TB treatment failure, recurrence and transmission. This has potential importance for focusing poverty reduction on those in greatest need and who have the most to benefit and preventing TB.
Technical Summary
BACKGROUND: TB kills more people than any other single infection. New interventions are needed to strengthen TB control. Poverty hampers access to care, increases vulnerability and is the main determinant of global TB rates. Socioeconomic interventions for TB control have been proposed but there is little evidence to guide how they should be used.
PRELIMINARY DATA: Socioeconomic intervention increased equitable access to TB care in our published 4-year pilot study.
HYPOTHESIS: Socioeconomic intervention prevents TB by synergistically improving access to TB care and reducing TB vulnerability.
POPULATION: impoverished shantytown households in which one resident has recently been diagnosed as having TB disease, putting the other residents at high risk of TB disease.
PROPOSAL: A community randomised-controlled study will include 12,552 members of 1,874 households in periurban Lima shantytowns with a registered population of 307,623. The impact of a complex socioeconomic intervention will be assessed by comparing 12 intervention versus 12 control shantytowns. The integrated community-based intervention was developed in our pilot study and includes a social dimension (community mobilisation for health promotion to inform care) and an economic dimension (conditional cash transfers to incentivise and enable care and reduce poverty-related TB vulnerability).
OUTCOMES: The primary outcome will be the impact of the social and economic interventions preventing TB disease assessed by combining incident TB post-intervention with a final prevalence survey of all participants. Secondary outcomes will be the impact of the interventions increasing equitable access to TB care, reducing poverty and associated TB vulnerability and reduction in community TB rates.
CONCLUSION: This study will provide the first evidence assessing the potential of socioeconomic intervention to prevent TB and its potential to expand TB care into community TB control.
PRELIMINARY DATA: Socioeconomic intervention increased equitable access to TB care in our published 4-year pilot study.
HYPOTHESIS: Socioeconomic intervention prevents TB by synergistically improving access to TB care and reducing TB vulnerability.
POPULATION: impoverished shantytown households in which one resident has recently been diagnosed as having TB disease, putting the other residents at high risk of TB disease.
PROPOSAL: A community randomised-controlled study will include 12,552 members of 1,874 households in periurban Lima shantytowns with a registered population of 307,623. The impact of a complex socioeconomic intervention will be assessed by comparing 12 intervention versus 12 control shantytowns. The integrated community-based intervention was developed in our pilot study and includes a social dimension (community mobilisation for health promotion to inform care) and an economic dimension (conditional cash transfers to incentivise and enable care and reduce poverty-related TB vulnerability).
OUTCOMES: The primary outcome will be the impact of the social and economic interventions preventing TB disease assessed by combining incident TB post-intervention with a final prevalence survey of all participants. Secondary outcomes will be the impact of the interventions increasing equitable access to TB care, reducing poverty and associated TB vulnerability and reduction in community TB rates.
CONCLUSION: This study will provide the first evidence assessing the potential of socioeconomic intervention to prevent TB and its potential to expand TB care into community TB control.
Planned Impact
WHICH GROUPS WILL BE IMPACTED?
TB-affected families: This project will have a direct impact on the life of TB patients and their families. By reducing TB dissemination it should also have an indirect impact on the life of other people living in the marginalised, poor communities where TB is most common.
TB & poverty stakeholders: Knowledge generated will benefit policy makers, TB control programs, funding providers, NGOs, charities and institutions working in TB prevention, care and human development.
The project is responding to the World Health Assembly and WHO's recent call for a more integrated approach to the control of diseases disproportionately affecting developing countries. In particular, it responds to the WHO STOP-TB Department increasing interest in innovative interventions to support the current TB control strategy (which is based on case finding and treatment) (Lonnroth K, 2009).
The project will contribute to the generation of better disaggregated data on the TB burden in a peri-urban population, whose paucity represents the first challenge in the prevention of TB in informal settlements like the trial setting (David A, 2008).
The project will also benefit NGOs, charities and institutions working in human development by identifying new routes and partners to widen and enhance the impact of their activities.
HOW WILL THE PROJECT IMPACT THESE GROUPS?
TB-affected families: The project results are intended to benefit the people living with a recent TB-diagnosis in the following ways:
1. In the short term, by directly reducing poverty, improving access and use of TB care, increasing empowerment and consequently improving participants' health.
2. In the medium term, by strengthening the coordinated response of civil society and the State to tackle poverty as a means for TB control, influencing regional and national policy.
3. In the long term by influencing knowledge, understanding, policy and practice nationally and globally, this project will benefit TB-affected families in poor communities on a much greater scale.
TB & poverty stakeholders: The results have the potential to inform policy changes in TB control. TB and poverty stakeholders will be provided with preliminary evidence on the introduction of socioeconomic interventions as an integral part of TB control. This project has the capacity to inspire pragmatic actions for TB control in Peru in the short term. In the medium-longer term, we expect further increased interest from the international donors on this under-researched area, which will lead to the replication and adaptation of the project to other settings. The process evaluation will help understanding of the discrepancies between expected and observed results whilst providing insights into the role of contextual factors and project transferability.
WHAT WILL BE DONE TO ENSURE THIS IMPACT OCCURS?
TB-affected families: The project team will continue their current day-to-day interventional activities to ensure continuing impact for the project participants. The dissemination activities described in this document will ensure that the TB-affected families in other parts of Peru and other countries will similarly benefit in the medium to long term.
TB & poverty stakeholders: The earlier the engagement with policy makers in the evaluation is, the better will be the outcome (Whitehead M, 2004). Engagement of policy makers is on going with field site visits from WHO, The Bill & Melinda Gates Foundation/FIND and World Bank economists are heavily involved in the project. This early and regular engagement with stakeholders beyond the academic research community is essential for achieving global impact. Throughout the project this will increase interest in the importance of addressing social determinants of health, aims to inspire similar projects in different settings, and will guide the translation of project findings into policy and public health impact.
TB-affected families: This project will have a direct impact on the life of TB patients and their families. By reducing TB dissemination it should also have an indirect impact on the life of other people living in the marginalised, poor communities where TB is most common.
TB & poverty stakeholders: Knowledge generated will benefit policy makers, TB control programs, funding providers, NGOs, charities and institutions working in TB prevention, care and human development.
The project is responding to the World Health Assembly and WHO's recent call for a more integrated approach to the control of diseases disproportionately affecting developing countries. In particular, it responds to the WHO STOP-TB Department increasing interest in innovative interventions to support the current TB control strategy (which is based on case finding and treatment) (Lonnroth K, 2009).
The project will contribute to the generation of better disaggregated data on the TB burden in a peri-urban population, whose paucity represents the first challenge in the prevention of TB in informal settlements like the trial setting (David A, 2008).
The project will also benefit NGOs, charities and institutions working in human development by identifying new routes and partners to widen and enhance the impact of their activities.
HOW WILL THE PROJECT IMPACT THESE GROUPS?
TB-affected families: The project results are intended to benefit the people living with a recent TB-diagnosis in the following ways:
1. In the short term, by directly reducing poverty, improving access and use of TB care, increasing empowerment and consequently improving participants' health.
2. In the medium term, by strengthening the coordinated response of civil society and the State to tackle poverty as a means for TB control, influencing regional and national policy.
3. In the long term by influencing knowledge, understanding, policy and practice nationally and globally, this project will benefit TB-affected families in poor communities on a much greater scale.
TB & poverty stakeholders: The results have the potential to inform policy changes in TB control. TB and poverty stakeholders will be provided with preliminary evidence on the introduction of socioeconomic interventions as an integral part of TB control. This project has the capacity to inspire pragmatic actions for TB control in Peru in the short term. In the medium-longer term, we expect further increased interest from the international donors on this under-researched area, which will lead to the replication and adaptation of the project to other settings. The process evaluation will help understanding of the discrepancies between expected and observed results whilst providing insights into the role of contextual factors and project transferability.
WHAT WILL BE DONE TO ENSURE THIS IMPACT OCCURS?
TB-affected families: The project team will continue their current day-to-day interventional activities to ensure continuing impact for the project participants. The dissemination activities described in this document will ensure that the TB-affected families in other parts of Peru and other countries will similarly benefit in the medium to long term.
TB & poverty stakeholders: The earlier the engagement with policy makers in the evaluation is, the better will be the outcome (Whitehead M, 2004). Engagement of policy makers is on going with field site visits from WHO, The Bill & Melinda Gates Foundation/FIND and World Bank economists are heavily involved in the project. This early and regular engagement with stakeholders beyond the academic research community is essential for achieving global impact. Throughout the project this will increase interest in the importance of addressing social determinants of health, aims to inspire similar projects in different settings, and will guide the translation of project findings into policy and public health impact.
Organisations
- Imperial College London, United Kingdom (Collaboration, Lead Research Organisation)
- Catholic University of Louvain, Belgium (Collaboration)
- Public Health England, United Kingdom (Collaboration)
- United Nations (UN) (Collaboration)
- Peruvian University Cayetano Heredia (Collaboration)
- University of Washington Medical Center (Collaboration)
- Municipality of Lima (Collaboration)
- University of Massachusetts Lowell, United States (Collaboration)
- University of Tampere (Collaboration)
- Ohio State University, United States (Collaboration)
- Tulane University, United States (Collaboration)
- Ministry of Development and Social Inclusion (Collaboration)
- National TB Reference Laboratory, Tbilisi, Georgia (Collaboration)
- United States Air Force (USAF), United States (Collaboration)
- Stanford University, United States (Collaboration)
- Regional Government of Callao (Collaboration)
- Savics (Collaboration)
- Washington University in St. Louis (Collaboration)
- National Council for Science, Technology and Technological Innovation (CONCYTEC) (Collaboration)
- Clinton Health Access Initiative (Collaboration)
- National Institute of Health of Peru (Collaboration)
- University of Antwerp, Belgium (Collaboration)
- National Multisectoral Health Coordinator (Collaboration)
- Karolinska Institute, Sweden (Collaboration)
- PRISMA ONG (Collaboration)
- Peruvian Association of Persons Affected by Tuberculosis (ASPAT) (Collaboration)
- World Bank Group (Collaboration)
- London Sch of Hygiene and Trop Medicine, United Kingdom (Collaboration)
- World Health Organization (WHO) (Collaboration)
- Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF) (Collaboration)
- Callao Regional Directorate of Health (Collaboration)
- Stellenbosch University, South Africa (Collaboration)
- National Tuberculosis Control Program (Collaboration)
- St George's Hospital (Collaboration)
- GENETUP (Collaboration)
- Duke University, United States (Collaboration)
- United States Department of Defense via NAMRU-6 (Collaboration)
- Naval Medical Research Center Unit-6 (Collaboration)
- Liverpool School of Tropical Medicine (Collaboration)
- Johns Hopkins University, United States (Collaboration)
Publications
Alnasser Y
(2016)
Colorimetric Detection of Plasmodium vivax in Urine Using MSP10 Oligonucleotides and Gold Nanoparticles.
in PLoS neglected tropical diseases
Alroy KA
(2015)
Correction: Prevalence and Transmission of Trypanosoma cruzi in People of Rural Communities of the High Jungle of Northern Peru.
in PLoS neglected tropical diseases
Alroy KA
(2015)
Prevalence and Transmission of Trypanosoma cruzi in People of Rural Communities of the High Jungle of Northern Peru.
in PLoS neglected tropical diseases
Alva A
(2017)
Mathematical algorithm for the automatic recognition of intestinal parasites.
in PloS one
André E
(2018)
Patient-led active tuberculosis case-finding in the Democratic Republic of the Congo.
in Bulletin of the World Health Organization
Antiporta DA
(2016)
Length of urban residence and obesity among within-country rural-to-urban Andean migrants.
in Public health nutrition
Arana Y
(2013)
Characterization of the carbohydrate components of Taenia solium oncosphere proteins and their role in the antigenicity.
in Parasitology research
Arriola CS
(2014)
New insights in cysticercosis transmission.
in PLoS neglected tropical diseases
Arroyo G
(2018)
Antibody Banding Patterns of the Enzyme-Linked Immunoelectrotransfer Blot and Brain Imaging Findings in Patients With Neurocysticercosis.
in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
| Title | Guide for peer mentors: "Consejeros" |
| Description | We have developed a short instruction guide for our peer mentors. Peer mentors are patients who are taking TB treatment or who are cured after having previously had TB. Their primary role is to provide peer support to TB affected households facilitating social empowerment through stigma reduction, accompaniment and information. The guide we produced is easy to follow and has been refined after consultation with peer mentors. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2017 |
| Impact | Empowerment of peer mentors through including them in the development process. Many peer mentors are people who have previously been isolated and stigmatised. They have expressed gratitude for being given an opportunity to be community leaders. |
| Title | Informational Booklet for CRESIPT Families |
| Description | This booklet describes CRESIPT in layman's terms, provides information on prevention and detection of TB, gives access to other social programs and information on TB discrimination laws in one place. The format is accessible for those of all reading levels. It also gives CRESIPT families a sense of identity and belonging in the mini-society we have formed with our intervention, reducing negative feelings associated with TB stigma. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2017 |
| Impact | Patients are better able to understand CRESIPT, have easy access to information about TB, and have a physical representation of belonging to a group. |
| URL | https://www.canva.com/design/DACF3JW4J94/5dLbIGa3lO_ugeTSiQFrnQ/edit |
| Title | Peer mentor certificate and pin |
| Description | We developed a certificate and pin for our peer mentors. Peer mentors are patients who are taking TB treatment or who are cured after having previously had TB. Their primary role is to provide peer support to TB affected households facilitating social empowerment through stigma reduction, accompaniment and information. The certificate and pin give them formal recognition for the important work that they are involved in delivering. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2017 |
| Impact | Empowerment of peer mentors. Many peer mentors are people who have previously been isolated and stigmatised. They have expressed gratitude for being given an opportunity to be community leaders and feel included in a civil society. The process of formally recognising peer mentors has also led to an increase in uptake of this aspect of the intervention. More TB survivors are now becoming peer mentors and more families affected by TB are willing to engage with peer mentors due to their continued and significant presence at our community events. |
| Title | Personal TB risk score leaflet |
| Description | We developed a simple leaflet for contacts of patients with tuberculosis that visually expresses their 10-year risk of developing tuberculosis disease. The leaflet is simple and suitable for all reading levels as the applicable sections for contacts are predominantly images. Contacts are recommended to take this leaflet to local health posts to consult with a doctor regarding tuberculosis preventive therapy. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2016 |
| Impact | Through informing people of their tuberculosis risk in a simple and visually facilitative manner, we are empowering high risk contacts of patients with tuberculosis to access health services engage in tuberculosis prevention. |
| Title | Poverty Warriors Youtube video |
| Description | We are working with an independent film maker to publish on Youtube a video describing this project and its potential importance. The video is complete and is now being edited and permission sought from the participants for publication. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2016 |
| Impact | Surprisingly, participation in the filming of this documentary was popular amongst households living with TB, despite the powerful stigma associated with TB. We are exploring the implications of this surprising finding in case helping people living with TB to video their experiences may paradoxically contribute to TB stigma reduction. |
| Title | Stigma presentation panels |
| Description | In order to deliver evidence based cognitive therapy to stigmatised people living with tuberculosis we have developed a system using flip charts, labels for emotions, thoughts and behaviours, and flip charts to demonstrate new facts, thoughts and behaviours. These CBT panels are transported throughout Lima to the different sites where we work. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2016 |
| Impact | The CBT panels have facilitated the delivery of CBT to TB-affected people in a resource limited setting. |
| Title | TB Stigma Drawings Booklet |
| Description | Booklets containing a series of hand-drawn colored pictures depicting culture-specific, locally-relevant events, situations, or encounters in which people with TB may experience enacted, anticipated, and TB self- stigma are used in TB Clubs by people with TB and their family members to facilitate identification of emotions, thoughts, and behaviors associated with these three stigma types. Each TB club member is provided a booklet and asked to think about an event, situation, or encounter in which they personally experienced TB stigma. The drawings serve as examples and memory prompts. Club members then describe their experience of TB stigma -- the emotions, associated thoughts, and resultant behaviors. Beyond building supportive networks among club members, identifying and sharing these particular components of their experiences provides the foundation steps for employing cognitive behavior therapy techniques to then explore alternative thoughts and behaviors that serve to empower club members in achieving goals, e.g. adhering to and completing TB treatment, having family members tested for TB. |
| Type Of Art | Artwork |
| Year Produced | 2016 |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in the delivery phase. |
| Title | Training Video of Production and Utilization of the Colour Test, a TB rapid diagnostic tool |
| Description | The Colour Test is a low-cost, low-tech rapid diagnostic tool that we have developed and utilize to diagnose patients with TB in CRESIPT. This tool is particularly useful in that it provides an alternative to high tech and/or expensive rapid diagnostic tools for TB and can find drug resistant strains of TB, which is especially useful in low-resource areas. While we have a written manuscript, we find that an accompanying visual component is helpful in understanding how to develop this tool and provides an alternative to face-to-face training here in Lima. We hope to publish this video with open-access in the Journal of Visualized Experiments, a journal dedicated to distributing accompanying video content. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2017 |
| Impact | We aim for this video to be a useful tool for our peers abroad, so that they may be able to utilize the Colour Test in low-resource areas throughout the world. |
| Title | WORDS AND PHRASES USED BY TB-AFFECTED HOUSEHOLDS TO DESCRIBE THE STIGMA OF TB |
| Description | A multi-colored, 3 ft x 6 ft, digital poster summarizing the main points of an abstract of the same name, including a word cloud and 2 tables. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2019 |
| Impact | Displayed for approximately 24 hours during the 2019 END TB Conference sponsored by the North American Region of the International Union of Tuberculosis and Lung Disease in Vancouver, BC, Canada. |
| Title | World Bank empowerment documentary |
| Description | Collaborators in the World Bank are preparing a video documentary showcasing success stories in empowerment in Peru. They have included several filmed interviews with one of our project participants. A TB-affected patient and household living in a peri-urban shantytown / slum who was supported by our research project to tackle social and economic challenges associated with TB disease and TB treatment. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2016 |
| Impact | This has been a highly and surprisingly positive experience for the filmed household who have overcome, and put aside the stigma and marginalisation that cause most people living with TB in Peru to keep their contagious disease a secret. Further impacts are expected when the World Bank completes and publicises their venture. The involvement of the participant from our project is already complete. |
| Guideline Title | NICE 2016 TB Guidelines - screening of contacts of patients with extrapulmonary TB being revisited. |
| Description | Article in Thorax being reviewed by NICE TB Guideline Committee members |
| Geographic Reach | National |
| Policy Influence Type | Citation in clinical guidelines |
| Description | Collaboration with Peru's National TB Strategy |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Qualitative data arising from a research study that investigated the social determinants that contribute to diagnostic delay has been and is continuing to be reviewed by leaders in the National TB Strategy of Peru. This data will be used to modify and/or implement policy that may change relationships between patients and their various healthcare providers to reduce diagnostic delay of tuberculosis disease. |
| Description | Contact investigation and TB preventive therapy |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | We have been extensively involved with the Peruvian NTP aiming to increase coverage of contact investigation and TB preventive therapy. Our data analysis and evidence presented at various meetings has led to the NTP endorsing a new policy for which contacts should receive TB preventive therapy. We are currently evaluating this policy as part of our study. This new policy aims to increase coverage of TB preventive therapy, reduce TB incidence in household contacts, and ultimately therefore improve quality of life. |
| Description | Health Promotion Workers TB Training Workshop |
| Geographic Reach | South America |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | This important workshop for frontline health promotion workers in Ventanilla was an essential part of disseminating the results of our research in a way that directly impacted the population we serve through our work. These health workers provide regular house visits and foster relationships with the most in need communities in order to provide essential education and guidance towards accessing healthcare appropriately and promptly. We trained these individuals with a series of talks and open peer discussion with the results of our work so far around risk factors for TB, advising how to overcome the barriers to accessing healthcare and around reducing simple daily costs which could all make a significant benefit to patient and household TB outcomes as well as build the basis for future engagement and collaboration. |
| Description | Implementation of the use rapid molecular DST |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | The patients have a screeing of MDR TB on the same day they are diagnosed by TB |
| Description | International Health Unit, Imperial College London |
| Geographic Reach | Europe |
| Policy Influence Type | Participation in a advisory committee |
| Impact | Informs national and international TB policy and practice through our extensive collaborations with diverse organisations in the UK and across Europe. Key interests include: Barriers to healthcare among hard-to-reach migrants, and the impact on migrants, the endogenous population, and the NHS The relationship between the social, behavioural and psychological impact of TB and similar diseases of poverty on migrant and local populations |
| URL | http://www.imperial.ac.uk/department-of-medicine/research/infectious-diseases/infectious-diseases-im... |
| Description | Membership of National Committee for Paediatric Tuberculosis |
| Geographic Reach | National |
| Policy Influence Type | Membership of a guideline committee |
| Impact | Dr Marco Tovar (a key, leading member of our team) is now a member of the Peruvian National Advisory Committee on Paediatric TB. This expert committee is responsible for reviewing evidence and proposing changes to national tuberculosis guidelines. Dr Tovar has been advocating for changes to national guidelines based on the results of our own research. |
| Description | Participation in Global TB Caucus |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Participation in a advisory committee |
| Impact | The Global TB Caucus is a unique global network of parliamentarians united by their shared commitment to end the tuberculosis (TB) epidemic. Led by its members for its members, the Caucus aims to transform the response to TB through targeted interventions at national, regional, continental, and global levels. The Caucus is led by Dr Aaron Motsoaledi, Minister of Health for South Africa, and the Rt Hon Nick Herbert MP from the United Kingdom. Under the leadership of Dr Motsoaledi and Mr Herbert, the network has grown to one of the world's largest parliamentary networks with 2,300 members in more than 130 countries. We are involved in the Caucus in an advisory role. |
| URL | https://www.globaltbcaucus.org |
| Description | Post TB lung disease steering committee |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Participation in a advisory committee |
| Description | Reducing TB patient costs and lost income during illness |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Participation in a national consultation |
| Description | Setting the national Peruvian TB research priorities |
| Geographic Reach | National |
| Policy Influence Type | Participation in a national consultation |
| Impact | Prof Carlton Evans, Drs Marco Tovar and Sumona Datta were involved in the "Taller determinacion de prioridades nacionales de investigacion en tuberculosis en Peru, 2018-2021", which was a working group meeting with TB researchers based in Peru, at the request of the Ministry of health, national TB program to set the 2018-2021 TB research agenda. This was as a consequence of the WHO and PAHO declaring Peru as one of their "model" TB research countries. This was held in Lima, Peru on 21st December 2017. |
| Description | Task force on UHC social protection - subgroup on measurements |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Membership of a guideline committee |
| Impact | This is part of the World Health Organisation global TB program post-2015 draft TB control strategy. Thus this group is influencing policy that will have health and economic impacts. |
| Description | The New TB elimination strategy |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Citation in other policy documents |
| Description | Training to principles TB laboratory focusing on tuberculosis diagnosis and biosefaty |
| Geographic Reach | South America |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | During this period of time, our TB laboratory in Cayetano Heredia University collaborated with the NAMRU-6 in Lima, Peru in order to implement the basic conditions to develop tuberculosis diagnosis using simple and practical conditions specially with the military laboratories from Guatemala, Belize, El Salvador, Nicaragua, Honduras, Dominican Republic, Colombia and Peru also. The useful for this kind of training was very useful to develop strategies to develop tuberculosis diagnosis and to improvement the biosafety conditions. |
| Description | WHO TB Patient Costs Survey Handbook - Core Author |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Membership of a guideline committee |
| Impact | Measurement of TB patients costs in 15 countries to date nationally. This is expanding all the time. I am running a costs survey in Nepal and potentially one in Mozambique. Identifying these costs has allowed them to be addressed more objectively. I am now working to try and develop tailored socioeconomic support packages for TB-affected households in diverse settings. |
| URL | http://www.who.int/tb/publications/patient_cost_surveys/en/ |
| Description | WHO post-2015 global TB control strategy |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Citation in other policy documents |
| Impact | International guidance calling for zero TB-affected families to incur catastrophic costs associated with TB treatment |
| URL | http://www.who.int/tb/post2015_tbstrategy.pdf?ua=1 |
| Description | Wellcome Center at Imperial College London Global Health Research Steering Committee |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Membership of a guideline committee |
| Impact | The Wellcome Trust-Imperial College Centre for Global Health Research is one of the five UK-wide centres funded by the Wellcome Trust to enhance global health research. The Centre aims to initiate and foster research that improves health, and reduces inequalities in health and healthcare, through the generation and deployment of knowledge that can lead to more effective and equitable prevention and treatment of illness, and to promoting positive health over the life course. The steering committee set the research agenda for this Centre, which has already made numerous discoveries that have changed global health policy. |
| URL | https://www.imperial.ac.uk/global-health-innovation/global-engagement/wellcome-centre-for-global-hea... |
| Description | Academy of Medical Sciences Young Investigator Award 2017 |
| Amount | £1,250 (GBP) |
| Organisation | Academy of Medical Sciences (AMS) |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 03/2017 |
| End | 04/2017 |
| Description | American Society of Tropical Medicine and Hygiene Travel Scholarship |
| Amount | $2,000 (USD) |
| Organisation | American Society of Tropical Medicine and Hygiene |
| Sector | Learned Society |
| Country | United States |
| Start | 11/2014 |
| End | 11/2014 |
| Description | Beca Doctorado en el Extranjero |
| Amount | $210,233 (USD) |
| Organisation | National Council for Science, Technology and Technological Innovation (CONCYTEC) |
| Sector | Public |
| Country | Peru |
| Start | 10/2018 |
| End | 09/2021 |
| Description | British Infection Association Research Project Primer Grant |
| Amount | £5,000 (GBP) |
| Organisation | British Infection Association (BIA) |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 09/2013 |
| End | 03/2014 |
| Description | British Infection Association Travel Award |
| Amount | £800 (GBP) |
| Organisation | British Infection Association (BIA) |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 11/2013 |
| End | 11/2013 |
| Description | CONCYTEC Grand Challenge Explorations |
| Amount | S/.130,000 (PEN) |
| Funding ID | 0XX-2014 |
| Organisation | National Council for Science, Technology and Technological Innovation (CONCYTEC) |
| Sector | Public |
| Country | Peru |
| Start | 10/2014 |
| End | 04/2016 |
| Description | Dorey Bequest Travel Award |
| Amount | £600 (GBP) |
| Organisation | Royal College of Ophthalmologists |
| Sector | Learned Society |
| Country | United Kingdom |
| Start | 02/2018 |
| End | 07/2018 |
| Description | Ethicon Foundation Fund |
| Amount | £1,500 (GBP) |
| Organisation | Royal College of Ophthalmologists |
| Sector | Learned Society |
| Country | United Kingdom |
| Start | 02/2018 |
| End | 07/2018 |
| Description | Fellowship for Dr Tom Wingfield |
| Amount | £5,000 (GBP) |
| Organisation | Innovation For Health and Development (IFHAD) |
| Sector | Charity/Non Profit |
| Country | Peru |
| Start | 02/2012 |
| End | 02/2013 |
| Description | Gates Grand Challenges Explorations |
| Amount | $100,000 (USD) |
| Funding ID | OPP1118545 |
| Organisation | Bill and Melinda Gates Foundation |
| Sector | Charity/Non Profit |
| Country | United States |
| Start | 11/2014 |
| End | 05/2016 |
| Description | Glasgow Liverpool Wellcome Trust Centre For Global Health Research Flexible Funding Pot |
| Amount | £5,900 (GBP) |
| Organisation | Wellcome Trust |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 02/2017 |
| End | 06/2018 |
| Description | Global Emerging Infection Surveillance and Response ...GEISS |
| Amount | $200,000 (USD) |
| Funding ID | Constitutes 120,000 USD contract to our team and 80,000 for collaborative work |
| Organisation | United States Department of Defense via NAMRU-6 |
| Sector | Public |
| Country | United States |
| Start | 10/2014 |
| End | 10/2015 |
| Description | Global Emerging Infection Surveillance and Response ...GEISS |
| Amount | $196,000 (USD) |
| Funding ID | Constitutes 165,000 USD contract for our team research plus 31,000 USD for collaborative activities |
| Organisation | United States Department of Defense via NAMRU-6 |
| Sector | Public |
| Country | United States |
| Start | 10/2013 |
| End | 10/2014 |
| Description | Grand Challenges Canada Explorations |
| Amount | $50,000 (CAD) |
| Funding ID | 0665-01-10 |
| Organisation | Government of Canada |
| Department | Grand Challenges Canada |
| Sector | Public |
| Country | Canada |
| Start | 10/2014 |
| End | 04/2016 |
| Description | IFHAD Clinical Research Fellowship |
| Amount | £5,000 (GBP) |
| Organisation | Innovation For Health and Development (IFHAD) |
| Sector | Charity/Non Profit |
| Country | Peru |
| Start | 09/2015 |
| End | 07/2016 |
| Description | Imperial College Global Health Clinical Fellowship Scheme ISSF |
| Amount | £60,000 (GBP) |
| Organisation | Imperial College London |
| Department | NIHR/Wellcome Trust Imperial Clinical Research Facility |
| Sector | Public |
| Country | United Kingdom |
| Start | 10/2013 |
| End | 12/2014 |
| Description | Imperial College London Wellcome Trust Infection and Global Health Research Annual Meeting: for 3 people |
| Amount | £4,000 (GBP) |
| Organisation | Imperial College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 11/2014 |
| End | 11/2014 |
| Description | Innovation For Health And Development (IFHAD) PhD Fellowship |
| Amount | £5,000 (GBP) |
| Organisation | Innovation For Health and Development (IFHAD) |
| Sector | Charity/Non Profit |
| Country | Peru |
| Start | 02/2013 |
| End | 08/2013 |
| Description | Innovation for Health and Development Clinical Research Fellowship |
| Amount | £5,000 (GBP) |
| Organisation | Innovation For Health and Development (IFHAD) |
| Sector | Charity/Non Profit |
| Country | Peru |
| Start | 07/2015 |
| End | 03/2016 |
| Description | Innovation for Health and Development Research Fellowship |
| Amount | $5,400 (USD) |
| Organisation | Imperial College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 09/2016 |
| End | 09/2017 |
| Description | Intergrated Clinical Academic Training Short Experience Fellowship |
| Amount | £3,530 (GBP) |
| Organisation | National Institute for Health Research |
| Sector | Public |
| Country | United Kingdom |
| Start | 02/2017 |
| End | 11/2017 |
| Description | International Union against Tuberculosis and Lung Disease Travel Grant |
| Amount | $2,000 (CAD) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 02/2016 |
| End | 02/2016 |
| Description | Johns Hopkins Bloomberg School of Public Health - the Dean's Scholarship |
| Amount | $2,500 (USD) |
| Organisation | Johns Hopkins University |
| Sector | Academic/University |
| Country | United States |
| Start | 06/2015 |
| End | 06/2016 |
| Description | Joint Global Health Trials stipend for research from Dr Carlton Evans' grant |
| Amount | £28,800 (GBP) |
| Funding ID | Joint Global Health Trials P43878 |
| Organisation | Medical Research Council (MRC) |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 02/2013 |
| End | 02/2015 |
| Description | Linacre Lecture Award |
| Amount | £750 (GBP) |
| Organisation | Royal College of Physicians of London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 01/2016 |
| End | 01/2016 |
| Description | Minor Field Studies Grant |
| Amount | 27,000 kr (SEK) |
| Organisation | Swedish International Development Cooperation Agency |
| Sector | Public |
| Country | Global |
| Start | |
| Description | National Institutes of Health Fogarty Global Health Fellowship |
| Amount | $32,228 (USD) |
| Funding ID | R25TW009340 |
| Organisation | Fogarty International Centre |
| Sector | Public |
| Country | United States |
| Start | 07/2016 |
| End | 05/2017 |
| Description | Overseas Development Assistance Research Seed Fund |
| Amount | £8,980 (GBP) |
| Organisation | Higher Education Funding Council for England |
| Sector | Public |
| Country | United Kingdom |
| Start | 02/2017 |
| End | 04/2017 |
| Description | Project Primer Grant |
| Amount | £5,000 (GBP) |
| Organisation | British Infection Association (BIA) |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 01/2013 |
| End | 01/2014 |
| Description | Royal Society of Medicine Ophthalmology Fellowship |
| Amount | £750 (GBP) |
| Organisation | Royal Society of Medicine |
| Sector | Learned Society |
| Country | United Kingdom |
| Start | 08/2017 |
| End | 07/2018 |
| Description | TB REACH Wave 5 |
| Amount | $400,000 (USD) |
| Organisation | Stop TB Partnership |
| Sector | Charity/Non Profit |
| Country | Switzerland |
| Start | 04/2017 |
| End | 10/2018 |
| Description | TB Union North America Region Annual Conference Travel Award |
| Amount | $1,400 (CAD) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 02/2013 |
| End | 03/2013 |
| Description | The TB Union Travel Award (International meeting in Paris, 2013 - funded travel to present as speaker) |
| Amount | £500 (GBP) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 11/2013 |
| End | 11/2013 |
| Description | The travel grant to attend to the 47th Union World Conference on Lung Health Liverpool, UK: 26 October - 29 October 2016 |
| Amount | S/.7,000 (PEN) |
| Organisation | Innovation For Health and Development (IFHAD) |
| Sector | Charity/Non Profit |
| Country | Peru |
| Start | 10/2016 |
| End | 10/2016 |
| Description | The travel to attend to the 44th Union World Conference on Lung Health. Paris, France: 31 October - 4 November 2013 |
| Amount | € 2,000 (EUR) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 10/2013 |
| End | 11/2013 |
| Description | Travel Award * 3 persons Vancouver |
| Amount | £3,000 (GBP) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 02/2013 |
| End | 03/2013 |
| Description | Travel Award - Bahia |
| Amount | $2,000 (USD) |
| Organisation | World Health Organization (WHO) |
| Sector | Public |
| Country | Global |
| Start | |
| Description | Travel Award - Paris |
| Amount | $2,000 (USD) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | |
| Description | Travel Grant |
| Amount | £800 (GBP) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 10/2016 |
| End | 10/2016 |
| Description | Travel Grant - Birmingham |
| Amount | £750 (GBP) |
| Organisation | British Infection Association (BIA) |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | |
| Description | Travel Grant - Sao Paulo |
| Amount | $1,500 (USD) |
| Organisation | World Health Organization (WHO) |
| Sector | Public |
| Country | Global |
| Start | |
| Description | Travel Grant - Sao Paulo |
| Amount | $2,000 (USD) |
| Organisation | United States Agency for International Development |
| Sector | Public |
| Country | United States |
| Start | 01/2013 |
| End | 01/2013 |
| Description | Travel Grant to attend the Joint 20th Conference of The Union North America Region and the National TB Controllers Association |
| Amount | $2,000 (CAD) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 02/2016 |
| End | 02/2016 |
| Description | Travel Grant to participate in The International Union Against TB & Lung Disease 46th Annual Conference |
| Amount | £1,700 (GBP) |
| Organisation | Innovation For Health and Development (IFHAD) |
| Sector | Charity/Non Profit |
| Country | Peru |
| Start | 12/2015 |
| End | 12/2015 |
| Description | Travel Grant to work in a consultancy capacity for World Health Organisation |
| Amount | £600 (GBP) |
| Organisation | World Health Organization (WHO) |
| Sector | Public |
| Country | Global |
| Start | 03/2017 |
| End | 03/2017 |
| Description | Travel Scholarship ASTMH |
| Amount | $2,000 (USD) |
| Organisation | American Society of Tropical Medicine and Hygiene |
| Sector | Learned Society |
| Country | United States |
| Start | 11/2014 |
| End | 11/2014 |
| Description | Travel Scholarship International Union |
| Amount | € 1,000 (EUR) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 10/2014 |
| End | 10/2014 |
| Description | Travel grant to Social Protection Action Research and Knowledge Sharing (SPARKS) network meeting |
| Amount | £700 (GBP) |
| Organisation | Karolinska Institute |
| Sector | Academic/University |
| Country | Sweden |
| Start | 12/2016 |
| End | 12/2016 |
| Description | Travel grant to attend the 21st Annual Conference of the Union - North American Region in Vancouver, BC |
| Amount | $2,000 (CAD) |
| Organisation | The Union North America Region |
| Sector | Charity/Non Profit |
| Country | United States |
| Start | 02/2017 |
| End | 02/2017 |
| Description | Travel grant to attend to the 17th Conference of The Union North America Region. 28 February-2 March 2013 |
| Amount | $1,200 (CAD) |
| Organisation | The Union North America Region |
| Sector | Charity/Non Profit |
| Country | United States |
| Start | 02/2013 |
| End | 02/2013 |
| Description | US-CDC Travel Award |
| Amount | £2,000 (GBP) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 12/2015 |
| End | 12/2015 |
| Description | USAID Travel Scholarship to present at USAID and WHO catastrophic costs and universal health coverage symposium |
| Amount | $2,200 (USD) |
| Organisation | United States Agency for International Development |
| Sector | Public |
| Country | United States |
| Start | 04/2013 |
| End | 04/2013 |
| Description | Union against TB and lung disease North American Region Conference Travel grant |
| Amount | $2,500 (CAD) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 02/2016 |
| End | 02/2016 |
| Description | Union against TB and lung disease North American Region Conference Travel grant |
| Amount | $2,500 (USD) |
| Organisation | International Union Against Tuberculosis and Lung Disease (The Union) |
| Sector | Charity/Non Profit |
| Country | Global |
| Start | 02/2013 |
| End | 02/2013 |
| Description | Wellcome Trust Imperial College Centre for Global Health Research Seed Grant |
| Amount | £9,295 (GBP) |
| Organisation | Imperial College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 01/2018 |
| End | 09/2018 |
| Description | Wellcome Trust Imperial College Centre for Global Health Research Travel Award |
| Amount | £901 (GBP) |
| Organisation | Imperial College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 11/2017 |
| End | 11/2017 |
| Description | Wellcome Trust Institutional Strategic Support Fund for Global Health Research Fellowship |
| Amount | £67,490 (GBP) |
| Funding ID | PS3059_WHRP |
| Organisation | Imperial College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 09/2017 |
| End | 08/2018 |
| Description | Wellcome Trust Research Training Fellowship |
| Amount | £251,068 (GBP) |
| Funding ID | 201251/Z/16/Z |
| Organisation | Wellcome Trust |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 04/2016 |
| End | 04/2020 |
| Title | "5 Words" Survey |
| Description | A survey was conducted during a 6 month period of the initial pilot phase of the CRESIPT study in which people with TB and their family members, after having participated in TB workshops that included TB-stigma and empowerment education, were each asked to provide 5 words that best described what TB stigma and empowerment meant to them. These responses were then collated to create 2 shortened lists of the most frequently-used words to describe TB stigma and empowerment. These 2 shortened lists were then used to inform the development of a cognitive behavior therapy-based TB support group intervention to reduce anticipated and TB self-stigma, and empower people with TB and their family members to achieve TB diagnosis and cure. |
| Type Of Material | Physiological assessment or outcome measure |
| Provided To Others? | No |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in the delivery phase. |
| Title | Anticipated TB Stigma Questionnaire |
| Description | We have adapted the Explanatory Model Interview Catalog (EMIC) to measure anticipated TB stigma among people with TB. The EMIC is a validated research tool developed to identify patterns of distress, perceived causes, help-seeking and treatment preferences, and general illness beliefs from the experience and perspective of people directly affected by a particular illness. Our TB-adapted questionnaire is being administered to participants in both the intervention and control groups of the CRESIPT study, both pre- and post-intervention, in order to establish baseline measurements of existing anticipated TB stigma, and demonstrate the effect of an anticipated TB stigma reduction intervention. |
| Type Of Material | Physiological assessment or outcome measure |
| Provided To Others? | No |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in its delivery phase. |
| Title | Carbendazim enriched culture media for Mycobacterium tuberculosis detection |
| Description | Many cultures fail due to contamination. We have tried and testing the addition of carbendazim, an anti-fungal in culture media reducing contamination rates in our laboratory in Lima, Peru by 90%. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2013 |
| Provided To Others? | Yes |
| Impact | Please published abstracts in the publications section. |
| Title | Catastrophic costs measurement methodology |
| Description | Definition of catastrophic costs for TB-affected families has been unclear. We devised a definition that was both locally-appropriate and clinically-relevant. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2014 |
| Provided To Others? | Yes |
| Impact | We were able to develop this with the WHO working group on social protection and UHC. This has since been published in PLOS Medicine to be used as an example for other research groups. |
| URL | http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001675 |
| Title | Data Collection Instruments |
| Description | Data collection instruments aiming to assess the socio-economic position (poverty), depression, stigma and TB risk factors of patients and people at risk of becoming TB patients. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2012 |
| Provided To Others? | Yes |
| Impact | This tool is in development stage, due to be piloted in the coming months. We have shared it freely with collaborators and anyone who requests it, in order to facilitate their research and work. |
| Title | Development of a household-level TB risk score |
| Description | We have derived and externally validated a score that can be used to identify households in which any contact, of any age, is at high risk of having tuberculosis disease within three years. This score can be used in all currently tuberculosis-affected households, including those in which the patient has extra-pulmonary tuberculosis, and can be found at this link: https://jscalc.io/calc/8xzrWJ99BMs6uCV7 |
| Type Of Material | Model of mechanisms or symptoms - human |
| Year Produced | 2018 |
| Provided To Others? | Yes |
| Impact | We have now begun collaborative research with the Peruvian health system in Iquitos to externally validate this tool in a different setting. |
| URL | http://www.ifhad.org/risk |
| Title | Internalized TB Beliefs, Attitudes, and Fear of Discrimination Among People Without TB Questionnaire |
| Description | We have adapted the Explanatory Model Interview Catalog (EMIC) to measure negative beliefs, attitudes, and fear of discrimination related to TB among people both with and without TB. The EMIC is a validated research tool developed to identify patterns of distress, perceived causes, help-seeking and treatment preferences, and general illness beliefs from the experience and perspective of people directly affected by a particular illness. Our TB-adapted questionnaire is being administered to participants in both the intervention and control groups of the CRESIPT study, both pre- and post-intervention, in order to establish baseline measurements of these stigma components and demonstrate the effect of a TB stigma reduction intervention. In addition, non-TB-affected members of the same communities, not participating in the CRESIPT study, are also being surveyed to establish baseline measurements of these TB stigma components among this group. |
| Type Of Material | Physiological assessment or outcome measure |
| Provided To Others? | No |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in the delivery phase. |
| Title | Quality Assurance |
| Description | For data collection, data entry and database management, and laboratory techniques, a paired system of quality assurance has been developed and implemented. Team members are responsible for pairing monthly with another team member to monitor and evaluate if research methods adhere to team protocols. Team members follow a guided checklist of essential research methods and correct non-adherences if they appear. |
| Type Of Material | Improvements to research infrastructure |
| Provided To Others? | No |
| Impact | A systematic quality assurance program ensures better data collection, data entry and database management, and laboratory procedures. |
| Title | Research nurse based poverty assessment |
| Description | We have evaluated a nurse based poverty assessment for estimating household socioeconomic position. During a household visit, trained research nurses complete a visual analogue scale characterising their perception of household socioeconomic position. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2017 |
| Provided To Others? | No |
| Impact | This tool is currently under evaluation. Initial results suggest the VAS correlates well with objective markers of poverty (e.g. income, assets, and access to services), and with TB adverse outcomes (treatment abandonment and TB disease among contacts). Evaluation of this VAS will therefore potentially significantly improve the efficiency of our data collection in the future. Currently our questionnaire is very detailed and time consuming. If the initial results and associations we observe hold true, we may significantly reduce the number of questions we ask. |
| Title | Research nurse based ventilation assessment |
| Description | Because reduced ventilation increases the risk of TB transmission to contacts, we have evaluated a nurse based ventilation assessment for estimating how well ventilated a household is. During a household visit, trained research nurses complete a visual analogue scale characterising their perception of household ventilation. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2017 |
| Provided To Others? | No |
| Impact | The tool is currently under evaluation. Initial results suggest this VAS is a good predictor of the risk of TB disease among household contacts, independently of household socioeconomic position. In the future we hope to assess the association of this VAS with objective measures of ventilation. If the VAS were to predict objective ventilation it would provide a simple field alternative to resource intensive measures of ventilation. |
| Title | Single Step decontamination for TB cultures |
| Description | TB culture often is marred by contamination from comensal bacteria and fungi, often reducing the quality of results. A single step decontamination with trisodium phosphate prior to placement of TB samples into standard Lowenstein-Jensen (LJ) media, has been noted to reduce growth of contaminant fungi in TB cultures. Our lab uses a trisodium phosphate solution, where the samples are placed for 20 minutes and then transferred to the LJ media. |
| Type Of Material | Biological samples |
| Year Produced | 2016 |
| Provided To Others? | Yes |
| Impact | This single step decontamination was used in the assessment of TB aerosol filters as a measure of infectivity of TB patients. In all clinical aerosol filter samples, no fungi or bacterial contamination was found following single step decontamination. In a concurrent validation experiment with fungi and TB, the single step decontamination also proved effective in decreasing fungal overgrowth. |
| Title | Supportive measures addressing mental health issues amongst TB patients |
| Description | Best evidence based supportive/treatment measures used to address mental health issues amongst TB patients to improve TB treatment compliance and TB outcomes. |
| Type Of Material | Model of mechanisms or symptoms - human |
| Provided To Others? | No |
| Impact | Initial development stage. Publication is in progress. |
| Title | TB Intermittent therapy definition |
| Description | At present, there is no agreed consensus defining intermittent adherence. In order to address this knowledge gap, we aimed to create an operational definition of intermittent adherence during the two phases of DOTS, characterise its association with clinical and socioeconomic risk factors and examine its association with the risk of TB recurrence. |
| Type Of Material | Model of mechanisms or symptoms - human |
| Provided To Others? | No |
| Impact | It is important to establish a standardized clinically-relevant threshold to classify intermittent or irregular adherence in order to allow comparison of adherence rates and clinical relevance in future studies. |
| Title | TB Self-stigma Questionnaire |
| Description | We have adapted the Internalized Stigma of Mental Illness Scale (ISMIS) to measure TB self-stigma among people with TB. The ISMIS is a validated research tool developed to measure self-stigma among people with psychiatric disorders. Our TB-adapted questionnaire is being administered to participants in both the intervention and control groups of the CRESIPT study, both pre- and post-intervention, in order to establish baseline measurements of existing TB self-stigma, and demonstrate the effect of a TB self-stigma reduction intervention. |
| Type Of Material | Physiological assessment or outcome measure |
| Provided To Others? | No |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in its delivery phase. |
| Title | TB knowledge questionnaire |
| Description | Created and implemented a TB knowledge questionnaire to highlight knowledge gaps. This is a self-rated questionnaire of multiple choice questions related to TB care, and health rights. |
| Type Of Material | Physiological assessment or outcome measure |
| Provided To Others? | No |
| Impact | Knowledge gaps will be addressed to tailor educational activities to improve TB control, and health related advocacy |
| Title | Thin-layer agar culture testing for TB prevalence surveys |
| Description | Most prevalence surveys collect sputum for microscopy testing. However, it is well known that microscopy has poor diagnostic sensitivity although cheap and appropriate for studies with high sample flows. We have implemented a simple culture technique using single step decontamination (please see entry in research tool for further explanation) and antimicrobial enriched thin-layer agar, to reduce the steps required for standard culture. This simple tool therefore is feasible for prevalence surveys, increasing the detection rates with a reduced workload and contamination rates than standard culture. This tool will be used for TB detection in the prevalence survey aspect of the CRESIPT study. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2016 |
| Provided To Others? | No |
| Impact | Results from our prevalence survey have been published in abstract form, please see publication section, and full manuscripts are in preparation. |
| Title | Tool to estimate 'preventability' of direct and indirect TB related costs |
| Description | A mixed-methods questionnaire tool was designed, tested and developed in the field to estimate to what degree indirect and direct costs incurred by TB patients are preventable or can be reduced. |
| Type Of Material | Physiological assessment or outcome measure |
| Provided To Others? | No |
| Impact | First group to knowingly describe this outcome measure. Assists in the innovation of interventions to reduce these costs and prevent catastrophic costs - therefore addressing the new Stop TB and WHO priorities focussed around social protection and eradicating catastrophic costs for TB affected households. These interventions will then be carried out and evaluated, then the findings disseminated to share with other research communities globally. |
| Title | Training Video of Ventilation Methods |
| Description | Currently developing a training video of ventilation methods, based on the work of Richard Menzies and A. Roderick Escombe. Ventilation is crucial in the prevention of TB, a complement to isoniazid prevention therapy in TB patients household contacts. It is our hope that producing this video facilitate our peers' utilization of this low-cost, low-tech method. We hope to publish this video in the Journal of Visualized Experiments (JoVE), a journal dedicated to distributing video content to researchers. |
| Type Of Material | Technology assay or reagent |
| Year Produced | 2017 |
| Provided To Others? | Yes |
| Impact | Once the video is distributed in JoVE, we hope that our peers abroad may be able to use this tool in order to prevent new infections of TB worldwide. |
| Title | Tuberculosis Patient Costs Survey Handbook |
| Description | Background To inform policy and practices for improved social protection of TB patients and affected households, and to reach the 2020 End TB Strategy target that no TB patient or their household should face "catastrophic total costs" due to TB, WHO is supporting countries to design, implement, analyze and translate into policy recommendations TB patient cost surveys. In 2015, the WHO Global TB Programme convened a Global task force on TB patient cost surveys and developed a field-testing protocol and survey instrument for the conduct of nationally-representative, health-facility-based surveys. The latter were used and evaluated in 10 countries ahead of a second Task Force meeting in 2017, where the survey methodology was reviewed and revised. Overview This handbook builds on lessons learned from surveys implemented 2015-2017 and advice provided by the Global task force on TB patient cost surveys. It provides a standardized methodology for conducting health facility-based cross-sectional surveys to assess the direct and indirect costs incurred by TB patients and their households. In addition, it provides recommendations on results dissemination, engaging across sectors in policy dialogue and enabling action and related research for effective modifications in care delivery models, in patient support, and wider cross-sectoral interventions. These surveys have two primary objectives: To document the magnitude and main drivers of different types of costs incurred by TB patients (and their households), in order to guide policies to reduce financial barriers to accessing care and minimize the adverse socioeconomic impact of TB. To determine the baseline and periodically measure the percentage of TB patients (and their households) treated in the national TB programme (NTP) network who incur catastrophic total costs due to TB. This information is needed to monitor progress towards one of the three high-level indicators of the End TB Strategy for which targets and milestones have been set. Audience National TB Programmes and partners involved in supporting TB programme planning, implementation, evaluation and associated operational research. WHO envisages that the Handbook will be put to use in all high TB burden countries ahead of 2020 and be used alongside other surveillance, monitoring and evaluation, and operational research tools to improve TB care and prevention and to end the epidemic. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2018 |
| Provided To Others? | Yes |
| Impact | Rolling out TB patient costs survey in 15 countries to date globally and working with countries around the world to implement and interpret this survey. |
| URL | http://www.who.int/tb/publications/patient_cost_surveys/en/ |
| Title | Wellbeing - Tuberculosis |
| Description | Adapted the WHO euroHISQOL-8 questionnaire to be applicable to our participants affected by tuberculosis living in peri-urban shantytowns, in a non english speaking country. |
| Type Of Material | Physiological assessment or outcome measure |
| Provided To Others? | No |
| Impact | If we can show that wellbeing score can highlight the most vulnerable people, it could be used in clinical settings as screening for the most vulnerable and require extra support. |
| Title | Automated relational database |
| Description | We have updated our database to make it more intuitive for our data team. This includes using images of the questionnaire to facilitate easy data entry and minimise error rates. The database is relational enabling us to rapidly and easily identify key data. We have developed automated systems enabling use to facilitate rapid bank transfers to patients recruited to the intervention. We have also developed a simple and intuitive system for digitising patient TB card data that enables us to easily view and update these data. |
| Type Of Material | Database/Collection of data |
| Provided To Others? | No |
| Impact | We have observed a reduction in our error rates and have improved the efficiency of our complex field processes. |
| Title | CRESIPT study database |
| Description | This award involves collection of intrinsically complex data. Data domains include communities, households, people, illnesses, treatment episodes, interviews, diagnostic samples, diagnostic test results and most study participants have data in most of these domains on multiple occasions. We have developed a relational database that efficiently manages these complex data. In preference to tablet computer-based systems that pose too great a staff security risk in our impoverished setting, we have developed a simple unidirectional paper-based data management system with integrated quality control and double digitisation. Importantly for our setting, we have also integrated a system of daily confidential, secure data backup to the 'Cloud' to ensure data security. This is integrated with the laboratory data management system that we have developed and is described in the software section. |
| Type Of Material | Database/Collection of data |
| Provided To Others? | No |
| Impact | These achievements have already had a major impact on the efficiency and productivity of our research team and ongoing project. Later in the project we plan to publish and share these resources that we have developed. We have already committed to making all data from this project widely available through anonymised inclusion in an online data repository, as required by the grant conditions. |
| Title | Tablet based data collection |
| Description | We are currently in the process of transforming our data collection from paper to tablet based questionnaires. We have piloted this system already with great success. Data are collected in the field and automatically uploaded to the cloud when the field member has internet connection. Data can then be downloaded directly from a secure cloud service, without any digitisation. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2018 |
| Provided To Others? | No |
| Impact | More efficient data collection with no digitisation errors. |
| Description | CDC/NAMRU-6 collaboration to evaluate appropriate technology TB diagnositics |
| Organisation | United States Department of Defense via NAMRU-6 |
| Country | United States |
| Sector | Public |
| PI Contribution | We provided the protocol for the colour test, and expert microbiology advice. In addition we went on site visits to the national TB laboratories in Tblisi, Georgia and Kathmandu Nepal in 2014 for capacity building sessions with the TB programe workers and laboratory technicians. Also we held a 1-week laboratory training and infection control workshop for international delegates including national TB laboratory managers from countries such as Mali. |
| Collaborator Contribution | They provided us with a MGIT culture machine and the geneXpert machine, the latter is used to provide rapid diagnostic results for every TB patient enrolled into the CRESIPT study. They also provided funding for this study titles "MDR/XDRTB Colour Test implementation study & training and received $117,000 for associated training program in 2012 + $196,000 renewal for expansion of an original grant in 2012/13), with ongoing academic support. |
| Impact | The 1-week workshop. Manuscripts are currently in preparation. |
| Start Year | 2012 |
| Description | CHEST study |
| Organisation | Karolinska Institute |
| Department | Department of Public Health Sciences |
| Country | Sweden |
| Sector | Academic/University |
| PI Contribution | Co-applicant, co-investigator, and consultant on the CHEST project which aims to improve linkage of TB and social care in Mozambique. We were successful in receiving funding of 500,000 euros to conduct this research. I am going out to Mozambique in April for site visits and logistical planning. I will also present to the National TB Program and Ministry of Health about addressing the social determinants of TB. |
| Collaborator Contribution | The study is being led and coordinated by Dr Salla Atkins of the University of Tampere, Finland. Other partners include Prof Knut Lonnroth, Dr Kerri Viney, and Ms Olivia Biermann of Karolinska Institutet, with whom I collaborate closely on other projects. Dr Atkins is making a visit to Liverpool to present at our cross campus research meeting "LIV-TB" later this year and has been helpful in terms of supporting my other research ideas including those related to the Academy of Medical Sciences Research Grant. |
| Impact | Multi-disciplinary: clinicians, social scientist, trialists, TB researchers, health economists, social workers, national TB program, implementers. The project is in its infancy and so there are no outputs at the present time. |
| Start Year | 2017 |
| Description | CHEST study |
| Organisation | University of Tampere |
| Country | Finland |
| Sector | Academic/University |
| PI Contribution | Co-applicant, co-investigator, and consultant on the CHEST project which aims to improve linkage of TB and social care in Mozambique. We were successful in receiving funding of 500,000 euros to conduct this research. I am going out to Mozambique in April for site visits and logistical planning. I will also present to the National TB Program and Ministry of Health about addressing the social determinants of TB. |
| Collaborator Contribution | The study is being led and coordinated by Dr Salla Atkins of the University of Tampere, Finland. Other partners include Prof Knut Lonnroth, Dr Kerri Viney, and Ms Olivia Biermann of Karolinska Institutet, with whom I collaborate closely on other projects. Dr Atkins is making a visit to Liverpool to present at our cross campus research meeting "LIV-TB" later this year and has been helpful in terms of supporting my other research ideas including those related to the Academy of Medical Sciences Research Grant. |
| Impact | Multi-disciplinary: clinicians, social scientist, trialists, TB researchers, health economists, social workers, national TB program, implementers. The project is in its infancy and so there are no outputs at the present time. |
| Start Year | 2017 |
| Description | CRESIPT Research Network |
| Organisation | Cayetano Heredia University |
| Country | Peru |
| Sector | Academic/University |
| PI Contribution | Lead research organisation of project award "Community randomised evaluation of socioeconomic intervention to prevent TB". Manage day to day running of the project. Facilitate, coordinate and initiate collaborative working within the network. |
| Collaborator Contribution | Contributions range from active working knowledge and relations with the study communities to informing study design and relevance within the scientific community. |
| Impact | At this early stage the Network have been finalising the project protocol. |
| Start Year | 2012 |
| Description | CRESIPT Research Network |
| Organisation | Imperial College London |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Lead research organisation of project award "Community randomised evaluation of socioeconomic intervention to prevent TB". Manage day to day running of the project. Facilitate, coordinate and initiate collaborative working within the network. |
| Collaborator Contribution | Contributions range from active working knowledge and relations with the study communities to informing study design and relevance within the scientific community. |
| Impact | At this early stage the Network have been finalising the project protocol. |
| Start Year | 2012 |
| Description | CRESIPT Research Network |
| Organisation | Johns Hopkins University |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | Lead research organisation of project award "Community randomised evaluation of socioeconomic intervention to prevent TB". Manage day to day running of the project. Facilitate, coordinate and initiate collaborative working within the network. |
| Collaborator Contribution | Contributions range from active working knowledge and relations with the study communities to informing study design and relevance within the scientific community. |
| Impact | At this early stage the Network have been finalising the project protocol. |
| Start Year | 2012 |
| Description | CRESIPT Research Network |
| Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Lead research organisation of project award "Community randomised evaluation of socioeconomic intervention to prevent TB". Manage day to day running of the project. Facilitate, coordinate and initiate collaborative working within the network. |
| Collaborator Contribution | Contributions range from active working knowledge and relations with the study communities to informing study design and relevance within the scientific community. |
| Impact | At this early stage the Network have been finalising the project protocol. |
| Start Year | 2012 |
| Description | CRESIPT Research Network |
| Organisation | PRISMA ONG |
| Country | Peru |
| Sector | Private |
| PI Contribution | Lead research organisation of project award "Community randomised evaluation of socioeconomic intervention to prevent TB". Manage day to day running of the project. Facilitate, coordinate and initiate collaborative working within the network. |
| Collaborator Contribution | Contributions range from active working knowledge and relations with the study communities to informing study design and relevance within the scientific community. |
| Impact | At this early stage the Network have been finalising the project protocol. |
| Start Year | 2012 |
| Description | CRESIPT Research Network |
| Organisation | United Nations (UN) |
| Country | Global |
| Sector | Public |
| PI Contribution | Lead research organisation of project award "Community randomised evaluation of socioeconomic intervention to prevent TB". Manage day to day running of the project. Facilitate, coordinate and initiate collaborative working within the network. |
| Collaborator Contribution | Contributions range from active working knowledge and relations with the study communities to informing study design and relevance within the scientific community. |
| Impact | At this early stage the Network have been finalising the project protocol. |
| Start Year | 2012 |
| Description | Center for TB research, faculty of medicine, Johns Hopkins University |
| Organisation | Johns Hopkins University |
| Department | School of Medicine Johns Hopkins |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | Collaboration and teaching at the centre for TB research directed by Prof Dick Chaisson. |
| Collaborator Contribution | Provides external research advice and perspective for the study design and protocol for CRESIPT and associated studies carried out in our cohort, especially from Dr Jonathan Golub, Dr David Dowdy and Prof Jacque Grosset. |
| Impact | Bi-annual regional teaching at Johns Hopkins Hospital campus. |
| Start Year | 2012 |
| Description | Clinton Health Access Initiative- India |
| Organisation | Clinton Health Access Initiative |
| Country | United States |
| Sector | Charity/Non Profit |
| PI Contribution | Provided expert consultation with regards to evaluating the new Indian national TB programme strategy to provide conditional cash transfers to all TB affected individuals ti improve TB disease outcomes, and reduce catastrophic costs, in line with pillar 3 of the WHO End TB Strategy |
| Collaborator Contribution | India has the highest burden of TB disease, and therefore is trying various new strategies to control the disease. They will lead the operational on-site evaluation of the cash transfers and impact. |
| Impact | A joint application was made to the MRC health systems strengthening call in January 2018. Council Reference: MR/S00453X/1 Proposal Title : Innovative Health Systems to End-Tuberculosis Principal Investigator : Dr Carlton Evans Organisation: Imperial College London Department : Dept of Medicine Your Reference : P74352 Proposal Scheme : MRC Jointly Funded Initiatives Outline Proposal Call/Mode/Type : Joint Health Systems Research Initiative Outline Jan 2018 |
| Start Year | 2017 |
| Description | Collaboration with Armstrong-James group at the National Heart and Lung Institute, UK |
| Organisation | Imperial College London |
| Department | National Heart & Lung Institute (NHLI) |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | This collaboration aims to study the patients treated for pulmonary tuberculosis which have persistent negative microbiological tests results for Mycobacterium tuberculosis. By analysis of preliminary data from Ventanilla district in Lima, Peru, the CRESIPT team has shown that around 29% of patients starting treatment do not have microbiological evidence of M. tuberculosis. Between July - August 2018, blood and sputum samples were taken from 20 patients with persistent negative microbiological tests for a pilot study on burden of Aspergillus fumigatus in patients receiving treatment for pulmonary tuberculosis. |
| Collaborator Contribution | The National Heart and Lung Institute (NHLI), through collaboration with Dr. Darius Armstrong-James group, will process blood and sputum samples using cutting-edge, high throughput technologies. The aim is to determine characteristics of Aspergillus fumigatus colonisation/infection in patients receiving treatment for pulmonary tuberculosis. |
| Impact | The preliminary data, which has been analysed by this collaboration, has presented in the Wellcome Centre for Global Health Research Annual Meeting in 2017. This multi-disciplinary collaboration includes expertise in epidemiology, public health, clinical medicine, immunology, microbiology and molecular biology. This collaboration allowed the award of a PhD scholarship for US$ 210,000 to perform further studies on the immune characteristic of Aspergillosis in patients with history of tuberculosis. |
| Start Year | 2017 |
| Description | Collaboration with CONAMUSA |
| Organisation | National Multisectoral Health Coordinator |
| PI Contribution | The National Multisectoral Health Coordinator (CONAMUSA) is a coordinating body consisting of government representatives, bilateral and multilateral international cooperation, civil society and people's organizations directly affected by HIV/AIDS, Tuberculosis and Malaria in the country. The CONAMUSA tries to promote and build consensus, develop messages and shared concepts among all sectors, close the gap between the public and private sectors, and complement and strengthen what the Peruvian government is working on in the prevention of HIV/AIDS, Tuberculosis and Malaria. Members our research group are part of this body and are involved in all its activities. |
| Collaborator Contribution | Exchange of knowledge, ideas and developments. |
| Impact | Involvement in the approval of the final proposal of Peru to the Global Fund |
| Start Year | 2016 |
| Description | Collaboration with Concytec-Fondecyt |
| Organisation | Imperial College London |
| Department | National Heart & Lung Institute (NHLI) |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | A well-established cohort will provide ex-vivo samples from selected patients in Peru to support the study of mycobacterial infection on Aspergillus fumigatus infection and chronic pulmonary aspergillosis. |
| Collaborator Contribution | Concytec-Fondecyt has granted US$ 210,000 for funding a 3-years PhD project on macrophages' immune dysfunction against Aspergillus fumigatus in Mycobacterium infection. This fund covers student's tuition fees at Imperial College London, stipends and transportation. Experimental work will be funded and performed by Armstrong-James' group at the National Heart & Lung Institute, Imperial College London. Most readouts of interest are based on pathways defined by this laboratory. |
| Impact | This multi-disciplinary collaboration includes expertise in epidemiology, public health, clinical medicine, immunology, microbiology and molecular biology. |
| Start Year | 2018 |
| Description | Collaboration with Concytec-Fondecyt |
| Organisation | National Council for Science, Technology and Technological Innovation (CONCYTEC) |
| Country | Peru |
| Sector | Public |
| PI Contribution | A well-established cohort will provide ex-vivo samples from selected patients in Peru to support the study of mycobacterial infection on Aspergillus fumigatus infection and chronic pulmonary aspergillosis. |
| Collaborator Contribution | Concytec-Fondecyt has granted US$ 210,000 for funding a 3-years PhD project on macrophages' immune dysfunction against Aspergillus fumigatus in Mycobacterium infection. This fund covers student's tuition fees at Imperial College London, stipends and transportation. Experimental work will be funded and performed by Armstrong-James' group at the National Heart & Lung Institute, Imperial College London. Most readouts of interest are based on pathways defined by this laboratory. |
| Impact | This multi-disciplinary collaboration includes expertise in epidemiology, public health, clinical medicine, immunology, microbiology and molecular biology. |
| Start Year | 2018 |
| Description | Collaboration with David Coleman, St George's Hospital, UK |
| Organisation | St George's Hospital |
| Country | United Kingdom |
| Sector | Hospitals |
| PI Contribution | We provided TB strains for David's own research based in London, UK |
| Collaborator Contribution | David helped train our laboratory in microbiological methods and infection control, whilst providing advice with the color test protocol, including the concept of including carbendazim in culture media. |
| Impact | Published abstracts - please see publication section, and also the carbendazim enriched media, please see research tools |
| Start Year | 2012 |
| Description | Collaboration with Dr Bill Pan, Duke University, USA |
| Organisation | Duke University |
| Department | Duke Clinical Research Institute |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | We processed the samples collected from a TB prevalence study that was part of a larger population study that Dr Pan was carrying out in Madre de Dios, Peru.Team members also went to the study site multiple times to train Dr Pan's research nurses on sample collection and facilitate transport of sample to our laboratory in Lima, Peru. |
| Collaborator Contribution | Dr Pan is an associate professor at Duke University and the principal investigator for a large study in the Madre de Dios district, an amazonian region of Peru that assessed the populations impacted by mining in the area, with the aim to evaluate the health impact and prevalent diseases. This study provided the data and samples for the TB prevalence study.Furthermore they communicated the results to the participants if TB was detected. |
| Impact | Published abstracts, please see publication section. The manuscript is in preparation. |
| Start Year | 2015 |
| Description | Collaboration with Dr Grant Theron at Stellenbosch University, South Africa |
| Organisation | University of Stellenbosch |
| Country | South Africa |
| Sector | Academic/University |
| PI Contribution | Enquiries were made about the protocol for our fluorescein diacetate (FDA) viability microscopy used to assess TB treatment response and infectious , please see the "research tools" and "publications" section. We wrote a comprehensive summary of our optimisation work, and final protocol which we shared with them. |
| Collaborator Contribution | The are assessing the use of our FDA microscopy to evaluate its role in monitoring treatment response and infectiousness in their local TB affected population in South Africa. |
| Impact | Work is undergoing and therefore no outputs have been made as of yet. |
| Start Year | 2017 |
| Description | Collaboration with Dr Leen Rigouts, University of Antwerp, Belgium |
| Organisation | University of Antwerp |
| Department | Faculty of Sciences |
| Country | Belgium |
| Sector | Academic/University |
| PI Contribution | Prof Evans was the sponsor for Dr Rigout's doctoral student, Francesca Barletta. The CRESIPT study cohort also provided samples, and our research laboratory processed the samples |
| Collaborator Contribution | Dr Rgouts was the main supervisor for the student, and provided research supervision and molecular biology training for the doctoral student. |
| Impact | Please see the article in the publication section, first author F Barletta. |
| Start Year | 2012 |
| Description | Collaboration with Dr Leo Martinez, Stanford University, USA |
| Organisation | Stanford University |
| Department | Division of Infectious Diseases & Geographic Medicine |
| Country | United States |
| Sector | Hospitals |
| PI Contribution | Collaborating in data collection and sharing for an an Individual Patient Meta-analysis of Primary Progressive Disease in Child Contacts of Tuberculosis Cases: A Methodological Protocol, that is being led by Dr Leo Martinez. |
| Collaborator Contribution | They will be leading this project. |
| Impact | No outputs as of yet |
| Start Year | 2018 |
| Description | Collaboration with Dr Mirko Zimic - Universidad Peruana Cayetano Heredia, Lima, Peru |
| Organisation | Cayetano Heredia University |
| Country | Peru |
| Sector | Academic/University |
| PI Contribution | We have collaborated with Dr Zimic's new biosensor TB diagnostic test. We have provided research design advice, clinical samples and processed the samples with clinical laboratory techniques. |
| Collaborator Contribution | Dr Zimic's group processes the samples with the biosensor test, and leads the analysis and write up. |
| Impact | The manuscript is under review with Science Translational Medicine |
| Start Year | 2017 |
| Description | Collaboration with Dr Nathan Furukawa University of Washington, USA |
| Organisation | University of Washington Medical Center |
| PI Contribution | Prof Evans provided research mentorship Dr Furukawa, and the team provided him with our costs data generated from cohort data prior to CRESIPT. |
| Collaborator Contribution | Due to the CRESIPT study, and published papers on catastrophic costs and social interventions, Dr Furukawa approached our research group, and proposed his research question and analysis strategy. Dr Furukawa set up the analysis of our cohort data to assess the cost effectiveness of social protection for TB. |
| Impact | Current manuscript is submitted to Social Science and Medicine journal. |
| Start Year | 2015 |
| Description | Collaboration with Dr Patricia Sheen - Universidad Peruana Cayetano Heredia |
| Organisation | Cayetano Heredia University |
| Country | Peru |
| Sector | Academic/University |
| PI Contribution | Prof Carlton Evans provides research consultation to their ongoing studies involving Mycobacterium tuberculosis pyrizinamide resistance |
| Collaborator Contribution | They lead the studies, analysis and research dissemination. |
| Impact | please see joint publication in the publications section. |
| Start Year | 2009 |
| Description | Collaboration with IMPACT TB study team |
| Organisation | Liverpool School of Tropical Medicine |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | The research of our team and our outputs from the CRESIPT study have directly informed the IMPACT TB team. IMPACT TB is an international study involving collaborations with LSTMed, Karolinska Institutet, KNCV, and the National TB Programs of Nepal and Vietnam, examining active case finding. |
| Collaborator Contribution | Using methodology developed by our research team, including measurement of TB patient costs and socioeconomic interventions to mitigate such costs, we have been able to develop some add-on studies for IMPACT-TB which will bring added value to their work and disseminate/broaden the impact of the CRESIPT study. |
| Impact | 1) Presentation on CRESIPT findings at IMPACT-TB meeting in Liverpool March 2017 2) Further presentations and workshops with Nepal and Vietnam National TB Programs planned for late March 2017 3) Funding applications for add-on studies ongoing. |
| Start Year | 2017 |
| Description | Collaboration with Ohio State University to evaluate the Colour Test |
| Organisation | Ohio State University |
| Department | Department of Medical Microbiology |
| Country | Nigeria |
| Sector | Private |
| PI Contribution | Collaboration with Drs Jordi Torelles and Shu-Hua Wang, who wanted to evaluate the colour test, which our group developed, in an international multi-site project. Went on site visits eg. Panama in November 2013 with this team. |
| Collaborator Contribution | They led the research and are disseminating the results |
| Impact | A manuscript that is in press in Journal of Clinical Microbiology |
| Start Year | 2013 |
| Description | Collaboration with Peruvian Ministry of Development and Social Inclusion (MIDIS) |
| Organisation | Ministry of Development and Social Inclusion |
| Country | Peru |
| Sector | Public |
| PI Contribution | We have begun collaborating with the Peruvian Ministry of Development and Social Inclusion (MIDIS), providing advice and consultation about how social protection might be scaled up within Peru based on our own experiences. |
| Collaborator Contribution | MIDIS have provided us with informative insights on how we might improve and refine our own interventions to make them more nationally applicable. We have been able to benefit from their understanding of the bureaucratic systems in place within the Peruvian government. |
| Impact | MIDIS |
| Start Year | 2017 |
| Description | Collaboration with Peruvian National Institute of Health |
| Organisation | National Institute of Health of Peru |
| PI Contribution | We regularly meet with representatives form the Peruvian NIH to discuss research agendas and priorities. We are frequently invited to arrange training for laboratory workers working with TB samples. We collaborate with local NIH laboratories regarding the MODS assay. |
| Collaborator Contribution | Sharing of research agendas and priorities. Dissemination of research results. Use of resources and venues. |
| Impact | The principal output from this collaboration is knowledge sharing and transfer. |
| Start Year | 2012 |
| Description | Collaboration with Professor Joseph Zunt, University of Washington, USA |
| Organisation | University of Washington |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | Prof Evans and his research team are hosting Prof Zunt's student Renee Newby. We are supervising her in the laboratory and processing her samples for the evaluation of PCR, microscopy and culture TB diagnostic techniques for CSF in TB meningitis, from patiented in Hospital Dos de Mayo, Lima, Peru. |
| Collaborator Contribution | Prof Zunt's team will be providing research supervision and training to Renee who is leading this study. |
| Impact | A study protocol was designed and the study is now in progress. Due the direct actions of this study, we were able to diagnose multiple patients with TB meningitis, and ensure that they were started on the correct therapy. |
| Start Year | 2017 |
| Description | Collaboration with Public Health England |
| Organisation | Public Health England |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | 1) Work on a project categorising the risk of LTBI/active TB in contacts of patients with EPTB - Thorax publication and multiple presentations 2) Work on categorising patient risk of poor clinical outcome on TB treatment using the locally-adapted enhanced case management scale - BMC Public Health publication and presentation 3) New project looking at catastrophic costs of TB for patients in England, with a pilot study in the north west (pending funding) |
| Collaborator Contribution | Dr Paul Cleary, Dr Peter MacPherson, and Dr Angela Tucker supported me in the write up of project 1. Dr Paul Cleary has supervised all the work and given overall advice. Dr Dominik Zenner is supporting project 3 in the hope that it will end up a national survey of catastrophic costs of TB patients |
| Impact | High prevalence of TB disease in contacts of adults with extrapulmonary TB. Wingfield T, MacPherson P, Cleary P, Ormerod LP. Thorax. 2017 Nov 16. pii: thoraxjnl-2017-210202. doi: 10.1136/thoraxjnl-2017-210202. [Epub ahead of print] PMID: 29146867 Quantifying the need for enhanced case management for TB patients as part of TB cohort audit in the North West of England: a descriptive study. Tucker A, Mithoo J, Cleary P, Woodhead M, MacPherson P, Wingfield T, Davies S, Wake C, McMaster P, Bertel Squire S. BMC Public Health. 2017 Nov 15;17(1):881. doi: 10.1186/s12889-017-4892-5. PMID: 29141600 |
| Start Year | 2016 |
| Description | Collaboration with the Municipality of Lima |
| Organisation | Municipality of Lima |
| Country | Peru |
| Sector | Private |
| PI Contribution | We provide educational workshops to multidisciplinary health professionals in the municipality of Lima. |
| Collaborator Contribution | Our partners provide us with a platform to present our work and allow us to use their resources and venues to carry out the educational workshops. |
| Impact | Through this collaboration we have established the Multisectoral Committee to Combat Tuberculosis. This working group is involved in outlining the priorities of the municipality for strengthening TB cure, care and prevention. |
| Start Year | 2015 |
| Description | Collaboration with the Social Protection Action and Research Knowledge Sharing (SPARKS) network |
| Organisation | Karolinska Institute |
| Department | Department of Public Health Sciences |
| Country | Sweden |
| Sector | Academic/University |
| PI Contribution | SPARKS is an international collaboration of researchers, policy makers, and stakeholders looking to provide a platform to propel the social protection research agenda forward |
| Collaborator Contribution | The CRESIPT team presented their methods, preliminary findings, and future plans at the SPARKS inaugural meeting at Karolinska Institutet, Stockholm, Sweden, December 2016. Members of the CRESIPT team are involved as part of the secretariat of SPARKS and in furthering this collaboration. |
| Impact | 1) SPARKS mission statement and agenda |
| Start Year | 2016 |
| Description | Collaborative group on the impact of digital technologies on TB |
| Organisation | World Health Organization (WHO) |
| Country | Global |
| Sector | Public |
| PI Contribution | Contributed to a paper titled "Digital health technologies for active TB treatment support: A cost-effectiveness analysis" as part of the collaborative group, led by WHO |
| Collaborator Contribution | WHO lead the collaborative group |
| Impact | One publication submitted to a journal |
| Start Year | 2017 |
| Description | IMPALA study |
| Organisation | Liverpool School of Tropical Medicine |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | I have been invited to become involved with the IMPALA program as a consultant. I will go out to the first meeting about this in Durban in April 2018. The International Multidisciplinary Programme to Address Lung Health and TB in Africa "IMPALA" is a four-year collaborative programme funded by the National Institute of Health Research under the first Global Health Research Programme call launched in 2016. LSTM was successful in securing funding under this call to establish an Africa-focused NIHR Global Health Research Unit for lung health and tuberculosis (TB) that will generate new scientific knowledge and implementable solutions for these high burden, under-funded and under-researched health problems. IMPALA will achieve this through multi- disciplinary collaborative work involving clinical, social, health systems, health economics and implementation scientists from Africa and the UK. IMPALA will be hosted by LSTM, a world leader in applied global health research to improve the health of the world's poorest people in low- and middle-income countries (LMICs). It will build on a unique critical mass of internationally excellent clinical and applied health scientists who are experts in lung health and TB in the tropics and on the momentum behind the LSTM-led Collaboration for Applied Health Research and Delivery (CAHRD): A global applied health research network with strong representation from LMICs that aims to strengthen health systems and the design, delivery and scale- up of practice- and policy-ready solutions to the health needs of the world's poor. |
| Collaborator Contribution | See above. |
| Impact | none yet |
| Start Year | 2018 |
| Description | Inter-American Training for Innovations in Emerging Infectious Diseases |
| Organisation | Tulane University |
| Department | School of Public Health Tulane |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | Prof Evans was a co-investigator for this Fogarty funded training program, and provided mentorship to IATIEID fellows who were undertaking research in Tuberculosis. The main objective of this program is to provide post-doctoral trainees with mentored training experiences and opportunities to work together as a team to identify problems in the diagnosis, management, or control of infectious diseases. Emerging infectious diseases, such as tuberculosis, malaria, and Chagas disease, present major public health problems in resource-limited countries and are an increasing problem in more developed countries. |
| Collaborator Contribution | The Tulane school of public health administered the grant, facilitated the ethics, and execution of the studies. Professor Richard Oberhelman and Dr Valerie Paz Soldan mentored and supervised all IATIED fellows who led the studies and analysis. |
| Impact | Please see published abstracts and articles by IATIED supervisors and fellows: Richard Oberhelman, Valerie Paz Soldan, Gwen Lee, and German Comina. |
| Start Year | 2012 |
| Description | Massachusetts supra-national tuberculosis reference laboratory - Dr Alex Sloutsky |
| Organisation | University of Massachusetts |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | Collaboration to assess the MGIT culture for TB diagnostics. |
| Collaborator Contribution | Dr Sloutsky provided expert microbiology advice for all our labortaory techniques and research projects. |
| Impact | outputs are in process |
| Start Year | 2013 |
| Description | NAMRU-6 in Peru |
| Organisation | GENETUP |
| Country | Nepal |
| Sector | Charity/Non Profit |
| PI Contribution | 1) Collaborative work concerning design of novel TB diagnostics 2) Implementation of novel TB diagnostics in resource-constrained settings |
| Collaborator Contribution | 1) Our team has provided formal training in laboratory methodology during the past three years for a NAMRU-6 led training course held at el laboratorio de investigacion y desarrollo at the Universidad Peruana Cayetano Heredia 2) Involvement in team research meetings for the past three years |
| Impact | 1) Development of the Color Test for TB diagnosis in low-resource settings 2) Formalised training of physicians and associated healthcare professionals in laboratory methodology with an emphasis on biohazard and biosecurity in mycobaterial diagnosis |
| Start Year | 2007 |
| Description | NAMRU-6 in Peru |
| Organisation | Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF) |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | 1) Collaborative work concerning design of novel TB diagnostics 2) Implementation of novel TB diagnostics in resource-constrained settings |
| Collaborator Contribution | 1) Our team has provided formal training in laboratory methodology during the past three years for a NAMRU-6 led training course held at el laboratorio de investigacion y desarrollo at the Universidad Peruana Cayetano Heredia 2) Involvement in team research meetings for the past three years |
| Impact | 1) Development of the Color Test for TB diagnosis in low-resource settings 2) Formalised training of physicians and associated healthcare professionals in laboratory methodology with an emphasis on biohazard and biosecurity in mycobaterial diagnosis |
| Start Year | 2007 |
| Description | NAMRU-6 in Peru |
| Organisation | National TB Reference Laboratory, Tbilisi, Georgia |
| Country | Georgia |
| Sector | Private |
| PI Contribution | 1) Collaborative work concerning design of novel TB diagnostics 2) Implementation of novel TB diagnostics in resource-constrained settings |
| Collaborator Contribution | 1) Our team has provided formal training in laboratory methodology during the past three years for a NAMRU-6 led training course held at el laboratorio de investigacion y desarrollo at the Universidad Peruana Cayetano Heredia 2) Involvement in team research meetings for the past three years |
| Impact | 1) Development of the Color Test for TB diagnosis in low-resource settings 2) Formalised training of physicians and associated healthcare professionals in laboratory methodology with an emphasis on biohazard and biosecurity in mycobaterial diagnosis |
| Start Year | 2007 |
| Description | NAMRU-6 in Peru |
| Organisation | Naval Medical Research Center Unit-6 |
| Country | Peru |
| Sector | Public |
| PI Contribution | 1) Collaborative work concerning design of novel TB diagnostics 2) Implementation of novel TB diagnostics in resource-constrained settings |
| Collaborator Contribution | 1) Our team has provided formal training in laboratory methodology during the past three years for a NAMRU-6 led training course held at el laboratorio de investigacion y desarrollo at the Universidad Peruana Cayetano Heredia 2) Involvement in team research meetings for the past three years |
| Impact | 1) Development of the Color Test for TB diagnosis in low-resource settings 2) Formalised training of physicians and associated healthcare professionals in laboratory methodology with an emphasis on biohazard and biosecurity in mycobaterial diagnosis |
| Start Year | 2007 |
| Description | NAMRU-6 in Peru |
| Organisation | United States Air Force |
| Country | United States |
| Sector | Public |
| PI Contribution | 1) Collaborative work concerning design of novel TB diagnostics 2) Implementation of novel TB diagnostics in resource-constrained settings |
| Collaborator Contribution | 1) Our team has provided formal training in laboratory methodology during the past three years for a NAMRU-6 led training course held at el laboratorio de investigacion y desarrollo at the Universidad Peruana Cayetano Heredia 2) Involvement in team research meetings for the past three years |
| Impact | 1) Development of the Color Test for TB diagnosis in low-resource settings 2) Formalised training of physicians and associated healthcare professionals in laboratory methodology with an emphasis on biohazard and biosecurity in mycobaterial diagnosis |
| Start Year | 2007 |
| Description | NAMRU-6/PROMELA collaboration for laboratory strengthening in Latin America |
| Organisation | United States Department of Defense via NAMRU-6 |
| Country | United States |
| Sector | Public |
| PI Contribution | Provided capacity building to various latin american TB program laboratories including Belize in 2013 |
| Collaborator Contribution | They facilitated the collaboration with the national TB programs in Latin America, and application for the Global Emerging Infectious Diseases (GEIS) research grant, where Prof Evans is a investigator, please see further funding for the "Collaborative Assessment of Regional MDR-TB Surveillance Enhancement by Use of both the Xpert MTB/RIF Assay and Colour Tests for Enabling More Timely Drug Sensitivity Testing in Diverse Settings." |
| Impact | Capacity building in Belize, Guatamala, Columbia and Honduras. |
| Start Year | 2012 |
| Description | NGO SAVICS providing software solutions for TB laboratory platforms |
| Organisation | Savics |
| PI Contribution | We are evaluating their DatatoCare platform with every patient sample provided by CRESIPT study participants for the Cepheid GeneXpert machine and software. |
| Collaborator Contribution | SAVICS is an NGO based in Brussels, Belgium. They have developed the software, and provide ongoing technical assistance. |
| Impact | Manuscript in process with regards to the use of geneXpert cycle time data in clinical care. |
| Start Year | 2016 |
| Description | Peru TB Control Strategy |
| Organisation | Callao Regional Directorate of Health |
| Country | Peru |
| Sector | Charity/Non Profit |
| PI Contribution | Actively working with the local government and civil society TB interest groups to design the study to be of most use and relevance to the communities we are working with. |
| Collaborator Contribution | Provide local data and knowledge. Raising the profile of the project with local policy makers and the study communities. |
| Impact | Community workshops for individuals and families of TB patients. |
| Start Year | 2012 |
| Description | Peru TB Control Strategy |
| Organisation | Peruvian Association of Persons Affected by Tuberculosis (ASPAT) |
| Country | Peru |
| Sector | Charity/Non Profit |
| PI Contribution | Actively working with the local government and civil society TB interest groups to design the study to be of most use and relevance to the communities we are working with. |
| Collaborator Contribution | Provide local data and knowledge. Raising the profile of the project with local policy makers and the study communities. |
| Impact | Community workshops for individuals and families of TB patients. |
| Start Year | 2012 |
| Description | Peru TB Control Strategy |
| Organisation | Regional Government of Callao |
| Country | Peru |
| Sector | Public |
| PI Contribution | Actively working with the local government and civil society TB interest groups to design the study to be of most use and relevance to the communities we are working with. |
| Collaborator Contribution | Provide local data and knowledge. Raising the profile of the project with local policy makers and the study communities. |
| Impact | Community workshops for individuals and families of TB patients. |
| Start Year | 2012 |
| Description | Peruvian Ministry of Health - National TB Program |
| Organisation | National Tuberculosis Control Program |
| Country | Peru |
| Sector | Public |
| PI Contribution | Updating with research findings, processing samples, training |
| Collaborator Contribution | Support, policy, training, exchange of ideas |
| Impact | Presentations at the Peruvian National TB conference |
| Start Year | 2012 |
| Description | Public Health partners |
| Organisation | World Health Organization (WHO) |
| Department | Global TB Program |
| Country | Switzerland |
| Sector | Public |
| PI Contribution | Research papers, membership of working groups, presentations at WHO Global TB program meetings |
| Collaborator Contribution | Input into study design and dissemination of research outputs. |
| Impact | Membership of advisory committees, invitation to speak at conferences and meetings. |
| Start Year | 2012 |
| Description | Tulane University, Health Office for Latin America (HOLA) |
| Organisation | Tulane University |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | This group has provided lab and experimental design support for the development and assessment of TB aerosol filters to assess infectivity of TB patients. All clinical samples were processed within our facility, as well as the validation experiement of the filters to test threshold of detection of the filters. |
| Collaborator Contribution | Fellows associatied with the HOLA office have designed and conducted the project, notably the enrollment of participants, collection of clinical samples, and subsequent data analysis of results. |
| Impact | Current results of the TB aerosol filter study are to be presented at the European Congress of Clinical Microbiology & Infectious Diseases. Partners involved are physicians/medical students, applied physicists, and epidemiologists. |
| Start Year | 2016 |
| Description | Universite catholique de Louvain - laboratory connectivity |
| Organisation | Catholic University of Louvain |
| Country | Belgium |
| Sector | Academic/University |
| PI Contribution | Survey coordinator and international collaborator for the "TB laboratory connectivity" study. |
| Collaborator Contribution | Overall coordination of the international survey, and central server to collect data. |
| Impact | multidisciplinary: researcher, policy makers, clinicians, microbiologists, laboratory technicians and software programmers |
| Start Year | 2017 |
| Description | WHO Global Task Force on Catastrophic Costs and Universal Health Coverage |
| Organisation | World Health Organization (WHO) |
| Country | Global |
| Sector | Public |
| PI Contribution | Involved in strategic meetings to take forward research and agenda on catastrophic costs |
| Collaborator Contribution | Part of the task force |
| Impact | Catastrophic costs section of the post-2015 global TB control strategy framework |
| Start Year | 2013 |
| Description | World Bank |
| Organisation | World Bank Group |
| Country | United States |
| Sector | Private |
| PI Contribution | The World Bank has been involved in the planning and development of our socioeconomic intervention to prevent TB. |
| Collaborator Contribution | Regular strategic meetings, contribution to World Bank organised educational and scientific research events, and study site visits by the World Bank and affiliated partners |
| Impact | 1) Multi-disciplinary collaboration between World Bank staff and our research team in the planning and implementation of a socioeconomic intervention to prevent TB |
| Description | World Health Organisation Task Force on Catastrophic Costs of Tuberculosis |
| Organisation | World Health Organization (WHO) |
| Country | Global |
| Sector | Public |
| PI Contribution | Members of the CRESIPT team are part of the WHO Task Force on Catastrophic Costs. Previous publications by our team and the ongoing work on the CRESIPT study represent ground-breaking research relating to identifying and addressing catastrophic costs of TB-affected households. We are continuing to work with WHO to roll out their TB Patient Costs Tool, which draws heavily on our previous methods and employs our catastrophic costs threshold which has been endorsed by WHO in their End TB Strategy. |
| Collaborator Contribution | Previous publications by our team and the ongoing work on the CRESIPT study represent ground-breaking research relating to identifying and addressing catastrophic costs of TB-affected households. We are continuing to work with WHO to roll out their TB Patient Costs Tool, which draws heavily on our previous methods and employs our catastrophic costs threshold which has been endorsed by WHO in their End TB Strategy. Tom Wingfield is involved in implementing the Costs Tool in Nepal, Vietnam, and Mozambique. |
| Impact | 1) WHO Global Catastrophic Costs Guidance 2) WHO TB Patient Costs Tool |
| Start Year | 2014 |
| Title | Buscadores: TB finders |
| Description | TB finders are TB survivors who are trained to become active community case finders, screening community members for TB. TB finders are trained to target high-risk community members who have TB risk factors or symptoms. |
| Type | Preventative Intervention - Behavioural risk modification |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2017 |
| Development Status | Actively seeking support |
| Impact | Some TB finders have become government approved health workers. Furthermore, TB finders have been responsible for diagnosing multiple community members with TB. Once diagnosed the TB finder becomes that person's peer mentor. |
| Title | CRESIPT cash transfer intervention |
| Description | As part of this study, we are currently evaluating a cash transfer intervention to incentivise and enable access to TB care. This specific economic intervention has evolved through various consultations, planning meetings and experience in the field and continues to evolve up until the time of writing (March 2018) |
| Type | Preventative Intervention - Behavioural risk modification |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Clinical Trial? | Yes |
| Impact | This intervention is currently under evaluation. |
| URL | http://www.isrctn.com/ISRCTN17820976 |
| Title | Colorimetric thin-layer agar test to diagnose TB in resource-constrained settings (The Color Test) |
| Description | TB is difficult to diagnose in low-resource settings that have limited access to laboratories with adequate biosafety. The Colour Test is a low-cost and low-intensity method of diagnosing TB and resistant TB using thin layer agar colour plates. We aim to be able to roll-out the Colour Test to relevant areas for assessment and do not intend to patent this product. |
| Type | Diagnostic Tool - Non-Imaging |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2013 |
| Development Status | Actively seeking support |
| Impact | The Colour Test findings have been presented at international meetings and published in international journals (see below). Assessment and evaluation is still ongoing. |
| URL | http://www.ncbi.nlm.nih.gov/pubmed/22762424 |
| Title | IFHAD score |
| Description | We have developed a simple TB risk score that can predict which contacts of patients with TB are at high risk of disease: the IFHAD score. We are currently evaluating, validating and refining this score using prospectively collected data. |
| Type | Preventative Intervention - Behavioural risk modification |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Impact | Identification of TB risk factors among household contacts. |
| Title | Methods to Providing Social Support |
| Description | Qualitative and quantitative research was done to explore the most essential components of providing social support to persons affected by tuberculosis. Focus groups with international researchers, field team nurses responsible for operational functions of CRESIPT, contacts of persons diagnosed with TB, and persons diagnosed with TB were conducted. Additionally, each of these groups were asked to write and rank what they believed were the three most essential components of providing social support. This knowledge has been used in guiding the delivery of social support in the CRESIPT study. |
| Type | Therapeutic Intervention - Psychological/Behavioural |
| Current Stage Of Development | Initial development |
| Year Development Stage Completed | 2017 |
| Development Status | Under active development/distribution |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in its delivery phase. |
| Title | Peer Mentors |
| Description | Peer mentors -- people with TB who are participants in the CRESIPT study and are no longer infectious -- provide support to people with TB and their family members newly-enrolled in the CRESIPT study. Peer mentors receive basic orientation in TB disease, transmission, diagnosis and treatment; sputum sample collection and transportation; TB stigma; and how to conduct TB clubs. Peer mentors perform home visits; accompany individuals and their families in obtaining testing for TB; collect and deliver TB sputum samples; assist people with TB to adhere to and complete TB treatment; inquire about TB medication side-effects; and conduct educational workshops and TB stigma reduction and empowerment support groups that are a part of TB clubs. This intervention is currently in the implementation and evaluation stage at multiple sites with large numbers of participants. Funding for this project falls under that provided for CRESIPT. |
| Type | Preventative Intervention - Behavioural risk modification |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in the delivery phase. |
| Title | Qualitative Background on Reducing Stigma |
| Description | Collection of qualitative data on the social determinants that contribute to diagnostic delay of tuberculosis has been completed. This data has been used to help develop and refine TB Clubs aimed to reduce the social stigma surrounding tuberculosis disease. The principle source of funding for this work has been a research fellowship granted for Lily Bonadonna by the Innovation for Health and Development (IFHAD) group. |
| Type | Health and Social Care Services |
| Current Stage Of Development | Refinement. Non-clinical |
| Year Development Stage Completed | 2016 |
| Development Status | On hold |
| Impact | The development of these TB clubs has shown us the important use and need for qualitative data while designing social interventions. |
| Title | Socio-economic support package for people living with TB |
| Description | Socio-economic support package to be offered to TB patients alongside the standard medical care that is already offered in Peru. The socio-economic support package is being assessed as to its value for reducing bad outcomes for TB patients and reducing risk factors within TB affected households. |
| Type | Health and Social Care Services |
| Current Stage Of Development | Initial development |
| Year Development Stage Completed | 2013 |
| Development Status | Under active development/distribution |
| Impact | Still under development due to begin testing in the coming months. |
| Title | TB Club Educational Workshops (TBCEW) |
| Description | Educational TB workshops, guided by peer mentors, employ interactive group participation activities to create a safe, non-judgemental environment and sense of cooperative group identity in which to communicate basic information regarding TB disease, transmission, diagnosis, treatment, and prevention; nutritional supplementation; and TB-related stigma. This intervention is currently in the implementation and evaluation stage at multiple sites with large numbers of participants. Funding for this project falls under that provided for CRESIPT. |
| Type | Preventative Intervention - Behavioural risk modification |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in the delivery phase. |
| Title | TB Club Support Groups (TBCSG) |
| Description | Mutual support groups, guided by peer mentors, employ TB Stigma Drawings Booklets (see entry in "Artistic and Creative Products" section) and an interactive TB Stigma Reduction Program (see entry in "Medical Products & Interventions" section) to support people with TB and their family members in identifying and resisting TB stigma, adhering to and completing TB treatment, and having family members tested for TB. Through sharing common experiences, emotions, and thoughts, a sense of common identity and solidarity may emerge, forming a supportive social network that through peer mentor guidance may serve as a foundation for a TB civil society organization (see entry in "Other Outputs & Knowledge/Future Steps" section) to further support and empower people with TB and their family members. This intervention is currently in the implementation and evaluation stage at multiple sites with large numbers of participants. Funding for this project falls under that provided for CRESIPT. |
| Type | Therapeutic Intervention - Psychological/Behavioural |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in the delivery phase. |
| Title | TB Clubs |
| Description | TB Clubs, guided by peer mentors, meet weekly at multiple sites throughout local communities in which the intervention limb of the CRESIPT study is being conducted. TB Clubs include both an educational workshop component and a support group component (see respective entries in "Medical Products, Interventions, and Clinical Trials" section). Overall objectives of the TB Clubs include educating participants about TB; reducing TB stigma; facilitating TB treatment adherence and completion among people with TB and TB testing of family members; creating a common identity, solidarity, and social support network among local community TB Club participants; and establishing a TB civil society organization to empower people with TB and their families at the local, departmental, and national levels. This intervention is currently in the implementation and evaluation stage at multiple sites with large numbers of participants. Funding for this project falls under that provided for CRESIPT. |
| Type | Preventative Intervention - Behavioural risk modification |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in the delivery phase. |
| Title | TB Stigma Reduction Program (TBSRP) |
| Description | The TB Stigma Reduction Program, based on cognitive behavior therapy techniques, serves as the foundation for the CRESIPT TB Club Support Groups (see entry in "Medical Products, Interventions and Clinical Trials" section). This interactive program is designed to guide people with TB and their family members through a series of predetermined questions and self-selected responses to aid them in identifying emotions, thoughts, and behaviors associated with their personal experience of TB stigma, and explore alternative thoughts and behaviors intended to empower them in identifying and resisting TB stigma, adhering to and completing TB treatment, and having family members tested for TB. Peer mentors conduct the support groups and facilitate members' use of the program. The TB Stigma Drawings Booklet (see entry in "Artistic and Creative Products" section) is employed in conjunction with the program. This intervention is currently in the implementation and evaluation stage at multiple sites with large numbers of participants. Funding for this project falls under that provided for CRESIPT. |
| Type | Therapeutic Intervention - Psychological/Behavioural |
| Current Stage Of Development | Late clinical evaluation |
| Year Development Stage Completed | 2016 |
| Development Status | Under active development/distribution |
| Impact | The impact of this research is still being evaluated as the CRESIPT study is currently in the delivery phase. |
| Title | Viability microscopy |
| Description | Using an old technique of viability assessment with Flouerscein diacetate now adapted to be used with Mycobacterium tuberculosis, we are assessing its role in monitoring treatment response and infectiousness screening in tuberculosis. We have improved the protocol so it can be used in all resource constraint settings, to highlight those not responding to treatment within days of commencement. This will be the first tool of it's kinds, and appropriate from rural to industrialised settings. |
| Type | Diagnostic Tool - Non-Imaging |
| Current Stage Of Development | Refinement. Clinical |
| Year Development Stage Completed | 2015 |
| Development Status | Under active development/distribution |
| Impact | Please see papers below: 1. Datta S, Sherman JM, Bravard M, Valencia T, Gilman RH, Evans CA. Clinical Evaluation of Tuberculosis Viability Microscopy for Assessing Treatment Response. Clin Infect Dis 2014;ciu 1153.: 2. Lawn SD, Nicol MP. Editorial commentary: dead or alive: can viability staining predict response to tuberculosis treatment? Clin Infect Dis 2015;60:1196-8. |
| Title | Appropriate technology TB diagnostic laboratory result management system |
| Description | The award involves a marked, and challenging increase in TB diagnostic testing by our laboratory, providing participants and the research with TB screening and TB drug-resistance testing. In trying to address this challenge, we noted that our lab team actually spend much longer handling information than handling samples. Checking a sample is quick, finding the right place to record and collate the information is more time consuming. This is because each sample has several tests, each checked on multiple days, so the information flow is quite complex. We were not the first to note this challenge and several companies have developed elegant computerised systems but these are expensive and just as importantly, inflexible. They would require us to fly in an expert programmer from the company every time we change our procedures, which would be inappropriate for a research team like ours. We are therefore developing and plan to publish an 'open access' data management system for diagnostic laboratories. Although developed for TB, it will likely be valuable for other diseases too. |
| Type Of Technology | Software |
| Year Produced | 2016 |
| Open Source License? | Yes |
| Impact | We have completed the first phase. All data associated with a sample is now attached on a miniature paper form to the test. This simple, but highly usual step, means that parallel systems for tests and forms are eliminated. For example, 500 TB diagnostic cultures in our incubators are no longer associated with 500 paper forms in folders that have to be found, cross-checked and updated several times each week for 6 weeks. Rather, all data is now attached to the ongoing culture in the incubator, and can be updated in a moment each time the culture is checked. Although this sounds simple, it is highly unusual or unique in TB laboratories and relies upon the second innovation, that these potentially contaminated, potentially infectious forms are then digitally photographers that the digital image is digitised, without exposing administrative staff to any infection risk. These simple innovations have remarkably increased efficiency and increased capacity to provide research diagnostic information for more participants. The current second phase is developing a flexible, simple, open access 'freeware' tablet computer system for replacing the paper forms. We have obtained independent research funding for this venture ($20,000 USD) and this is in progress with collaborators in NAMRU-6. |
| Title | Household TB risk score |
| Description | A webpage version of a household level score to predict risk of TB among contacts of patients with TB |
| Type Of Technology | Webtool/Application |
| Year Produced | 2018 |
| Impact | Freely available to other research groups and public health programs wishing to implement this score. |
| URL | https://jscalc.io/calc/8xzrWJ99BMs6uCV7 |
| Title | Monitoring activities of research nurses |
| Description | We have used ODK collect (android based freeware), to develop a cloud based system of monitoring the working hours and activities of our research nurses. This has enabled us to implement a more transparent reimbursement policy and accurately summarise the activities of each of our field nurses. |
| Type Of Technology | Webtool/Application |
| Year Produced | 2019 |
| Impact | Improvements to our field procedures. |
| Title | Personal TB risk score |
| Description | A web page version of the IFHAD score |
| Type Of Technology | Webtool/Application |
| Year Produced | 2017 |
| Impact | We are currently in the process of developing this app and will evaluate its potential for field use. |
| URL | https://jscalc.io/calc/qoLectXm5TiopbbD |
| Description | Oral presentation and panel discussion - National TB Program - annual conference (Lima, Peru) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presenting recent research findings to the audience including national policy makers, sparking discussion and debate about future policies in Peru. |
| Year(s) Of Engagement Activity | 2014,2015 |
| Description | Oral presentation and panel discussion - Chagas, TB and HIV conference (Santa Cruz, Bolivia) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Chagas, TB and HIV conference (Santa Cruz, Bolivia) - A conference run in collaboration with Universidad Catholica, Santa Cruz, Bolivia and Johns Hopkins, USA. Dr Datta was asked to present a lecture of TB diagnostics and her research findings. Many people were interested in the work, and new collaborations have been made. |
| Year(s) Of Engagement Activity | 2016 |
| Description | 2° Seminario internacional enfermedades infecciosas - Santa Cruz, Bolivia. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Involved in a Johns Hopkins University School of Public Health hosted regional research training event, discussing the ethics, study design, study protocol, writing, and dissemination aspects of research. The main objective was to provide capacity building to local health care workers and researchers in public health research in the Santa Cruz district of Bolivia. |
| Year(s) Of Engagement Activity | 2017 |
| URL | http://www.ucbscz.edu.bo/es/seminario_internacional_enfermedades_infecciosas |
| Description | Abstract and poster presentation at 2019 END TB Conference, the Union-NAR, Vancouver, BC. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | I presented a 15 minute talk to a group of approximately 20 people, summarizing our abstract and poster, which described our work documenting TB-affected household members' personal definitions and descriptions of TB stigma, and the types of TB stigma these definitions and descriptions may have reflected. After the talk I responded to approximately different 6 conference attendees who were either about to conduct their own stigma-related research and had study design and implementation questions, or who were interested in more in-depth discussion of our study findings. |
| Year(s) Of Engagement Activity | 2019 |
| Description | Article for The Conversation |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Article about the social determinants of health to "The Conversation" in line with World Tb Day. The Conversation is an independent source of news and views, sourced from the academic and research community and delivered direct to the public. |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://theconversation.com/uk |
| Description | CRESIPT TB Club Film Documentation |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Currently developing plans to film the CRESIPT TB Clubs, which will demonstrate the CRESIPT approach to holding social support workshops. The video will feature our team interacting with our participants through a series of activities, including but not limited to: assessment of treatment progression with patients and their families, discussing stigma and discrimination in small groups, educational games, and a group meal. We intend this video to be most useful for our peers, but the video's format will be accessible for the general public as well. |
| Year(s) Of Engagement Activity | 2017 |
| Description | Capacity Building Workshop in DIRESA Callao |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Two day capacity building and teaching workshops designed and delivered by members in the research team to a mixed group of delegates from the Regional Health Administrative Centre in Callao. We received positive feedback regarding the open style of teaching and the 'building your own research question' discussion with all members of the team, from fieldwork nurses to experienced senior researcher. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Capacity building - Santa Cruz, Bolivia |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | TB, HIV, Chronic infections training day in Santa Cruz, Bolivia. The objective was to share experiences, teach students and capacity build budding researchers. |
| Year(s) Of Engagement Activity | 2016,2017 |
| Description | Civil society of patient and ex-patient consultation and focus group discussions |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Participants in your research and patient groups |
| Results and Impact | Discussion and feedback on conditional cash transfers for TB affected families. Set conditional cash transfer size, frequency and duration |
| Year(s) Of Engagement Activity | 2013,2014 |
| Description | Community workshops for people living with TB |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Type Of Presentation | Workshop Facilitator |
| Geographic Reach | Local |
| Primary Audience | Participants in your research and patient groups |
| Results and Impact | Patients and TB patient groups attended workshops to discuss stigma and depression and how to best address these barriers in TB care locally. On going activities. The findings are to be used to inform the design of the socio-economic intervention offered to TB patients within the activities of the project. |
| Year(s) Of Engagement Activity | 2012,2013 |
| URL | http://more information available at www.ifhad.org |
| Description | Debate: socioeconomic support versus biomedical interventions for tuberculosis control |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | A debate was held at the World Conference on Lung Health in Cape Town 2015. The debate sparked intense and fruitful discussion among all participants and was very well received by audience members. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Editorial - Infectious diseases news (USA) |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Interview on our recent article that was published in clinical infectious diseases. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://www.healio.com/infectious-disease/respiratory-infections/news/online/%7Ba41b0a57-3cc5-4c25-a2... |
| Description | Ending tuberculosis: "Miradas y Compromisos Multisectorales" |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | A multisectoral expert meeting organised by the Peruvian Ministry of Health and CONAMUSA (both our collaborators). This meeting was convened to help set the national agenda for tuberculosis research in Peru. |
| Year(s) Of Engagement Activity | 2017 |
| Description | European Congress of Clinical Microbiology & Infectious Diseases 2017 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Mycobacterium tuberculosis (TB) aerosol droplets pose significant occupational risks, particularly to healthcare workers, who in low and middle-income countries (LMICs) have presented with at least a three-times higher incidence of TB. Assessing the infectiousness of TB patients is particularly challenging, especially in LMICs. Improvement of infectivity detection could have broad impacts on global TB control. Material/methods: We enrolled subjects with suspected TB, with 2+ or 3+ auramine smear, in Lima, Peru and collected clinical, microbiological, radiographic, and cough frequency data. In addition, air-sampling was performed over a 15 minute period of maximally induced cough via a portable 2L/minute vacuum pump onto a PTFE filter with 0.3m pores. Air-sampling was taken on day 0 and 14 of treatment. Air was sampled at 1m distance from the patient's face in an airborne infection isolation room. In parallel, we performed serial dilutions of 1 McFarland TB suspension overlaid on filter material, to define the limits of detection of TB on this medium. The filters were subsequently tested with GeneXpert PCR, standard Microscopic Observation Drug Susceptibility (MODS) assay, MODS with a single-step disinfectant, and MODS with NaOH decontamination. Cultures were assessed up to 8 weeks or until positivity. Results: 5 subjects, so far, have been enrolled and completed the two air-samplings. 4 subjects were 3+ on auramine smear at diagnosis, and 1 subject was 2+. All subjects were found to have positive MODS sputum cultures from their day 0 collection. The average time to positive culture was 8.4 days (95% CI: 4.82 to 11.98). Only 1 subject had a positive day 14 MODS culture, which presented after 6 days. All subjects were drug-sensitive on MODS, in all cultures. The filters of subjects revealed no positive GeneXpert PCR, nor any positive cultures of MODS with or without disinfectant. Nonetheless, none of the filters developed fungal or bacterial contaminant cultures. Results of serial dilution reveals GeneXpert PCR can identify H37RB TB up to 1: 104 McFarland dilution on these filters. It can be assumed that our clinical samples have no greater than this dilution of TB in their aerosol sample. Conclusions: Low-cost effective tests for infectivity of TB patients is needed within LMIC healthcare settings for a quick risk assessment of TB aerosols. Our device, so far, has not shown presence of TB aerosols, despite the subjects having active TB on sputum culture. This could be a result of desiccation of mycobacteria on the filter or TB aerosols being below the threshold of detection. No contamination of cultures reveals the efficacy of the disinfectant, as contamination remains a problem in prior studies. The concurrent laboratory study will find the threshold of detection of these filters. These studies combined will elucidate the applicability and efficacy of this device. Prior studies have used unique models to measure TB transmission. Current limitations include small sample size. Future studies will further improve low-cost tests for TB infectivity. |
| Year(s) Of Engagement Activity | 2016,2017 |
| Description | Focus group discussions with Peruvian National TB Program |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | 1) Deciding on activity and work in parallel with the healthposts 2) Streamline project activities including collection of patients' sputum samples 1) Refinement of the socioeconomic intervention 2) Discussion of how best to collect and process sputum samples 3) Concerns raised about conditional cash transfers and future sustainability of the project |
| Year(s) Of Engagement Activity | 2014 |
| Description | Focus group discussions with participants |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Participants in your research and patient groups |
| Results and Impact | 1) Informing and education 2) Participant feedback 3) Refinements of the intervention 4) Responding to participants' issues 1) Refinement of the socioeconomic intervention 2) Set up of facilitator training for participants to assist us in our intervention |
| Year(s) Of Engagement Activity | 2014 |
| Description | Health personnel capacity building |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We have been involved in extensive capacity building with health personnel working at government health posts who deliver TB care. This has predominantly focussed on TB prevention but has also involved TB diagnosis and management of MDR-TB and contacts of MDR-TB. We have received repeated invitations for further capacity building events at these health posts. |
| Year(s) Of Engagement Activity | 2016,2017,2018 |
| Description | Interview - New Scientist |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Fresh air and sunshine: The forgotten antibiotics written by Frank Swain for New Scientist, 13 December 2013. Interview of Prof Evans about his guinea pig studies and the findings that UV light and fresh air were the best interventions to reduce TB transmission in healthcare settings. |
| Year(s) Of Engagement Activity | 2013 |
| URL | https://www.newscientist.com/article/mg22029470.700-fresh-air-and-sunshine-the-forgotten-antibiotics... |
| Description | Interview - Science News |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Article "A new way to make bacteria glow could simplify TB screening" written by Maria Temming. We were interviewed to explain the potential of a new trehalose test on TB diagnosis and the the limitations of the research published was after the publication Sci Translational Med. 2018 Feb 28;10(430) by Kamariza M et al. |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://www.sciencenews.org/article/new-way-make-bacteria-glow-could-simplify-tb-screening |
| Description | Interview - The Wire, India |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Article "Microscopy-based TB detection gets a much-needed make-over" written by Sarah Iqbal. We were interviewed to explain the potential of a new trehalose test on TB diagnosis and the the limitations of the research published was after the publication Sci Translational Med. 2018 Feb 28;10(430) by Kamariza M et al. |
| Year(s) Of Engagement Activity | 2018 |
| Description | Interview national Peruvian television |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Other audiences |
| Results and Impact | Interview on national television during the National Peruvian TB research conference. Presented our findings in TB diagnostic delay, stigma, mitigating TB related costs. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Interview with Contagion Live |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Interview given to online infectious diseases news website regarding recent publication in Lancet Infectious Diseases. |
| Year(s) Of Engagement Activity | 2018 |
| URL | http://www.contagionlive.com/news/researchers-create-scoring-system-to-predict-tb-risk-in-adults |
| Description | Keynote speakers at Universidad de Ciencias y Humanidades, Lima, Peru |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Undergraduate students |
| Results and Impact | Carlton Evans, Sumona Datta and Matthew Saunders all gave 45 minute keynote presentations at this event, which aimed to promote the importance of research among undergraduate students. The university reported the presentations were very well received and led to an increased interest in research from their students. |
| Year(s) Of Engagement Activity | 2018 |
| Description | Meeting with JUNTOS national conditional cash transfer scheme in Peru |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | 1) Shared experiences with JUNTOS concerning their roll-out nationally of a poverty-reduction conditional cash transfer scheme 1) Devised conditional cash transfers scheme for our intervention 2) Were able to narrow down appropriate bank providers for the conditional cash transfers |
| Year(s) Of Engagement Activity | 2014 |
| Description | NIHR health protection research unit (HPRU) evening symposia Key Note Speaker. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Professor Carlton Evans gave a talk titled "MDR TB - A Peruvian Experience." This was during the 2 day London advanced TB course, hosted by the NIHR Health Protection Research Unit in Respiratory Infections at Imperial College London. The course was help from 16-17 November 2017 for TB practitioners and public health researchers in the South England region. |
| Year(s) Of Engagement Activity | 2017 |
| Description | National TB Program consultation and focus group discussions |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Feedback from Peruvian National TB program on acceptability and feasibility of conditional cash transfers for Tb-affected families Began pilot project of cash transfers that was rolled out to 32 communities, working alongside the Peruvian National TB Program |
| Year(s) Of Engagement Activity | 2013,2014 |
| Description | Nature microbiology community |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Behind the paper - Mystery patients reveal weakness in tuberculosis care in China written by Dr M Pai, McGill university who discusses the arguments made by our Perspective piece "Improving tuberculosis diagnosis: Better tests or better healthcare? Datta S, Saunders MJ, Tovar MA, Evans CA. PLoS Med. 2017 Oct 17;14(10):e1002406. This was in response to new data his group had generated with regards to health system strengthening for better TB care in China. |
| Year(s) Of Engagement Activity | 2017 |
| URL | https://naturemicrobiologycommunity.nature.com/users/20892-madhukar-pai/posts/21403-mystery-patients... |
| Description | Official Facebook page |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | To provide an overview about the project and to communicate relevant information about tuberculosis for lay-people. Information published has been viewed and shared by over 1400 people. |
| Year(s) Of Engagement Activity | 2018,2019 |
| URL | https://www.facebook.com/Innovation-For-Health-and-Development-820440131489541/ |
| Description | Oral presentation - Royal Free Hospital, Infectious diseases meeting (London, UK) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Discussion of personal research findings and update on ongoing TB research within our group |
| Year(s) Of Engagement Activity | 2013 |
| Description | Oral presentation and panel discussion - Imperial College London - Global Health Meeting (London) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Annual international meeting for Global Health and Innovations at Imperial College London, asked to present recent research findings , and take part in a debate session afterwards with other experts in global health. |
| Year(s) Of Engagement Activity | 2013,2014 |
| URL | https://www.imperial.ac.uk/global-health-innovation/global-engagement/wellcome-centre-for-global-hea... |
| Description | Participation in Peruvian TB program research priorities 2018 - 2021 |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Working group of TB researchers in Peru to set a national research agenda and priorities for the years 2018-2021. |
| Year(s) Of Engagement Activity | 2017 |
| Description | Participation in TB and mental health working group |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Discussion and dialogue about pushing forward the agenda of helping relieving the strain of poor mental health in TB affected persons. This working group was held at the 2017 annual world UNION against TB and Lung Disease conference in Guadalajara, Mexico. |
| Year(s) Of Engagement Activity | 2017 |
| Description | Presentation Belgian NTP - Social Protection |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | To share our experiences in socio-economic protection, and discuss ideas to improve TB care and socio-economic support for the national TB program in Belgium |
| Year(s) Of Engagement Activity | 2017 |
| Description | Presentations at the annual Peruvian TB program conference |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Keynote speakers at the annual Peruvian TB conference that also lead to television interviews that were streamed live and on the ministry of health website. |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://www.gob.pe/institucion/minsa/noticias/19836-mas-de-1000-profesionales-de-salud-participan-en... |
| Description | Press release in National Peruvian Newspaper |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Press release in Correo Online, a online supplement for the national Peruvian newspaper Correo prior to keynote presenattion at the Shircon 2018 conference. |
| Year(s) Of Engagement Activity | 2018 |
| URL | https://diariocorreo.pe/salud/proponen-nuevo-metodo-para-detectar-mas-rapido-la-tuberculosis-en-el-p... |
| Description | Radio Interview on National Station |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Jimena Castellanos Aguirre was interviewed on national radio program, "Encuentro con la ciencia," hosted by Modesto Montoya about work with IFHAD. |
| Year(s) Of Engagement Activity | 2016 |
| URL | https://www.youtube.com/watch?v=yp7t2JVBxro |
| Description | Research training capacity building programme |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Members of our research group delivered talks as a part of a research training capacity building programme to local government members and practitioners. |
| Year(s) Of Engagement Activity | 2016 |
| Description | Shircon 2018:III CONGRESO INTERNACIONAL DE INVESTIGACIÓN EN CIENCIAS Y HUMANIDADES |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Undergraduate students |
| Results and Impact | Keynote speakers for the Annual Shiron conference at Universidad de Ciencias y Humanidades, Lima Peru |
| Year(s) Of Engagement Activity | 2018 |
| URL | http://congreso.uch.edu.pe/shircon/expositores |
| Description | Talk at Universidad Científica del Sur about training in clinical research |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Undergraduate students |
| Results and Impact | A talk to undergraduate students at Universidad Científica del Sur has been scheduled for May 2018. A talk about the clinical research training of a Peruvian graduate in the UK and his current activities within the CRESIPT project. This activity aims to provide medical students with an overview about clinical research training, discussing different medical career paths, and to highlight the importance of research on public health. |
| Year(s) Of Engagement Activity | 2018 |
| Description | UK Academics for TB |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | We are a group of academics and clinicians working together to eliminate TB - the world's deadliest infectious disease. We joined forces in early 2018 so that we could combine our research and experience to inform the UN General Assembly meeting that is being organised specifically to tackle this worldwide issue. |
| Year(s) Of Engagement Activity | 2018 |
| URL | http://ukatb.org/ |
| Description | University of Minnesota Grand Challenges: Toward Conquest of Disease - A Brief History of Tuberculosis and the CRESIPT Study |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Undergraduate students |
| Results and Impact | Approximately 30 undergraduate students enrolled in a "Grand Challenges" curriculum course at the University of Minnesota entitled "Towards Conquest of Disease" (GCC 3007/5007), attended a one hour lecture that presented an overview the history of tuberculosis (TB), it's socioeconomic determinants, and factors involved in both the decline of TB in high-income countries and the ongoing TB pandemic in low- and middle-income countries. The design and implementation of the Community Randomized Economic and Social Intervention to Prevent TB study (CRESIPT) was described. Challenges that arose during the design and implementation phases, and steps taken to resolve these issues were also discussed. The course professor later remarked that a number of concepts presented stimulated ongoing class discussions, and several specific issues regarding CRESIPT design and implementation directly impacted students projects. |
| Year(s) Of Engagement Activity | 2017 |
| Description | Visiting Lecture - Summer Institute, Tropical Medicine, Johns Hopkins (Baltimore, USA) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Giving a talk to Masters students on TB diagnostics, was asked to focus mainly on our research activities. |
| Year(s) Of Engagement Activity | 2014,2015 |
| Description | Visiting Lecture - Winter Institute Tropical medicine, Johns Hopkins (Baltimore, USA) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Giving a talk to Masters students on TB diagnostics and was asked to focus mainly on our research activities. |
| Year(s) Of Engagement Activity | 2015,2016 |
| Description | WHO Global TB Symposium presentation - Fighting poverty to control TB |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | The WHO Symposium on 10 October 2017 was co-organised by the WHO, The Union and the Pan American Health Organization/AMRO. Professor Evans was invited by Dr Diana Weil and Dr Priya Shete, to present to this audience of key stakeholders, ministers, national TB program managers from around the globe, and United Nations representatives to present our results on socioeconomic interventions to control TB and foster multisectoral research to end TB . This meeting's objective was to discuss the top outcome areas of the WHO Global Ministerial Conference on Ending TB in the Sustainable Development Era: A Multisectoral Response in 2017 and in advance of the first UN General Assembly High-Level Meeting on TB in 2018. |
| Year(s) Of Engagement Activity | 2017 |
| URL | http://guadalajara.worldlunghealth.org/programme/official-pre-conference-and-side-events/who-global-... |
| Description | Weekly TB clubs. |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | In the 16 communities receiving the intervention described, we hold weekly community meetings called TB clubs. Approximately 100 TB patients and their family members attend each of these clubs where we discuss multiple aspects of TB prevention, care and cure. These meetings have been very well received with participants frequently attending multiple events. |
| Year(s) Of Engagement Activity | 2017,2018,2019 |
| Description | Working meeting - Peruvian president P. Kuczynski |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | The then Presidential candidate requested a meeting with the Prof Carlton Evans and Dr Sumona Datta to present their research, experiences with the TB and the Peruvian health system and discuss ways to improve TB related social protection. |
| Year(s) Of Engagement Activity | 2015 |
| Description | World TB Day |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Public/other audiences |
| Results and Impact | Every year our research group helps to organise and take part in community activities to raise awareness for World TB day in March. These activities involve marches, street "markets" where information on TB is readily accessible to the general public, and engagement with local media. |
| Year(s) Of Engagement Activity | 2013,2014,2015,2016,2017 |
| Description | Zero TB initiative two day training event for health professionals |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Members of our research group participated in and gave presentations at this training days set up by the Zero TB initiative. |
| Year(s) Of Engagement Activity | 2017 |
| URL | https://www.zerotbinitiative.org/new-blog/2018/1/25/momentum-builds-at-zero-tb-event-in-lima-peru |