Healthy survival after tuberculosis
Lead Research Organisation:
Liverpool School of Tropical Medicine
Department Name: Clinical Sciences
Abstract
HEALTHY SURVIVAL FROM TUBERCULOSIS. Tuberculosis (TB) is the biggest killer by a single infectious agent, causing disease in 10 million people a year with almost one fifth of patients having unsuccessful antibiotic therapy. The number of deaths, cases, and treatment success, clearly highlights that TB is a global health priority, but they poorly describe the burden that TB has on an individual's health. Health is defined as "a state of complete physical, mental and social well-being, and not merely the absence of disease". Public health strategies that target only traditional epidemiological measurements will not lead to healthy survival from TB, and consequently will have an inadequate impact on the overall burden of TB on society.
WHY?
- TB IS BEYOND PHYSICAL SYMPTOMS. TB predominately affects the lungs leading to symptoms such as cough and shortness of breath. However, directly observed therapy, concerns regarding TB transmission, and its strong association with poverty, consequently diminish peoples' psychological and socio-economic wellbeing in addition to the physical symptoms experienced.
- TB HAS EFFECTS BEYOND PATIENTS. Not only do contacts of people diagnosed with TB have a risk of developing TB disease themselves, but they may also have their daily life disrupted by preventative treatment. Furthermore, healthy members of TB-affected households, especially caregivers, also have their wellbeing affected as they absorb the costs of their loved ones who have the disease.
- TB HAS IMPACTS BEYOND TREATMENT. There is growing awareness that due to the complexities stated above, the impact of TB on a person's health does not stop on the last day of antibiotic treatment. Individuals with TB may be left with residual impairments, remain at high risk of developing TB again, and are at higher risk of dying early compared to people who have not had TB. Despite this increasing awareness, the long-term impacts of TB on health - and the interventions that may alleviate them - are poorly understood.
RESEARCH AIM. To identify the most cost-effective interventions that would support the healthy survival of people affected by TB.
HOW?
- LONG-TERM FOLLOW-UP. In 1999-2002, 411 TB-affected families (2346 people) living in the Pampas shanty-town in Lima, Peru were recruited when a member of their household was diagnosed with TB. These households have been followed-up in regular intervals since recruitment.
- COMPARE WITH PEOPLE NOT AFFECTED BY TB. This MRC Skills Development Fellowship (SDF) will enable the completion of a 20-year follow-up interviews of TB-affected people, and will compare their health, which includes physical, psychological and social wellbeing with the same number of people who live in the same community who did not have any household member with active TB.
THE DATA WILL:
1. DESCRIBE the life-long health impact of TB and consequently quantify the overall burden of disease in TB-affected people;
2. EXPLAIN how TB causes these life-long health impacts;
3. IDENTIFY at which points interventions could have the most effective impact in promoting healthy survival from TB.
WHY?
- TB IS BEYOND PHYSICAL SYMPTOMS. TB predominately affects the lungs leading to symptoms such as cough and shortness of breath. However, directly observed therapy, concerns regarding TB transmission, and its strong association with poverty, consequently diminish peoples' psychological and socio-economic wellbeing in addition to the physical symptoms experienced.
- TB HAS EFFECTS BEYOND PATIENTS. Not only do contacts of people diagnosed with TB have a risk of developing TB disease themselves, but they may also have their daily life disrupted by preventative treatment. Furthermore, healthy members of TB-affected households, especially caregivers, also have their wellbeing affected as they absorb the costs of their loved ones who have the disease.
- TB HAS IMPACTS BEYOND TREATMENT. There is growing awareness that due to the complexities stated above, the impact of TB on a person's health does not stop on the last day of antibiotic treatment. Individuals with TB may be left with residual impairments, remain at high risk of developing TB again, and are at higher risk of dying early compared to people who have not had TB. Despite this increasing awareness, the long-term impacts of TB on health - and the interventions that may alleviate them - are poorly understood.
RESEARCH AIM. To identify the most cost-effective interventions that would support the healthy survival of people affected by TB.
HOW?
- LONG-TERM FOLLOW-UP. In 1999-2002, 411 TB-affected families (2346 people) living in the Pampas shanty-town in Lima, Peru were recruited when a member of their household was diagnosed with TB. These households have been followed-up in regular intervals since recruitment.
- COMPARE WITH PEOPLE NOT AFFECTED BY TB. This MRC Skills Development Fellowship (SDF) will enable the completion of a 20-year follow-up interviews of TB-affected people, and will compare their health, which includes physical, psychological and social wellbeing with the same number of people who live in the same community who did not have any household member with active TB.
THE DATA WILL:
1. DESCRIBE the life-long health impact of TB and consequently quantify the overall burden of disease in TB-affected people;
2. EXPLAIN how TB causes these life-long health impacts;
3. IDENTIFY at which points interventions could have the most effective impact in promoting healthy survival from TB.
Technical Summary
BACKGROUND. Health is defined as "a state of complete physical, mental and social wellbeing and not merely the absence of disease". Yet TB treatment outcomes are principally assessed by microbiological indicators immediately after completing antibiotics. Patients who have successfully completed treatment may have residual lung damage, remain at high risk of developing TB again and have a higher risk of early all-cause mortality. In addition, household contacts of patients with TB are at high risk of developing TB disease. Despite increasing awareness that TB affects the life course trajectory, the long-term impacts of TB on health - and the interventions that may mitigate against them - are poorly understood.
HYPOTHESIS. TB-affected people have an unfavourable life trajectory compared with people not affected by TB.
STUDY DESIGN. A prospective case control study with 20-year follow-up in the Pampas shanty-town, Lima, Peru. Data from 411 TB-affected households (2346 individuals) in which the index case was diagnosed, recruited and interviewed multiple times during treatment between 1999-2002 will be compared with the same number of community controls who were recruited into surveys in the same area and time period, who did not have any household member with active TB.
STUDY PLAN. The individual and household-level data collected at multiple time points between recruitment and final follow-up aim to:
- characterise and quantify the long-term impact of TB on the health trajectories of patients and their households, utilising measurements for physical, mental and social components of health;
- identify determinants and causal pathways associated with long-term impacts of TB from the multitude of explanatory variables that have been collected; and
- develop a predictive model of TB-related drivers over the life course and use this to identify cost-effective interventions suitable for diminishing the long-term health and socioeconomic impacts of TB.
HYPOTHESIS. TB-affected people have an unfavourable life trajectory compared with people not affected by TB.
STUDY DESIGN. A prospective case control study with 20-year follow-up in the Pampas shanty-town, Lima, Peru. Data from 411 TB-affected households (2346 individuals) in which the index case was diagnosed, recruited and interviewed multiple times during treatment between 1999-2002 will be compared with the same number of community controls who were recruited into surveys in the same area and time period, who did not have any household member with active TB.
STUDY PLAN. The individual and household-level data collected at multiple time points between recruitment and final follow-up aim to:
- characterise and quantify the long-term impact of TB on the health trajectories of patients and their households, utilising measurements for physical, mental and social components of health;
- identify determinants and causal pathways associated with long-term impacts of TB from the multitude of explanatory variables that have been collected; and
- develop a predictive model of TB-related drivers over the life course and use this to identify cost-effective interventions suitable for diminishing the long-term health and socioeconomic impacts of TB.
Planned Impact
The research proposed will quantify and help understand the long-term impact of TB on health, and identify potential points for intervention. Therefore, the direct impacts are academic and will be demonstrated immediately. It is hoped that in the long-term, the proposed research will be the start of multiple projects and collaborations investigating the field of health after TB.
IMMEDIATE IMPACTS.
The immediate impacts are to: (1) advance understanding regarding the impact of TB on long-term health, (2) understand the role of its mediators in the causal pathway, (3) identify interventions that would promote healthy survival; (4) evaluate the tools that will be used to measure the long-term impacts on health, and; (5) contribute towards the "Post TB" research agenda.
RESEARCHERS working in the fields listed in the academic beneficiaries' section will be able to use the tools shown to be able to measure pertinent health outcomes, replicate findings in other sites, evaluate the interventions proposed, and use the results generated as the basis for other research questions. Furthermore, by demonstrating the importance of previous TB in general health status, this will sensitise funders, hopefully opening up more funds for this field of research.
THE POST TB STEERING COMMITTEE is a group of international multi-disciplinary health professionals who are working in the field of improving the health of TB-affected people after treatment has finished. They organised the first symposia and working group for Post TB in June 2019, which highlighted the lack of published evidence to guide this field. I am a member of this committee, and the findings from the research will define problems "Post TB", recommend a new definition of treatment outcome, facilitate consensus in the terms and strategies required, and generate interest in health after TB within researchers and policymakers in international health organisations.
PUBLIC HEALTH PRACTITIONERS working within national public health bodies including TB programs will be interested to understand how and by how much previous TB has a role in other diseases and general health status. This will allow them to take previous TB status into consideration when implementing public health interventions, social programs or carrying out epidemiological investigations.
POLICYMAKERS within international, national, local government will have the potential to declare new programmatic definitions, recommend new public health targets, propose guidelines, and roll out interventions based on the results that will be generated by the research.
LONG-TERM IMPACTS
The long-term impacts of the research will contribute in improving (1) the quality of life of TB affected people; (2) societal wellbeing; and (3) effectiveness of TB programs in restoring people to good health.
TB-AFFECTED FAMILIES will benefit from future interventions that will not only ensure TB cure, but mitigate costs and promote good health once TB treatment has finished. This will impact not only patients that were previously diagnosed and treated for TB, but also their household members regardless of whether they developed secondary TB disease.
TB-AFFECTED SOCIETIES. TB disease affects mainly young adults of working age. Therefore, restoring this group back to good health during their TB treatment, will strengthen the working population of TB-affected societies, with the potential of making it a more productive one.
IMMEDIATE IMPACTS.
The immediate impacts are to: (1) advance understanding regarding the impact of TB on long-term health, (2) understand the role of its mediators in the causal pathway, (3) identify interventions that would promote healthy survival; (4) evaluate the tools that will be used to measure the long-term impacts on health, and; (5) contribute towards the "Post TB" research agenda.
RESEARCHERS working in the fields listed in the academic beneficiaries' section will be able to use the tools shown to be able to measure pertinent health outcomes, replicate findings in other sites, evaluate the interventions proposed, and use the results generated as the basis for other research questions. Furthermore, by demonstrating the importance of previous TB in general health status, this will sensitise funders, hopefully opening up more funds for this field of research.
THE POST TB STEERING COMMITTEE is a group of international multi-disciplinary health professionals who are working in the field of improving the health of TB-affected people after treatment has finished. They organised the first symposia and working group for Post TB in June 2019, which highlighted the lack of published evidence to guide this field. I am a member of this committee, and the findings from the research will define problems "Post TB", recommend a new definition of treatment outcome, facilitate consensus in the terms and strategies required, and generate interest in health after TB within researchers and policymakers in international health organisations.
PUBLIC HEALTH PRACTITIONERS working within national public health bodies including TB programs will be interested to understand how and by how much previous TB has a role in other diseases and general health status. This will allow them to take previous TB status into consideration when implementing public health interventions, social programs or carrying out epidemiological investigations.
POLICYMAKERS within international, national, local government will have the potential to declare new programmatic definitions, recommend new public health targets, propose guidelines, and roll out interventions based on the results that will be generated by the research.
LONG-TERM IMPACTS
The long-term impacts of the research will contribute in improving (1) the quality of life of TB affected people; (2) societal wellbeing; and (3) effectiveness of TB programs in restoring people to good health.
TB-AFFECTED FAMILIES will benefit from future interventions that will not only ensure TB cure, but mitigate costs and promote good health once TB treatment has finished. This will impact not only patients that were previously diagnosed and treated for TB, but also their household members regardless of whether they developed secondary TB disease.
TB-AFFECTED SOCIETIES. TB disease affects mainly young adults of working age. Therefore, restoring this group back to good health during their TB treatment, will strengthen the working population of TB-affected societies, with the potential of making it a more productive one.
Organisations
- Liverpool School of Tropical Medicine (Fellow, Lead Research Organisation)
- Cayetano Heredia University (Collaboration)
- Stellenbosch University (Collaboration)
- University of London (Collaboration)
- Johns Hopkins University (Collaboration)
- Zambart (Collaboration)
- University of California, Davis (Collaboration)
- Johns Hopkins Bloomberg School of PH (Project Partner)
- Imperial College London (Project Partner)
People |
ORCID iD |
Sumona Datta (Principal Investigator / Fellow) |
Publications
Allwood BW
(2020)
Post-tuberculosis lung health: perspectives from the First International Symposium.
in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Carballo-Jimenez P
(2022)
A protocol for a systematic review and meta-analysis of strategies to quantify or eliminate catastrophic costs due to tuberculosis
in Wellcome Open Research
Carballo-Jimenez P
(2022)
Interventions aiming to eliminate catastrophic costs due to tuberculosis: a protocol for a systematic review and meta-analysis
in Wellcome Open Research
Carlsson C
(2023)
A protocol for a systematic review and meta-analysis of tuberculosis care around the time of pregnancy
in Wellcome Open Research
Datta S
(2022)
Life events and tuberculosis
Datta S
(2020)
Quality of life, tuberculosis and treatment outcome; a case-control and nested cohort study.
in The European respiratory journal
Datta S
(2023)
A prospective cohort study of economic and nutritional changes during the COVID-19 pandemic in urban Callao, Lima, Peru
in Wellcome Open Research
Datta S
(2023)
A prospective cohort study of economic and nutritional changes during the COVID-19 pandemic in urban Callao, Lima, Peru
in Wellcome Open Research
Datta S
(2020)
The uncertainty of tuberculosis diagnosis.
in The Lancet. Infectious diseases
Description | Contribution to a successful call that the Peruvian government formally investigate how national COVID-19 policies contributed to obesity |
Geographic Reach | National |
Policy Influence Type | Contribution to new or Improved professional practice |
URL | https://www.gob.pe/institucion/minsa/normas-legales/2781425-158-2022-minsa |
Description | Invitation to participate in the SPARKS working group |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Participation in a guidance/advisory committee |
Impact | sharing results and moving towards policy changes in addition to the WHO End TB Strategy to have zero catastrophic costs by 2030. |
Description | Johns Hopkins University Health in Migrants course: invited lecturer for "TB in migrants" |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Influenced training of practitioners or researchers |
Impact | Training post graduate clinicians and public health trainees re the impacts of migration on TB , and the societal impacts on recently entered migrants and thier health rights using TB as an example. |
Description | Johns Hopkins University Health in Tropical medicine course: invited speaker for "Global Health Priorities" lecture |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Influenced training of practitioners or researchers |
Impact | Training post graduate students and clinicians interested in global health |
Description | Policy recommendations for the use of digital/telephone surveys in community research |
Geographic Reach | National |
Policy Influence Type | Implementation circular/rapid advice/letter to e.g. Ministry of Health |
Impact | Recommended that digital and telephone platform should be used in research but not to completely replace face to face contact as it will neglect data from the most vulnerable households due to a selection bias |
Description | Review of current evidence of micronutrient supplementation for COVID-19 |
Geographic Reach | National |
Policy Influence Type | Implementation circular/rapid advice/letter to e.g. Ministry of Health |
Impact | Recommended that currently no evidence to provide micronutrient supplementation for the prevention or treatment of COVID-19, although many physicians has been promoting their use added to the costs of households. |
Description | Training clinicians and public health trainees in the Santa Cruz, Bolivia |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Influenced training of practitioners or researchers |
Impact | Providing training and skills for adequate analysis of data and critical review of other evidence |
Description | Training clinicians in the Amazonian city Iquitos the difference and need for clinical cohort studies versus clinical trials |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Influenced training of practitioners or researchers |
Impact | Training clinicians to critically review the evidence that inform their clinical decision making |
Description | Proyectos Especiales: Respuesta al COVID-19. "Suplementos dietéticos para prevenir COVID-19 grave en la población vulnerable." |
Amount | S/ 300,000 (PEN) |
Funding ID | 083-2020-FONDECYT |
Organisation | National Council for Science, Technology and Technological Innovation (CONCYTEC) |
Sector | Public |
Country | Peru |
Start | 08/2020 |
End | 02/2021 |
Description | Research and Innovation for Global Health Transformation (RIGHT) Programme PPDA |
Amount | £10,000 (GBP) |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 03/2020 |
End | 09/2020 |
Description | Datamanagement and bioinformatics |
Organisation | Cayetano Heredia University |
Country | Peru |
Sector | Academic/University |
PI Contribution | Collaborating to make a multi relational database for 100000+ people from the 20 year cohort of TB affected familes in Ventanilla, Peru. Also to make application for future utility. |
Collaborator Contribution | Guiding us in the creation of the relational databases and applications |
Impact | in process |
Start Year | 2022 |
Description | Health and Internal Diplacement Network (HIDN) core |
Organisation | University of London |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Recently invited to be part of the HIDN core group. Gave lecture for the Webinar series and part of expert panel in long term health effects of IDP focussing in Peru |
Collaborator Contribution | Contribution to advocacy and dissemination of data and results |
Impact | Webinar and podcast |
Start Year | 2021 |
Description | International Post TB steering committee |
Organisation | University of Stellenbosch |
Department | Faculty of Medicine and Health Sciences |
Country | South Africa |
Sector | Academic/University |
PI Contribution | I am part of the steering committee and facilitated with the organisation of the 1st global symposia and consequent report. |
Collaborator Contribution | Lead the endeavour and sought funding for the Symposia. |
Impact | Symposia, working group, policy document, publication, presentations |
Start Year | 2019 |
Description | Lung Ultrasound |
Organisation | Johns Hopkins University |
Department | Johns Hopkins Bloomberg School of Public Health |
Country | United States |
Sector | Academic/University |
PI Contribution | Contributed to study design, will co-ordinate one of the study sites and involved in the grant application |
Collaborator Contribution | Leading the research and consortium |
Impact | Grant application to NIH, UK and NIHR Global Health Group |
Start Year | 2022 |
Description | Lung Ultrasound |
Organisation | University of California, Davis |
Country | United States |
Sector | Academic/University |
PI Contribution | Contributed to study design, will co-ordinate one of the study sites and involved in the grant application |
Collaborator Contribution | Leading the research and consortium |
Impact | Grant application to NIH, UK and NIHR Global Health Group |
Start Year | 2022 |
Description | Lung Ultrasound |
Organisation | Zambart |
Country | Zambia |
Sector | Public |
PI Contribution | Contributed to study design, will co-ordinate one of the study sites and involved in the grant application |
Collaborator Contribution | Leading the research and consortium |
Impact | Grant application to NIH, UK and NIHR Global Health Group |
Start Year | 2022 |
Description | Grand round Imperial College Healthcare Trust |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation at grand round, sparked discussion and new colloborations |
Year(s) Of Engagement Activity | 2022 |
Description | Presentation of COVID-19 findings from community survey |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | An online event to present findings from the Perivian CONCYTEC funded project |
Year(s) Of Engagement Activity | 2022 |
Description | Presentation to LIV TB |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presenting findings of wellbeing impacts in TB-affected people |
Year(s) Of Engagement Activity | 2021 |
Description | Presentation to Peruvian National TB programme |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Presented findings of impacts on wellbeing in TB-affected people to a conference by the national TB programme |
Year(s) Of Engagement Activity | 2021 |
Description | Refugee Law Initiative: Presentation for Webinar on long term health effects for internally displaced people |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | More than 100 participated in the live event and more listened to the subsequent podcast of the presentation of long term heath effects of our cohort in Peru which is predominantly internally displaced people who moved to informal settings in 2002. Others on the expert panel presented inter-generational mental health effects from IDP in Georgia and Columbia |
Year(s) Of Engagement Activity | 2022 |
Description | Tulane University International Health course: invited speaker for "Social Determinants of TB" |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Undergraduate students |
Results and Impact | Presented a 1 hour lecture on the social determinants of TB presented findings from our research group in Peru |
Year(s) Of Engagement Activity | 2021 |