Tackling Tuberculosis: BWH leads global innovation in TB Care

Reprinted from BWH Clinical Research News Sept 2019

At the Brigham, researchers are taking approaches to tuberculosis (TB) treatment, looking at this notorious infectious disease from genetic, chemical and public health angles. Many researchers from the Brigham work in affiliation with Socios En Salud (Partners In Health) in Peru, as well as tackling research at home and at other global locations.

Developing Sustainable Systems and Increasing Access

Courtney Yuen, PhD

One researcher who focuses on TB, Courtney Yuen, PhD, associate epidemiologist in the Division of Global Health Equity, obtained her doctorate in chemistry, initially thinking she would pursue a career focused on basic science. But upon realizing the length of time it can take research in a lab to impact people and their health, she decided to retrain as an epidemiologist at the Centers for Disease Control and Prevention (CDC), in hopes of seeing the more direct effect her work could have on people’s welfare.

“I wanted to focus my research on an area that affects vulnerable populations, and TB falls into this category. TB is a disease of inequality,” Yuen said. “In the U.S., it disproportionately affects people in homeless shelters or prison, as well as immigrants and refugees. Globally, it tends to affect people in countries that don’t have as many resources and are at the center of the AIDS epidemic.”
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Dr. Keshavjee Pushes the Boundaries of Tuberculosis Care with the Zero TB Initiative

by Brittany Stopa

Brittany Stopa is a Clinical Research Regulatory Coordinator in the BWH Department of Neurosurgery, and she holds a Masters of Public Health in Global Health. She is a contributor to the BWH Global Health Hub.

Dr. Salmaan Keshavjee, Associate Professor, Division of Global Health Equity, Brigham and Women’s Hospital

The BWH Global Health Delivery Partnership Grand Rounds, offered monthly, are open to all staff and clinicians at BWH. I attended the September 2017 Grand Rounds where Dr. Salmaan Keshavjee captivated an audience of global health and health equity supporters with his talk about the Zero TB Initiative. In addition to his appointment as Associate Professor in the BWH Division of Global Health Equity, Dr. Keshavjee serves as Director of Harvard Medical School Center for Global Health Delivery-Dubai and Associate Professor in the Department of Global Health and Social Medicine, at Harvard Medical School.

Dr. Keshavjee had our attention immediately when he declared that there are 10.4 million new cases of tuberculosis (TB) each year, but only 6.1 million of them are diagnosed and treated. Further, 1.8 million of those cases result in death each year, making TB the biggest infectious killer of adults globally. That’s a staggering 4,000 people each day that die from TB, a disease that has been treatable since 1947.

“TB is the biggest infectious killer of adults globally. A staggering 4,000 people each day die from TB, a disease that has been treatable since 1947.”

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Pericardial Tuberculosis in the “Last Mile”

Nyaya
Nirajan

Duncan Maru, MD, PhD, a resident in BWH’s Division of Global Health Equity, is a co-founder of the organization, Nyaya Health. Nyaya’s mission is to realize the right to health by delivering transparent, data-driven health care for Nepal’s rural poor.

In a recent blog post for Nyaya, Maru writes about a patient named Nirajan.

“Nirajan is a nine-year-old boy who had been seen by our clinicians two weeks prior and diagnosed via ultrasound with a massive pericardial effusion. The diagnosis was not hard to make, and the etiology was almost certainly to be tuberculosis. Over 12 hours away from an intensive care unit or a cardiologist, our clinicians at that time made the decision that most rural doctors would make; they prescribed Nirajan anti-tuberculosis therapy and steroids.”

Read Nirajan’s story and learn more about the work of Nyaya Health.

Rwanda’s University of Global Health Equity partners with BWH faculty member Michelle Morse, MD, MPH

When Dr. Paul Farmer, Division of Global Health Equity Chief and Co-Founder and Chief-Strategist of PIH, began his work in some of the world’s most marginalized regions, he realized quickly that the traditional scope of health care did not and could not apply. Without consideration of the cultures, the geopolitical structures, and the intrinsic ties between poverty and health, one could not begin to properly offer quality care or address the even greater systemic challenges at work. Expanding his vision for system strengthening, Dr. Farmer helped to found the University of Global Health Equity in Rwanda. to educate the next generation of global health professionals—doctors, nurses, researchers, and public health and policy experts—into leaders and changemakers who strive to deliver more equitable, quality health services for all.

Dr. Michelle Morse teaching an HUM resident best techniques for using and interpreting portable ultrasound equipment.

Globally, the pipeline of future doctors, nurses and global health leaders is far too limited. Top health and medical programs around the world  attract a narrow group of students who often end up leaving their underserved communities or countries to practice in urban centers or abroad. But simply training more doctors and nurses isn’t enough. The global health education system is failing to prepare students to solve our most pressing health challenges— from containing new diseases like Ebola and stemming the rapid rise of noncommunicable diseases to designing and running health care systems. To solve these challenges, global health leaders including Dr. Farmer and DGHE faculty must reimagine global health education; UGHE is doing just that.Dr. Michelle Morse has committed her decade long career to building disruptive pedagogy and medical education systems in countries from Haiti to Rwanda to the U.S. Trained in internal medicine and public health, Dr. Morse teaches at Brigham and Women’s Hospital, Harvard Medical School, the University of Global Health Equity (UGHE), and the organization she co-founded, EqualHealth. As Visiting Faculty at UGHE, Dr. Morse teaches in the foundational Principles of Global Health Equity course in the Master of Science in Global Health Delivery (MGHD) program. Through her work with EqualHealth, an NGO that aims to inspire and support the development of Haiti’s next generation of health care leaders, Dr. Morse is course director for a social medicine immersion course which has been held every July in Haiti since 2013.

Below, is UGHE’s  interview with Dr. Morse about radicalizing training in global health by pioneering a curriculum focused on equity.

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Partners In Health Receives UNITAID Grant to Revolutionize Access to MDR-TB Treatment

This week, Partners In Health announced a new partnership with UNITAIDDoctors Without Borders/ Médecins Sans Frontières (MSF), and IRD to revolutionize access to new multidrug-resistant tuberculosis (MDR-TB) treatment in 17 countries, especially among the poor.

“We’re grateful for this support from UNITAID, and particularly for their partnership, with which we’re hoping to make diagnosis and treatment of drug-resistant tuberculosis more effective and more tolerable for patients, as well as more readily accessible and lower-cost,” says Paul Farmer, MD, PhD, co-founder of Partners In Health and chief of BWH’s Division of Global Health Equity. “UNITAID has given us a way to use the power of markets to serve the poor, driving down the cost of essential commodities and helping to deliver them to the people who need them most.”

Read more about the UNITAID grant that will make this work possible.

Partners In Health Receives UNITAID Grant to Revolutionize Access to MDR-TB Treatment

This week, Partners In Health announced a new partnership with UNITAIDDoctors Without Borders/ Médecins Sans Frontières (MSF), and IRD to revolutionize access to new multidrug-resistant tuberculosis (MDR-TB) treatment in 17 countries, especially among the poor.

“We’re grateful for this support from UNITAID, and particularly for their partnership, with which we’re hoping to make diagnosis and treatment of drug-resistant tuberculosis more effective and more tolerable for patients, as well as more readily accessible and lower-cost,” says Paul Farmer, MD, PhD, co-founder of Partners In Health and chief of BWH’s Division of Global Health Equity. “UNITAID has given us a way to use the power of markets to serve the poor, driving down the cost of essential commodities and helping to deliver them to the people who need them most.”

Read more about the UNITAID grant that will make this work possible.

New Childhood TB Estimates Double the Number Previously Thought

Researchers from BWH and Harvard Medical School have estimated that around one million children suffer from tuberculosis (TB) annually— twice the number previously thought to have tuberculosis and three times the number that are diagnosed every year.

The researchers also estimated that around 32,000 children suffer from multidrug-resistant tuberculosis (MDR-TB) annually. These findings were published in The Lancet on March 23, 2014.

“Despite children comprising approximately one quarter of the world’s population, there have been no previous estimates of how many suffer from MDR-TB disease,” explained Ted Cohen, MD, DrPH, HMS associate professor of Medicine in BWH’s Division of Global Health Equity and co-senior author of this study. “Our estimate of the total number of new cases of childhood TB is twice that estimated by the WHO in 2011 and three times the number of child TB cases notified globally each year.”

These findings underscore the urgent need for expanded investment in the global response to TB and MDR-TB in children.

“Our findings demonstrate that there is a need for improved methods for collecting data on childhood TB. A good starting place would be improved diagnostic methods for children and more systematic collection of information on how many children are suffering with this disease,” explained Helen Jenkins, PhD, HMS instructor in BWH’s Division of Global Health Equity and lead statistician on the project.

Read more about the study in this article by Fox News.

New Childhood TB Estimates Double the Number Previously Thought

Researchers from BWH and Harvard Medical School have estimated that around one million children suffer from tuberculosis (TB) annually— twice the number previously thought to have tuberculosis and three times the number that are diagnosed every year.

The researchers also estimated that around 32,000 children suffer from multidrug-resistant tuberculosis (MDR-TB) annually. These findings were published in The Lancet on March 23, 2014.

“Despite children comprising approximately one quarter of the world’s population, there have been no previous estimates of how many suffer from MDR-TB disease,” explained Ted Cohen, MD, DrPH, HMS associate professor of Medicine in BWH’s Division of Global Health Equity and co-senior author of this study. “Our estimate of the total number of new cases of childhood TB is twice that estimated by the WHO in 2011 and three times the number of child TB cases notified globally each year.”

These findings underscore the urgent need for expanded investment in the global response to TB and MDR-TB in children.

“Our findings demonstrate that there is a need for improved methods for collecting data on childhood TB. A good starting place would be improved diagnostic methods for children and more systematic collection of information on how many children are suffering with this disease,” explained Helen Jenkins, PhD, HMS instructor in BWH’s Division of Global Health Equity and lead statistician on the project.

Read more about the study in this article by Fox News.

Snapshot: Life after War in Liberia

BRIDGEhome

Liberia is one of the poorest war-torn nations on earth. Today, it recovers from a devastating civil war which destroyed the majority of health facilities and caused a mass exodus of professional health workers. From 1999 until 2003, there was no system in place for health care, education or government.

When the war ended, the Liberia was left with 51 doctors in a country of almost 4 million. The numbers equate to around 10 doctors treating the entire city of San Francisco.

To receive access to health care, rural villagers must navigate narrow dirt paths winding through thick jungle – often impassable – to neighboring communities with life-saving health services. Consequently, diseases that are considered ‘easily treatable’ in the US can be a death sentence.

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North Korea’s Other Crisis

KJ Seung
K.J. Seung

“There's a crisis brewing in North Korea that has nothing to do with nuclear weapons or six-party talks. Tuberculosis has long been recognized as one of the biggest public health problems in North Korea, but there is a disturbing new development: much of the TB in North Korea is resistant to regular antibiotics.”

This is the introduction to a compelling new piece in The Atlantic by K.J. Seung, MD, a physician in BWH's Division of Global Health Equity and deputy director for the Partners In Health project in Lesotho, who regularly travels to North Korea.

Read the article to learn why he believes that multi-drug resistant TB is basically a death sentence for patients in North Korea.

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