MDR-TB Treatment & Prevention
Fwd: [tb-update] Week of December 11 to December 17, 2011
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Subject: [tb-update] Week of December 11 to December 17, 2011
TB-Related News and Journal Items Weekly Update Week of December 11 to
December 17, 2011
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CDC provides the TB-Related News and Journal Items Weekly Update as a
public service only. This update is a compilation of TB-related articles
published for the benefit and information of people interested in TB, and
we do not confirm the accuracy of the data in the articles that are
abstracted. Providing synopses of key scientific articles and lay media
reports on TB does not constitute CDC endorsement. This update may also
include information from CDC and other government agencies, such as
background on Morbidity and Mortality Weekly Report (MMWR) articles, fact
sheets, press releases, and announcements. Reproduction of this text is
encouraged; however, copies may not be sold. For those items reproduced
from the first section of the TB weekly update, the CDC
HIV/Hepatitis/STD/TB Prevention News Update should be cited. For any other
items in the TB weekly update, you may cite the CDC TB-Related News and
Journal Items Weekly Update.
* *
*The TB Update will be on hiatus for the next two weeks and will resume
publication on January 6, 2012. *
This Week's Contents
TB-Related Announcements <#13447e23283bf417_H1>
News Item(s) From the CDC HIV/Hepatitis/STD/TB Prevention News
Update<#13447e23283bf417_H2>
Headlines <#13447e23283bf417_H3>
Journal Articles <#13447e23283bf417_H4>
Job Announcements <#13447e23283bf417_H5>
Upcoming Conferences, Trainings, and Other Events <#13447e23283bf417_H6>
TB-Related Announcements
*1. Winners of the Award for Excellence in Reporting on TB and Images to
Stop TB Award *
Stop TB Partnership, October 26, 2011
The Stop TB Partnership announced the winners of the Award for Excellence
in Reporting on TB and Images to Stop TB Award.
The journalism award recognizes outstanding reporting and commentary in
print and on the web that materially increases the public's knowledge and
understanding of TB and multidrug-resistant TB (MDR-TB), in countries
affected by the disease. The Partnership confers first, second, and third
prizes in two categories: for journalists based in low- and middle-income
countries and those based in high-income countries.
The Images to Stop TB Award seeks to raise awareness about TB through the
powerful medium of photography. Every year the award provides one talented
photographer with the support needed to generate outstanding photographs
and photo stories depicting the impact of TB on individuals and communities
and successful responses to the disease. Photojournalist Gary Knight serves
as Chair of the award's Advisory Board.
Both awards are supported by the Lilly MDR-TB Partnership.
JOURNALISM AWARD
Low- and middle-income country category
First prize (US$ 3000): *Bharathi Ghanashyam *of India. Her blog, "Children
and TB – the diagnostic
challenges"<http://www.stoptb.org/assets/documents/news/bharatitbdiagnosischildren.pdf>tells
the moving stories of three children affected by TB, while
highlighting the challenge of diagnosing the disease in this age group in
India, where the problem is rampant.
Second prize (US$ 2000): *David Dizon* of the Philippines. His article "Stigma
still a hindrance in TB
prevention"<http://www.stoptb.org/assets/documents/news/Stigma%20still%20a%20hindrance%20in%20TB%20prevention.pdf>,
published on ABS-CBN News Online, draws on the personal experience of
having his baby become ill with TB, to focus attention on fearful attitudes
in Manila about seeking diagnosis when TB symptoms appear.
Third prize (US$ 1000): *Evelyn Lirri *of Uganda. "Tuberculosis is curable
but is still a silent killer in
Uganda"<http://www.stoptb.org/assets/documents/news/lirritb%20is%20a%20silentkiller.pdf>,
published in the *Saturday Monitor*, challenges her country to do more to
tackle its TB and TB/HIV epidemics.
High-income country category
First prize (US$ 3000):* Michael Specter* of the United States. His feature
in the *New Yorker*, "A Deadly
Misdiagnosis"<http://www.stoptb.org/assets/documents/news/048-053_Specter_TB-Dept.pdf>,
warns of the dangers of TB misdiagnosis in India, which has the highest
rate of TB in the world and also points to recently developed molecular
tests as offering hope.
Second prize (US$ 2000): *Ray Suarez* of the United States. His blog on the
PBS News Hour web site, "South Africa Still Struggling with Deadly TB-HIV
Epidemic"<http://www.stoptb.org/assets/documents/news/suarezsouthafrica.pdf>,
reports on how South Africa is striving to meet the challenge of its TB/HIV
and MDR-TB epidemics.
Third prize (US$ 1000): *Jason Overdorf* of the United States. His
article, "India:
As the middle class rises, so does
tuberculosis"<http://www.stoptb.org/assets/documents/news/OverdorfIndiamiddleclass.pdf>,
published in the *Global Post*, overturns misconceptions that TB affects
only the poor, but instead is striking a growing number of affluent people
in India.
Images to Stop TB Award
The 2011 winner is the Mexican photographer Carlos Cazalis. Mr. Cazalis'
portfolio, which chronicles the health challenges faced by the people of
Haiti, was selected by an international jury from among 50 entries. He will
receive a grant of $5000 to produce a photo essay on TB, and $5000 in prize
money.
*World Bank criteria: World Bank Country
Classification<http://data.worldbank.org/about/country-classifications>
*2. 5th edition of the “Core Curriculum on Tuberculosis: What the Clinician
Should Know”*
CDC Division of Tuberculosis Elimination, NCHHSTP, October 25, 2011
The print version of the 5th edition of the Core Curriculum on
Tuberculosis: What the Clinician Should Know is now available for ordering
on the CDC TB Publications Order Form,
http://wwwn.cdc.gov/pubs/tb.aspxPublication number: 21-1092
*3. WHO and PATH Publish Toolkit on Strategies to Address MDR-TB *
Stop TB Partnership, October 4, 2011
WHO and PATH have published a
toolkit<http://www.path.org/publications/detail.php?i=1678>designed to
help countries develop or strengthen the multidrug-resistant TB
(MDR TB) components within national TB strategies or plans.
The toolkit contains guidance on the key steps of the planning process,
including developing objectives, identifying current gaps in service
coverage, securing funding sources, and determining how to monitor progress.
The toolkit is aimed at countries, technical partners, international
organizations, and donors who want to improve the detection and treatment
of drug-resistant TB.
An MDR-TB assessment and monitoring
tool<http://www.path.org/publications/detail.php?i=1678>,
on which the new toolkit is based, is also available in English, Russian,
and Spanish.
For the announcement, visit:
http://stoptb.org/news/announcements/2011/a11_018.asp
News Item(s) From the CDC HIV/Hepatitis/STD/TB Prevention News Update
News Item(s) From the CDC HIV/Hepatitis/STD/TB Prevention News Update
*1. US Urges Shorter Treatment for TB *
Agence France Presse, December 8, 2011
On December 8, CDC released new recommendations that offer certain
populations with latent TB infection a shorter treatment course. Three
randomized controlled trials have found “a new combination regimen of
isoniazid (INH) and rifapentine (RPT) administered weekly for 12 weeks as
DOT is as effective for preventing TB as other regimens and is more likely
to be completed than the US standard regimen of 9 months of INH daily
without DOT,” the CDC authors wrote. A major drawback to the longer,
traditional, self-supervised regimens is that they “have completion rates
of 60 percent or less in typical settings, attributable largely to the
duration of six or more months,” CDC said. In cases where the TB infection
is thought to be INH-resistant, patients are often given daily rifampin
(RIF) for four months. RPT, like RIF, is a rifamycin-class antibiotic
approved for TB disease; its use for latent TB infection (LTBI) is off
label. Patients who could benefit from the new, shorter treatment regimen
for LTBI include otherwise healthy people age 12 and older who have a
predictive factor for greater likelihood of TB developing, including recent
exposure to contagious TB; conversion from negative to positive on an
indirect test for TB (i.e., interferon-gamma release assay or tuberculin
skin test); and radiographic findings of healed pulmonary TB; certain
precautions are noted. “HIV-infected patients who are otherwise healthy and
are not yet taking antiretroviral medications are also included in this
category,” CDC said, again with certain precautions noted. In considering
whether a treatment regimen is appropriate, physicians and patients should
consider whether there is adequate access to a physician for weekly
treatments, how easy or hard it is to get the drugs, and personal
preference, CDC said. The full report, “Recommendations for the Use of an
Isoniazid-Rifapentine Regimen with Direct Observation to Treat Latent
Mycobacterium tuberculosis Infection,” was published in CDC’s Morbidity and
Mortality Weekly Report (2011;60(48):1650-1653). To view the full
recommendations, visit:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6048a3.htm?s_cid=mm6048a3_w .
*2. Pennsylvania State University Student Diagnosed with Tuberculosis *
Associated Press, December 9, 2011
Pennsylvania State University (PSU) and state officials are notifying
individuals who have had contact with a student who has been diagnosed with
TB. Testing is being recommended only for those in very close contact with
the student, who attends class on the main campus in State College,
Pennsylvania. PSU said Friday that the student did not receive TB care at
University Health Services; the school said it confirmed the case by
contacting the state health department.
*3. No Active TB Found at Denton High *
Dallas Morning News, December 10, 2011, by Britney Tabor
More than 200 students and staff underwent skin testing for TB on Dec. 6 at
a local high school; fewer than 5 percent tested positive for TB exposure;
and no active cases were found, according to the Denton County Health
Department and school district officials. “Hopefully everything will work
out well, and this will be the end of any TB situations in the district at
this time,” said Sharon Cox, a district spokesperson. Those who tested
positive but whose X-ray results confirmed they do not have signs of active
TB disease will be given the option of taking preventive treatment for nine
months, said Bob Martinez, a health department spokesperson and public
health preparedness coordinator. Skin tests were administered on Oct. 11 to
students and staff identified as having had contact with a student with
confirmed TB. That individual has been treated, is no longer contagious,
and has been cleared to return to class. At the initial screening, fewer
than 5 percent of people tested positive, and chest X-rays found no signs
of active TB. The second round of testing was administered as a precaution.
Martinez said the most recent testing was the final screening for the
district, and that there is no trace of active TB disease and no danger of
a schoolwide outbreak.
Headlines
*1. Scientists to Develop New Drug to Treat Tuberculosis (United Kingdom)*
HealthCanal.com, www.healthcanal.com, December 8, 2011
A team of scientists at the University of Liverpool and the Liverpool
School of Tropical Medicine in Liverpool, United Kingdom, are working in
collaboration with the GlaxoSmithKline pharmaceutical company to design a
new drug to treat TB. The Liverpool team includes biochemists,
pharmacologists, and medicinal chemists. The researchers will investigate
compounds that could inhibit essential components of the respiratory system
of the bacteria so that the drugs can destroy both active disease and
latent TB infection. It is hoped that they will be able to develop a drug
that can be administered over a shorter treatment period. Drug candidates
will then be put forward for pre-clinical development. The £1 million (US
$1,554,533) project is funded by the Medical Research Council, United
Kingdom.
* *
*2. TB Patients Pay High Price for Free Treatment (Zimbabwe)*
Newsday, www.new sday.co.zw, December 7, 2011, by Problem Masau
Although Zimbabwe has a policy of providing free TB treatment, the country
has the fourth highest TB mortality rate in the world, and is ranked 17th
on the WHO list of tuberculosis high-burden nations. Part of the reason is
that patients are defaulting from treatment when they are unable to pay the
medical bills charged by hospitals and clinics. Most private clinics and
missionary hospitals in Zimbabwe charge consultation fees for TB patients.
Some patients were aware of the government’s free treatment policy, but
felt they had to pay the consultation fees if they wanted to be treated.
Others attended private clinics because of lack of information, and some
did not know of the government policy. Patients in the rural areas were
particularly victimized because they could not afford the consultation
fees. Dr. Charles Sandy, Deputy Director of AIDS and TB Programs in the
Ministry of Health and Child Welfare, warned hospitals against
circumventing policies, and that the government will come down on hospitals
that charge fees for diseases that are treated free under government
policy. He suggested the supervision of hospitals by provincial health
offices. Statistics from the Ministry of Health and Child Welfare indicate
that about 83,000 people annually get TB, and two thirds of these people
(about 47,000) are not treated. In 2007, Zimbabwe had 71,961 new TB
diagnoses, with an incidence of 539 cases per 100,000 population. The
number of new reported TB cases declined 2.6 percent in 2006 and 2007. The
case detection rate declined from 46 percent in 2002 to 27 percent in 2007,
and treatment success rate declined from 71 percent in 2001 to 60 percent
in 2006.
* *
*3. Tuberculosis Cases Double (United Kingdom)*
Lep.co.uk, www.lep.co.uk, December 12, 2011
There have been 44 TB cases in Preston, Lancashire, England so far in 2011,
compared to 23 in 2009 and 33 in 2011. Dr. Steve Gee, Consultant in
Communicable Disease Control at Cumbria and Lancashire Health Protection
Agency, commented that the majority of TB patients in the Preston area were
of families from countries with a high incidence of TB, particularly the
Indian subcontinent. He explained that people with TB symptoms do not seek
medical advice for various reasons, including stigma associated with TB.
Also, some think that the symptoms such as coughing up blood and weight
loss indicate cancer and are afraid to find out. As a result, people have
died because they did not seek help. Dr. Gee said that it is not clear why
there has been an increase in TB cases, but surmised it might be a
combination of factors. He acknowledged that TB seems to be missed more
often nowadays because it is not recognized by the public or doctors.
* *
*4. Exposed Hospital Staff Get TB (New Zealand)*
Stuff.co.nz, www.stuff.co.nz, December 10, 2011, by Sarah Young
After a 70-year-old patient at Nelson Hospital, New Zealand, was diagnosed
with TB at death, two or three staff members have tested positive for
latent TB infection. Additional staff who may have been exposed to the
patient are being tested, and others would be retested. Also, family,
friends, and colleagues of the patient are being tested, but so far none of
them have tested positive for infection. According to Bruce King, a
physician at Nelson Hospital, the patient was moved out of isolation when
alternative clinical conditions were confirmed in addition to a negative
initial laboratory result for TB. The only positive TB test was a culture
that grew in two weeks. Dr. King stated that the hospital followed
risk-limiting infection control procedures to protect employees against TB.
Dr. Jill Sherwood, Medical Officer of Health, said that the hospital could
not be certain staff were infected by the patients, as they could have been
exposed to someone else or exposed during travel overseas, but it was
difficult to tell without a date for a negative test first. Since the
patient was an employee of a company that cleaned a school after hours,
staff in the areas where he worked were notified, and their risk will be
determined.
* *
*5. Burma to Target Tuberculosis in National Health Plan (Myanmar)*
Eurasia Review, www.eurasiareview.com, December 12, 2011
The government of Myanmar is in the process of creating a five-year
national TB strategic plan. Meanwhile, TB/HIV collaborative activities are
underway in 17 townships, and the scale-up plan will be extended. Myanmar
is on the WHO list of tuberculosis high-burden nations, on the list of 27
high multidrug-resistant TB burden nations, and on the list of 41 high
TB/HIV burden nations. According to Dr. Pe Thet Khin, Union Minister for
Health, in the two-year plan that began in July 2009, 300 MDR TB patients
were treated, and there are plans to treat 1,800 MDR TB patients during
2011-2015, with the help of the Global Fund. Dr. Khin was speaking at the
Advocacy & Workshop on Childhood TB Management, which was held recently in
Myanmar.
* *
*6. Patients: New TB Drugs Too Strong (Tanzania)*
IPPMedia, www.ippmedia.com, December 12, 2011, by Patrick Kisembo
Patients with multidrug-resistant TB (MDR TB) at the TB hospital in
Kibong’oto, Kilimanjaro Region, Tanzania, are complaining that the newly
received drugs are too strong and are causing adverse reactions. Treatment
had been suspended from November 8 until recently, when a consignment of
the two drugs arrived. The two drugs are part of the five drugs
administered daily to MDR TB patients for 18 to 24 months. The patients
complained that they did not experience these side effects previously, and
they question whether the drugs are different. Dr. Saidi Egwaga, National
TB and Leprosy Program Manager, said that the medicines were of very good
quality and have been approved by the World Health Organization. He noted
that they are the same as the patients had before and are accepted
worldwide. He felt that the issue of whether the medicine is strong or not
should be discussed between patient and doctor. There are 27 MDR TB
patients at the hospital who are undergoing the first phase of treatment,
which is 6-8 months.
* *
*7. Defaulting on TB Treatment Is Dangerous (Botswana)*
The Monitor, www.mmegi.bw, December 12, 2011, by Lindiwe Mozola
Onkamile Sebetela, District TB Coordinator in Francistown, Botswana, stated
that TB patients usually stop taking their drugs after two months of
treatment, instead of continuing for six to eight months. As a result,
they endanger themselves and others around them. Sebetela noted that 13
percent of people in Botswana are dying of TB; 40 percent are living with
HIV/AIDS and TB; and 536 of 1,000 people are being diagnosed with HIV
yearly. He explained that after two months of treatment, the tests are
negative, but the disease is not yet cured. After defaulting, the patient
has to begin treatment all over, and will need to be on medication for
twelve months instead of six to eight months. Sebetela was speaking at a
health meeting at the Monarch Customary Court in Francistown. The Monarch
Court president noted that Monarch has the highest number of people living
with TB because of their lifestyle, including unhygienic surroundings,
alcohol abuse, and unhealthy foods. He called on the population to work to
change Monarch and to fight TB. Sebetela declared that the objective is to
have a TB-free generation by 2016, but with the current default rates,
doubted that possibility.
Journal Articles
*1.* American Journal of Epidemiology. 2011 Jul 15; Volume 174, Number 2:
243-51. Epub 2011 May 23. *Influence of Sampling on Clustering and
Associations with Risk Factors in the Molecular Epidemiology of
Tuberculosis;* Borgdorff, M.W., van den Hof, S., Kalisvaart, N., Kremer,
K., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21606233>
Molecular epidemiologic studies may use genotypic clustering of isolates as
an indicator of recent transmission. It has been shown that missing cases
lead to underestimating clustering, and modeling studies suggested that
they may also lead to underestimating odds ratios for clustering. Using a
national, comprehensive database from the Netherlands covering 15 years
between 1993 and 2007 and including over 12,000 patients and their
isolates, the authors determined the effects of sampling at random, in
time, and by geographic area. As expected, sampling reduced the observed
clustering percentages. However, sampling did not reduce the observed odds
ratios for clustering. The main explanations for this discrepancy with
model outcomes were that a substantial proportion of clustered cases were
found in large clusters and that risk factors for clustering tended to
be-among clustered cases-also risk factors for large clusters. The authors
conclude that, in settings where risk factors for clustering may be
interpreted as risk factors for recent transmission, these risk factors are
also associated with larger cluster sizes. As a result, odds ratios would
show limited sampling bias.
*2.* American Journal of Ophthalmology. 2011 Sep; Volume 152, Number 3:
433-440.e1. Epub 2011 Jun 8. *QuantiFERON-TB Gold Cut-Off Value:
Implications for the Management of Tuberculosis-Related Ocular Inflammation;
* Gineys, R., Bodaghi, B., Carcelain, G., Cassoux, N., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21652022>
This study evaluated the accuracy of QuantiFERON-TB Gold testing in
patients with presumptive tuberculosis-ocular inflammation. In a
prospective nonrandomized case series and clinical laboratory
investigation, 96 consecutive patients presenting with ocular inflammation
between January and October 2007 were tested using QuantiFERON-TB Gold.
Positive patients received a 6-month antituberculosis treatment. Patient
follow-up ranged from 12 months to 24 months. Treatment was considered
effective at the end of follow-up, in cases of no or a 2-point decrease of
ocular inflammation (SUN criteria) and systemic corticosteroids stopped or
tapered to 10 mg/day. Mean age was 51 ± 17 years. Types of ocular
inflammation included scleritis (n = 7), panuveitis (n = 34), and posterior
(n = 15), intermediate (n = 14), and anterior uveitis (n = 15).
QuantiFERON-TB Gold was positive in 42 cases (44%), negative in 51 cases
(53%), and undetermined in 3 cases (3%). Among positive QuantiFERON-TB Gold
patients, 25 received a full antituberculosis treatment, which was
effective in 15 cases (60%). Associated systemic steroids were given to 6
patients and tapered to 10 mg/day or less in all cases. Median
QuantiFERON-TB Gold value was significantly higher in the group with a
successful therapeutic response (7.67 IU/mL [0.46 to 33.37]) compared to
the group with treatment failure (1.22 IU/mL [0.61 to 4.4]), P = .026.
Results of antituberculosis treatment were encouraging in QuantiFERON-TB
Gold-positive ocular inflammation, especially with values over 2 IU/mL in
this study, suggesting that a higher cut-off value than that given by the
manufacturer should be considered to better identify ocular inflammation
that can benefit from full antituberculosis treatment.
*3.* American Journal of Respiratory and Critical Care Medicine. 2011 Aug
1; Volume 184, Number 3: 362-7. Epub 2011 Mar 11. *Evaluating Tuberculosis
Case Detection via Real-Time Monitoring of Tuberculosis Diagnostic Services;
* Davis, J., Katamba, A., Vasquez, J., Crawford, E., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21471088>
TB case-detection rates are below internationally established targets in
high-burden countries. Real-time monitoring and evaluation of adherence to
widely endorsed standards of TB care might facilitate improved case
finding. This study monitored and evaluated the quality of TB
case-detection and management services in a low-income country with a high
incidence of TB. The researchers prospectively evaluated TB diagnostic
services at five primary health-care facilities in Uganda for 1 year, after
introducing a real-time, electronic performance-monitoring system. They
collected data on every clinical encounter, and measured quality using
indicators derived from the International Standards of TB Care. In 2009,
there were 62,909 adult primary-care visits. During the first quarter of
2009, clinicians referred only 21% of patients with cough greater than or
equal to 2 weeks for sputum smear microscopy and only 71% of patients with
a positive sputum examination for TB treatment. These proportions increased
to 53% and 84%, respectively, in the fourth quarter of 2009. The cumulative
probability that a smear-positive patient with cough greater than or equal
to 2 weeks would be appropriately evaluated and referred for treatment rose
from 11% to 34% (P = 0.005). The quarterly number of TB cases identified
and prescribed treatment also increased four-fold, from 5 to 21. Poor
adherence to internationally accepted standards of TB care improved after
introduction of real-time performance monitoring and was associated with
increased TB case detection. Real-time monitoring and evaluation can
strengthen health systems in low-income countries and facilitate
operational research on the effectiveness and sustainability of
interventions to improve TB case detection.
*4.* Antimicrobial Agents and Chemotherapy. 2011 May; Volume 55, Number 5:
2032-41. Epub 2011 Feb 7. *Molecular Detection of Mutations Associated with
First- and Second-Line Drug Resistance Compared with Conventional Drug
Susceptibility Testing of Mycobacterium tuberculosis; *Campbell, P.J.,
Morlock, G.P., Sikes, R.D., Dalton, T.L., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21300839>
The emergence of multi- and extensively drug-resistant TB is a significant
impediment to the control of this disease because treatment becomes more
complex and costly. Reliable and timely drug susceptibility testing is
critical to ensure that patients receive effective treatment and become
noninfectious. Molecular methods can provide accurate and rapid drug
susceptibility results. The researchers used DNA sequencing to detect
resistance to the first-line antituberculosis drugs isoniazid (INH),
rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) and the
second-line drugs amikacin (AMK), capreomycin (CAP), kanamycin (KAN),
ciprofloxacin (CIP), and ofloxacin (OFX). Nine loci were sequenced: rpoB
(for resistance to RIF), katG and inhA (INH), pncA (PZA), embB (EMB), gyrA
(CIP and OFX), and rrs, eis, and tlyA (KAN, AMK, and CAP). A total of 314
clinical *Mycobacterium tuberculosis* complex isolates representing a
variety of antibiotic resistance patterns, genotypes, and geographical
origins were analyzed. The molecular data were compared to the phenotypic
data and the accuracy values were calculated. Sensitivity and specificity
values for the first-line drug loci were 97.1% and 93.6% for rpoB, 85.4%
and 100% for katG, 16.5% and 100% for inhA, 90.6% and 100% for katG and
inhA together, 84.6% and 85.8% for pncA, and 78.6% and 93.1% for embB. The
values for the second-line drugs were also calculated. The size and scope
of this study, in numbers of loci and isolates examined, and the phenotypic
diversity of those isolates support the use of DNA sequencing to detect
drug resistance in the *M. tuberculosis* complex. Further, the results can
be used to design diagnostic tests utilizing other mutation detection
technologies.
*5.* BMC Health Services Research. 2011 May 23; Volume 11: 118. *Integrating
Intensified Case Finding of Tuberculosis into HIV Care: An Evaluation from
Rural Swaziland;* Elden, S., Lawes, T., Kudsk-Iversen, S., Vandelanotte,
J., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21605437>
Swaziland has the highest HIV prevalence in the world and the highest
estimated TB incidence rate in the world. An estimated 80% of TB patients
are also infected with HIV. TB detection through intensified case finding
(ICF) has yet to become a routine aspect of integrated TB and HIV care.
This study evaluated implementation of ICF for TB into routine integrated
TB and HIV care at 16 community clinics and one district hospital in
Swaziland. Nurses and lay counselors conducted ICF using a TB screening
tool and patient pathway at all HIV service entry points in clinics and the
hospital. The patient pathway had three-stages; screening, sputum smear
diagnosis, and TB treatment initiation. Outcomes and losses to follow up
were monitored at each stage. Patient demographics, access, and service
feasibility and effectiveness were compared at hospital and clinic sites.
At clinics and the hospital, 1,467 patients were screened over a 3 month
period. Large losses to follow up occurred prior to the sputum diagnosis
stage; only 47% (n = 172) of TB suspects provided a specimen. Twenty-eight
cases of smear positive TB were diagnosed and 24 commenced treatment.
People screened at clinics were significantly more likely to be female,
older, and from rural or geographically remote areas (p < 0.001). There was
no significant difference between the hospital and clinics sites in the
proportion of all participants screened who were smear positive (x2 =
1.909; p = 0.16). The number to be screened to detect one sputum positive
TB case was 34 at clinics and 63 at the district hospital. ICF was
operationally feasible and became established as a routine aspect of TB and
HIV integrated care. ICF in community clinics was potentially more
accessible to an underserved, rural population and was as effective as the
hospital service in detecting smear positive TB.
*6.* BMC Health Services Research. 2011 May 20; Volume 11: 110. *Tuberculosis
Patients' Reasons for, and Suggestions to Address Non-Uptake of HIV
Testing: A Cross-Sectional Study in the Free State Province, South
Africa;*Kigozi, N.G., Heunis, J.C., Wouters, E., van den Berg, H.S.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21599883>
South Africa endorses the global policy shift from primarily
client-initiated voluntary counseling and testing (VCT) to
routine/provider-initiated testing and counseling (PITC). The reason for
this policy shift has been to facilitate uptake of HIV testing amongst
at-risk populations in high-prevalence settings. Despite ostensible
implementation of routine/PITC, uptake amongst TB patients in this country
remains a challenge. This study presents the reasons that non-tested TB
patients offered for their refusal of HIV testing and reflects on all TB
patients' suggestions as to how this situation may be alleviated. In
February-March 2008, a cross-sectional survey was conducted amongst 600 TB
patients across 61 primary health care facilities in four sub-districts in
the Free State. Patient selection was done proportionally to the numbers
registered at each facility in 2007. Data were subjected to bivariate tests
and content analysis of open-ended questions. Almost one-third (32.5%) of
the respondents reported that they had not undertaken HIV testing, with the
most often offered explanation being that they were “undecided” (37.0%).
Other self-reported reasons for non-uptake included: fear (e.g. of testing
HIV-infected, 19.0%); perception of being at low risk of HIV infection
(13.4%); desire first to deal with TB “on its own” (12.5%); and because HIV
testing had not been offered to them (12.0%). Many patients expressed the
need for support and motivation not only from health care workers (33.3%),
but also from their significant others (56.6%). Patients further expressed
a need for (increased) dissemination of TB-HIV information by health care
workers (46.1%). Patients did not undergo HIV testing for various
patient-/individual-related reasons. Non-uptake of HIV testing was also due
to health system limitations such as the non-offer of HIV testing. Other
measures may be necessary to supplement routine/provider-initiation of HIV
testing. From the TB patient's perspective, there is a need for (improved)
dissemination of information on the TB-HIV link. Patients also require
(repeated) motivation and support to undergo HIV testing, the onus for
which rests not only on the public health authority and health care
workers, but also on other people in the patients' social support networks.
*7.* BMC Health Services Research. 2011 May 11; Volume 11: 97. *Risk
Factors for Non-Cure among New Sputum Smear Positive Tuberculosis Patients
Treated in Tuberculosis Dispensaries in Yunnan, China;* Jianzhao, H., van
den Hof, S., Lin, X., Yubang, Q., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21569305>
Yunnan province in China has a high TB burden. Cure rates in general are
high, but they were below the target of 85% in 26 out of 129 counties in
2005. In these 26 counties the researchers assessed which patient-related
and treatment-related factors were associated with non-cure. The
researchers conducted a prospective cohort study. Smear positive pulmonary
TB patients treated at the local Center for Disease Control and Prevention
(CDC) were interviewed before start of treatment and during the fifth month
of treatment using structured questionnaires. Information on treatment
outcome was extracted from patient records. Patients cured at the end of
treatment were compared to patients with unsuccessful treatment outcomes
(failure, default, and death). A total of 841 patients were registered
between January-June 2007 of which 792 (94%) were cured. Independent risk
factors for non-cure were having a low income (<3000 RMB per year), not
having medical insurance, a delay in health care seeking >30 days, a
positive smear test result two months after start of treatment, not being
aware of the need to go to the CDC for medical follow up during treatment,
and not seeing the need for treatment observation. Reducing the financial
burden of TB disease and providing health education to improve adherence to
treatment could increase the proportion of patients with successful
treatment outcomes.
*8.* BMC Pulmonary Medicine. 2011 May 23; Volume 11: 26. *Incidence, Risk
Factors and Mortality of Tuberculosis in Danish HIV Patients
1995-2007; *Taarnhøj,
G.A., Engsig, F.N., Ravn, P., Johansen, I.S., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21605366>
* *
HIV infection predisposes to TB. The researchers described incidence, risk
factors, and prognosis of TB in HIV-1 infected patients during pre
(1995-1996), early (1997-1999), and late Highly Active Antiretroviral
Therapy (HAART) (2000-2007) periods. They included patients from a
population-based, multicenter, nationwide cohort. The researchers
calculated incidence rates (IRs) and mortality rates (MRs). Cox's
regression analysis was used to estimate risk factors for TB infection with
HAART initiation included as time updated variable. Kaplan-Meier was used
to estimate mortality after TB. Among 2,668 patients identified, 120
patients developed TB during the follow-up period. The overall IR was 8.2
cases of TB/1,000 person-years of follow-up (PYR). IRs decreased during the
pre-, early, and late-HAART periods (37.1/1000 PYR, 12.9/1000 PYR and
6.5/1000 PYR respectively). African and Asian origin, low CD4 cell count,
and heterosexual and injection drug user route of HIV transmission were
risk factors for TB and start of HAART reduced the risk substantially. The
overall MR in TB patients was 34.4 deaths per 1,000 PYR (95% Confidence
Interval: 22.0-54.0) and was highest in the first two years after the
diagnosis of TB. Incidence of TB was still associated with conventional
risk factors as country of birth, low CD4 count, and route of HIV infection
while HAART reduced the risk substantially. The mortality in this patient
population was high in the first two years after TB diagnosis.
* *
* *
*9.* PLoS One. 2011; Volume 6, Number 9: e24720. Epub 2011 Sep 13.
*Matrix-Assisted
Laser Desorption/Ionization Time-of-Flight Mass Spectrometry Identification
of Mycobacteria in Routine Clinical Practice;* El Khéchine, A., Couderc,
C., Flaudrops, C., Raoult, D., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21935444>
Non-tuberculous mycobacteria recovered from respiratory tract specimens are
emerging confounder organisms for the laboratory diagnosis of TB worldwide.
There is an urgent need for new techniques to rapidly identify mycobacteria
isolated in clinical practice. Matrix-assisted laser desorption
time-of-flight mass spectrometry (MALDI-TOF MS) has previously been proven
to effectively identify mycobacteria grown in high-concentration inocula
from collections. However, a thorough evaluation of its use in routine
laboratory practice has not been performed. The researchers set up an
original protocol for the MALDI-TOF MS identification of heat-inactivated
mycobacteria after dissociation in Tween-20, mechanical breaking of the
cell wall and protein extraction with formic acid and acetonitrile. By
applying this protocol to as few as 10(5) colony-forming units of reference
isolates of *Mycobacterium tuberculosis, Mycobacterium avium*, and 20 other
Mycobacterium species, the researchers obtained species-specific mass
spectra for the creation of a local database. Using this database, the
protocol enabled the identification by MALDI-TOF MS of 87 *M. tuberculosis*,
25 *M. avium* and 12 non-tuberculosis clinical isolates with identification
scores ≥2 within 2.5 hours. Data indicate that MALDI-TOF MS can be used as
a first-line method for the routine identification of heat-inactivated
mycobacteria. MALDI-TOF MS is an attractive method for implementation in
clinical microbiology laboratories in both developed and developing
countries.
*10.* PLoS One. 2011; Volume 6, Number 9: e24435. Epub 2011 Sep 8. *A
Multi-Center Study to Evaluate the Performance of Phage Amplified
Biologically Assay for Detecting TB in Sputum in the Pulmonary TB Patients;
*Zhu, C., Cui, Z., Zheng, R., Yang, H., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21931714>
This study evaluated the performance of phage amplified biologically assay
(PhaB) for detecting TB in sputum in the pulmonary TB (PTB) patients.
Shanghai TB Key Laboratory of Shanghai Pulmonary Hospital participated in
the project in collaboration with the laboratories of six hospitals and a
total of 1,660 eligible participants (1,351 PTB patients and 309 non-TB
patients) were included in the study. The sputum samples from the
participants were detected by smear microscopy, PhaB, and Löwenstein-Jensen
(L-J) culture method, respectively. The overall sensitivity of PhaB were
higher than that of L-J culture and smear microscopy (p<0.05). The
sensitivity of PhaB for detecting smear-negative specimens was obviously
higher than that of L-J culture (p<0.05). Compared with L-J culture, the
overall sensitivity, specificity, PPV, NPV, ACC and Kappa value of PhaB
were 98.4 (95% Cl: 96.9-99.3), 71.6 (95% Cl: 68.4-74.6), 67.7, 98.7, 81.7%
and 0.643, respectively. The detection median time of PhaB only needed 48
hours, which was significantly less than that (31 days) of L-J culture
method. It is concluded that the PhaB method is a rapid and sensitive
method for detecting TB in sputum in PTB patients; especially for the
diagnosis of smear-negative PTB, PhaB method is obviously more sensitive
than L-J culture method.
*11.* PLoS One. 2011; Volume 6, Number 9: e23870. Epub 2011 Sep 8.
*Mycobacterium
tuberculosis Lineage Influences Innate Immune Response and Virulence and Is
Associated with Distinct Cell Envelope Lipid Profiles; *Krishnan, N.,
Malaga, W., Constant, P., Caws, M., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21931620>
The six major genetic lineages of *Mycobacterium tuberculosis* are strongly
associated with specific geographical regions, but their relevance to
bacterial virulence and the clinical consequences of infection are unclear.
Previously, the researchers found that in Vietnam, East Asian/Beijing and
Indo-Oceanic strains were significantly more likely to cause disseminated
TB with meningitis than those from the Euro-American lineage. To
investigate this observation the researchers characterized 7 East
Asian/Beijing, 5 Indo-Oceanic, and 6 Euro-American Vietnamese strains in
bone-marrow-derived macrophages, dendritic cells, and mice. East
Asian/Beijing and Indo-Oceanic strains induced significantly more TNF-α and
IL-1β from macrophages than the Euro-American strains, and East
Asian/Beijing strains were detectable earlier in the blood of infected mice
and grew faster in the lungs. The researchers hypothesized that these
differences were induced by lineage-specific variation in cell envelope
lipids. Whole lipid extracts from East Asian/Beijing and Indo-Oceanic
strains induced higher concentrations of TNF-α from macrophages than
Euro-American lipids. The lipid extracts were fractionated and compared by
thin layer chromatography to reveal a distinct pattern of
lineage-associated profiles. A phthiotriol dimycocerosate was exclusively
produced by East Asian/Beijing strains, but not the phenolic glycolipid
previously associated with the hyper-virulent phenotype of some isolates of
this lineage. All Indo-Oceanic strains produced a unique unidentified
lipid, shown to be a phenolphthiocerol dimycocerosate dependent upon an
intact pks15/1 for its production. This was described by Goren as the
“attenuation indictor lipid” more than 40 years ago, due to its association
with less virulent strains from southern India. Mutation of pks15/1 in a
representative Indo-Oceanic strain prevented phenolphthiocerol
dimycocerosate synthesis, but did not alter macrophage cytokine induction.
Findings suggest that the early interactions between *M. tuberculosis* and
host are determined by the lineage of the infecting strain; but the
researchers were unable to show these differences are driven by
lineage-specific cell-surface expressed lipids.
*12.* PLoS One. 2011; Volume 6, Number 9: e23715. Epub 2011 Sep 13. *Initial
Presentations Predict Mortality in Pulmonary Tuberculosis Patients - A
Prospective Observational Study;* Feng, J.Y., Su, W.J., Chiu, Y.C., Huang,
S.F., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21931610>
Despite effective anti-TB treatments, TB remains a serious threat to public
health and is associated with high mortality. Old age and multiple
co-morbidities are known risk factors for death. The association of
clinical presentations with mortality in pulmonary TB patients remains an
issue of controversy. This prospective observational study enrolled newly
diagnosed, culture-proven pulmonary TB patients from five medical centers
and one regional hospital, which were referral hospitals of TB patients.
Radiographic findings and clinical symptoms were determined at the time of
diagnosis. Patients who died for any reason during the course of anti-TB
treatment were defined as mortality cases and death that occurred within 30
days of initiating treatment was defined as early mortality. Clinical
factors associated with overall mortality and early mortality were
investigated. A total of 992 patients were enrolled and 195 (19.7%) died.
Nearly one-third (62/195, 31.8%) of the deaths occurred before or within 30
days of treatment initiation. Older age (RR = 1.04, 95%CI: 1.03-1.05),
malignancy (RR = 2.42, 95%CI: 1.77-3.31), renal insufficiency (RR = 1.77,
95%CI: 1.12-2.80), presence of chronic cough (RR = 0.63, 95%CI: 0.47-0.84),
fever (RR = 1.45, 95%CI: 1.09-1.94), and anorexia (RR = 1.49, 95%CI:
1.07-2.06) were independently associated with overall mortality.
Kaplan-Meier survival analysis demonstrated significantly higher mortality
in patients present with fever (p<0.001), anorexia (p = 0.005), and without
chronic cough (p<0.001). Among patients of mortality, those with
respiratory symptoms of chronic cough (RR = 0.56, 95%CI: 0.33-0.98) and
dyspnea (HR = 0.51, 95%CI: 0.27-0.98) were less likely to experience early
mortality. The radiological features were comparable between survivors and
non-survivors. In addition to demographic characteristics, clinical
presentations including the presence of fever, anorexia, and the absence of
chronic cough, were also independent predictors for on-treatment mortality
in pulmonary TB patients.
*13.* Scandinavian Journal of Infectious Diseases. 2011 Jul; Volume 43,
Numbers 6-7: 424-9. Epub 2011 Feb 18. *Tuberculin Skin Test and
Interferon-γ Release Assay Show Better Correlation after the Tuberculin
'Window Period' in Tuberculosis Contacts;* Anibarro, L., Trigo, M.,
Villaverde, C., Pena, A., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21332285>
T-cell interferon-gamma release assays (IGRAs) have been shown to be
effective tools for the detection of *Mycobacterium
tuberculosis*infection, offering an enhanced specificity compared to
the tuberculin skin
test (TST). Most TB contact studies have shown a better correlation of IGRA
with the intensity of *M. tuberculosis* exposure than that obtained using
the TST. However, the correlation between tests performed before and after
the tuberculin “window period” (time between infection and when the
immunological response becomes measurable) remains to be studied. A
longitudinal prospective analysis was performed in TB contacts. The
researchers analyzed the correlation between a commercially available IGRA
(QuantiFERON®-TB Gold in-Tube, QFT) and the TST before and after the
tuberculin window period (2 months). Concordance between both tests was
assessed using the Kappa coefficient (κ). Correlation of both tests with
the degree of TB exposure was also analyzed. One hundred and fifty-two TB
contacts were included in the study. Agreement between the TST and IGRA was
better after the window period (κ = 0.60 at the first visit and κ = 0.73
after 2 months), especially for non-BCG vaccinated subjects (κ = 0.81).
Both a positive TST and QFT were correlated, after the window period, with
the size of place of contact (the smaller the place of contact, the higher
the probability of having a positive test) (p = 0.022 and p = 0.02,
respectively) and with the total numbers of hours spent with the index case
(p = 0.006 for TST and p = 0.007 for QFT). IGRAs are a good alternative to
the TST in contact tracing studies, especially after the tuberculin window
period.
*14.* Tropical Doctor. 2011 Oct; Volume 41, Number 4: 224-6. Epub 2011 Aug
30. *Prevalence of Nocardia Species among HIV-Positive Patients with
Suspected Tuberculosis;* Alnaum, H.M., Elhassan, M.M., Mustafa, F.Y.,
Hamid, M.E.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21878441>
This study determined the frequency of nocardiosis in HIV-infected and
HIV-non-infected individuals clinically suspected of having TB. The study
population (n = 171) were those who attended chest hospitals in Khartoum
State, Sudan, between January and March 2010. The patients suffered from
pulmonary infections with positive acid-fast bacilli. Blood (n = 171) and
sputum (n = 171) samples were collected simultaneously. Blood samples were
tested serologically for the presence of antibodies using HIV/Intensified
Combination Prevention (ICP) test and sputum were cultured onto Lowenstein
Jensen slants according to standard methods. Isolates showing rapid growth
characteristic of Nocardiae were subcultured and subsequently identified
using glucose yeast extract agar medium. All candidates in the study
population (n = 171) suffered from pulmonary infections, nocardiosis was
diagnosed in 4% (n = 7), HIV-infected cases were 17 (9.9%). Five Nocardia
species were isolated from HIV-negative patients whereas two were from
HIV-infected patients. Nocardia spp. cause pulmonary infections (4.09%) in
both immunocompetent (2.92%) as well as immunocompromised (1.17%) patients
who attend chest clinics in Sudan.
*15.* Vaccine. 2011 Jun 24; Volume 29, Numbers 29-30: 4839-47. Epub 2011
May 5. *Extended Safety and Efficacy Studies of a Live Attenuated Double
Leucine and Pantothenate Auxotroph of Mycobacterium tuberculosis as a
Vaccine Candidate; *Sampson, S.L., Mansfield, K.G., Carville, A., Magee,
D.M., et al.
Click here for PubMed abstract:
PubMed<http://www.ncbi.nlm.nih.gov/pubmed/21549795>
The researchers have previously described the development of a live, fully
attenuated *Mycobacterium tuberculosis* (Mtb) vaccine candidate strain with
two independent attenuating auxotrophic mutations in leucine and
pantothenate biosynthesis. In the present work, those studies have been
extended to include testing for protective efficacy in a long-term guinea
pig survival model and safety testing in the highly TB susceptible Rhesus
macaque. To model the safety of the ΔleuD ΔpanCD strain in HIV-infected
human populations, a Simian immunodeficiency virus (SIV)-infected Rhesus
macaque group was included. Immunization with the non-replicating ΔleuD
ΔpanCD conferred long-term protection against challenge with virulent *M.
tuberculosis* equivalent to that afforded by BCG as measured by guinea pig
survival. In safety studies, clinical, hematological and bacteriological
monitoring of both SIV-positive and SIV-negative Rhesus macaques immunized
with ΔleuD ΔpanCD, revealed no vaccine-associated adverse effects. The
results support the further development of the ΔleuD ΔpanCD strain as a
viable TB vaccine candidate.
Job Announcements
*All job announcements will be posted for two months. Please notify us if a
job is filled before the end of the two-month posting period, and we will
remove the job announcement. Thank you. *
*1. Coordinator II (Data Coordinator) *
*Sponsor: Harvard Medical School, Global Health and Social Medicine*
Location: Boston, Massachusetts
Auto req ID: 25015BR
Duties and Responsibilities:
This position will support execution of a Phase II randomized, controlled,
doubleblinded
clinical trial to evaluate the potential for higher-than-standard doses of
rifampin
to shorten standard treatment for tuberculosis. The three-year study,
entitled
Randomized Trial of High-Dose Rifampin in Patients with New Smear-Positive
TB
(HIRIF), is funded through a cooperative agreement between US NIH/NIAID and
the
Department of Global Health and Social Medicine (DGHSM) with
co-investigators at
other institutions in the US and UK. The study will be run out of the HIRIF
study
center at Harvard; study participants will be enrolled in Peru.
In close collaboration with the coordinators at the sites and the PIs,
statistician,
programmer, and project manager, the Data Coordinator will be responsible
for
completing the study data management plan; developing data management flow;
coordinating data entry system design; validating and documenting data
systems;
development of case report forms; development of reporting systems for
generating,
tracking, reviewing and resolving data discrepancies; data cleaning;
locking archiving;
elaborating procedures and work instructions for all data-related study
components.
S/he will ensure that data management procedures are fully compliant with
International Conference on Harmonization (ICH) requirements for Good
Clinical
Practice and US Food and Drug Administration (FDA) guidance. S/he will be
responsible for training and supervising the data coordinators at the
project sites and
will also work closely with the OpenMRS programming team in database
development,
validation, and maintenance. S/he will also be responsible for data
collection,
management, and quality for data entered at collaborating sites (e.g.,
pharmacokinetic
data, microbiology quality control, etc.). S/he will work with the study
programmer to
conduct statistical analyses to verify quality of data received as well as
perform
descriptive analysis and provide reports to study team and safety monitoring
committee, consulting, as needed, with investigators. Development of the
final study
database will be done in collaboration with the statisticians and the
Principal
Investigator.
Basic Qualifications:
College degree strongly preferred or an equivalent of education plus
relevant business
experience. 3-5 years of data management experience (including data base
design,
validation and maintenance) compliant with ICH and FDA requirements.
This is a 12-month, grant funded position, subject to renewal contingent on
funding.
Interested candidates can search for this position and apply through
Harvard University's External Talent Gateway at:
http://www.employment.harvard.edu/ using the AutoReqID 25015BR.
*2. Project Manager *
*Sponsor: Harvard Medical School, Global Health and Social Medicine*
Location: Boston, Massachusetts
Auto req ID: 25003BR
Duties and Responsibilities:
This position will support the execution of a Phase II randomized,
controlled, doubleblinded
clinical trial to evaluate the potential for higher-than-standard doses of
rifampin
to shorten standard treatment for tuberculosis. The three-year study,
entitled
Randomized Trial of High-Dose Rifampin in Patients with New Smear-Positive
TB
(HIRIF), is funded through a cooperative agreement between US NIH/NIAID and
the
Harvard Medical School Department of Global Health and Social Medicine
(DGHSM)
with co-investigators at other institutions in the US and UK. The study
will be run out
of the HIRIF study center at Harvard; study participants will be enrolled
in Peru.
Receiving general direction from the co -Principal Investigators (co-PIs ),
PIs, the
project manager will work closely with the study coordinator and be
responsible for all
activities necessary to start, activate, conduct, and close out the
protocol at all study
sites. The incumbent will support day-to-day implementation of the study
protocol in
Peru and is the key liaison among the co-PIs, co-investigators, the Peru
PI, industry
sponsor, and NIAID staff.
The project manager will provide direct supervision and is responsible for
the conduct,
operations, and results of Harvard-based HIRIF staff including a research
assistant/research coordinator, data manager, and translator. S/he will
also oversee
work performed by consultant hired to complete IND submission. The
individual will
oversee procurement and shipping of supplies, equipment, and medications as
needed; arrange travel, accommodation and coordination of meetings and site
visits.
Basic Qualifications:
BA degree and 5 to 7 years of clinical research experience required,
including both
regulatory management experience and international multi center trials. The
individual
must be proficient in Spanish. This individual must have 1 to 3 years of
previous
supervisory experience and a proven track record in leading teams and
projects.
This is a 12-month, grant funded position, subject to renewal contingent on
funding.
Interested candidates can search for this position and apply through
Harvard University's External Talent Gateway at:
http://www.employment.harvard.edu/ using the AutoReqID 25003BR.
*3. Coordinator II (Study Coordinator) *
*Sponsor: Harvard Medical School, Global Health and Social Medicine*
Location: Boston, Massachusetts
Auto req ID: 25016BR
Duties and Responsibilities:
This position will support execution of a Phase II randomized, controlled,
doubleblinded
clinical trial to evaluate the potential for higher-than-standard doses of
rifampin
to shorten standard treatment for tuberculosis. The three-year study,
entitled
Randomized Trial of High-Dose Rifampin in Patients with New Smear-Positive
TB
(HIRIF), is funded through a cooperative agreement between US NIH/NIAID and
the
Department of Global Health and Social Medicine (DGHSM) with
co-investigators at
other institutions in the US and UK. The study will be run out of the HIRIF
study
center at Harvard; study participants will be enrolled in Peru.
The Study Coordinator will coordinate all clinical and regulatory aspects
of the study.
Working closely with the PIs, site co-investigators, site coordinators, and
study project
manager, the individual will ensure that all study procedures are
implemented
according to protocol. With the clinical PI and co-investigators s/he will
develop the
clinical standard operating procedures and participate in the development
of CRFs.
S/he will be in regular, direct communication with the clinical and project
management
teams to provide guidance and support throughout the study and will provide
training
and supervision for the nurses, treatment supporters, and pharmacy staff at
the study
sites. This will include physical exams, symptom review, adverse event
assessments,
pharmacokinetic sampling, sputum collection for microbiologic testing,
consenting
procedures, packaging and distribution of study drugs, local transfer and
international
shipping of study samples. This will involve travel to South America (<=3
trips/year)
and regular phone, Skype and email communication. The study coordinator will
provide guidance to local nurses in identifying, preventing, solving
complex/recurring
patient care, recruitment, or retention problems. Particular support will
be provided for
the relationship among study nurses, treatment supporters, and study
participants.
S/he may review and authorize all enrollment requests submitted. S/he will
participate
in investigators’ meetings and have the opportunity to participate in
development of
manuscripts and talks to disseminate study findings. Study coordinator will
manage
regulatory process, including responsibility for maintaining appropriate
standing with
IRBs supervising all collaborating and enrolling sites. The incumbent is
the key liaison
among the study team, IRBs, and regulatory agencies. S/he will receive
reports of
adverse events, serious adverse events, and protocol deviations from
participating
sites; ensure timely review with clinical PI, and coordinate timely
reporting to IRBs and
other relevant authorities.
Basic Qualifications:
College degree strongly preferred or an equivalent of education plus
relevant business
experience. Five or more years of related clinical research experience,
including
studies done under IND required.
This is a 12-month, grant funded position, subject to renewal contingent on
funding.
Interested candidates can search for this position and apply through
Harvard University's External Talent Gateway at:
http://www.employment.harvard.edu/ using the AutoReqID 25016BR.
Upcoming Conferences, Trainings, and Other Events Find up-to-date
information on TB-related conferences, US training opportunities, and other
events at the DTBE Monthly Calendar<http://www.cdc.gov/tb/events/default.htm>
.
*1. Philadelphia TB Update NEW*
Sponsor: New Jersey Medical School Global Tuberculosis Institute
Date: March 21, 2012
Location: Philadelphia, Pennsylvania
This half-day course will provide clinicians and TB program staff with
updated information, including current TB trends in Philadelphia, new
diagnostics and treatment regimens, pediatric TB, contact investigations,
and working with foreign-born populations.
For more information, contact Bill Bower. E-mail ; or
access the Web site at
http://www.umdnj.edu/globaltb/courses/brochures/2012/phillytbupdate.html .
*2. Drug Resistance and Persistence in Tuberculosis NEW*
Sponsor: Keystone Symposia on Molecular and Cellular Biology
Dates: May 3 – 18, 2012
Location: Kampala, Uganda
Early registration deadline: March 13, 2012
This meeting on Drug Resistance and Persistence in TB aims to bring
together basic and clinical researchers and public health experts from
diverse backgrounds to explore the following: (1) the fundamental biology
underlying genetic and phenotypic drug-resistance in TB; (2) progress in
expanding capacity in high-burden settings to perform drug susceptibility
testing; (3) identification of novel drug targets; (4) innovative
strategies for drug discovery; and (5) advances in developing multi-drug
regimens that will be effective against currently drug-resistant as well as
drug-sensitive strains of *M. tuberculosis*. Investigators from outside the
TB field will be included to provide new perspectives and stimulate fresh
approaches for tackling this global public health priority.
Abstract & Scholarship deadline: January 13, 2012
For more information, contact Keystone Symposia. E-mail
; phone (800) 253-0685 or (970) 262-1230; fax (970)
262-1525; or access the Web site at http://www.keystonesymposia.org/ .
3. Targeted Testing and Treatment of Latent TB Infection: An Online
Presentation (60 minutes)
Sponsor: The Francis J. Curry National Tuberculosis Center
This slide presentation is presented by L. Masae Kawamura, M.D., TB
Controller of the San Francisco Department of Public Health and
co-principal investigator of the Francis J. Curry National TB Center/UCSF.
Dr. Kawamura explores the diagnosis and treatment of LTBI, including the
rationale for TB screening and what is meant by "targeted testing," risk
factors for TB, the tuberculin skin test and new interferon gamma release
assays (IGRAs), current LTBI treatment guidelines, and how to counsel and
motivate patients. This slide presentation with streaming audio provides
information on how to effectively target test for TB as well as how to
treat latent TB infection (LTBI). A question and answer guide, a printable
PowerPoint slide file, and other useful resources are also included as
supplemental materials.
For more information, visit
http://www.nationaltbcenter.ucsf.edu/testing_ltbi/ .
*4. Practical Solutions for TB Infection Control: Infectiousness and
Isolatio*n
Sponsor: Francis J. Curry National Tuberculosis Center
Location: Online Course
Length: 60 minutes
This 60-minute Flash presentation with streaming audio provides information
on how to determine whether a TB patient is infectious and demonstrates
practical ways to prevent TB transmission in the clinic, in transit, and in
the patient's home. Throughout the training, interactive questions allow
participants to test and apply what has been learned. At the end of the
presentation, there is a list of additional resources that includes links
to further written information as well as links to the Regional Training
and Medical Consultation Centers (RTMCCs).
For further assistance, contact Francis J. Curry National Tuberculosis
Center. E-mail ; telephone (415) 502-4600;
or fax (415) 502-4620.
For a course description, visit
http://www.nationaltbcenter.ucsf.edu/tbicweb/ .
*5. Legal Interventions in TB Control: A Web-Based Seminar *
Sponsor: New Jersey Medical School Global Tuberculosis Institute
Location: Web-Based Seminar
This web-based seminar, presented by the Global TB Institute, was
originally held on September 11, 2007 and explored successful and
innovative approaches to implementing legal interventions in TB control
programs in the US. Experts shared legal and ethical considerations, as
well as hands-on experiences, practical steps, and legal tools that can be
used to improve outcomes of case management, treatment outcomes, and
contact investigations. Points were illustrated using lectures and case
presentations
Please follow the link below to view this web-based seminar:
http://www.umdnj.edu/globaltb/audioarchives/legal.htm .
*6. 1st International Conference on Drug Therapy in TB Infection *
Sponsor: Africa Health Research Organization
Dates: January 6 – 7, 2012
Location: Edinburgh, United Kingdom
This conference will provide a stimulating scientific environment for
exchange of ideas and updates in TB medicine. The conference includes the
following tracks: (1) Biology & Epidemiology of TB; (2) TB Immunology &
Pathogenesis; (3) Current TB Chemotherapy; (4) Drug Resistance; (5) HIV/TB:
A Deadly Syndemic; (6) Current Strategies in TB Drug Development: From
Bench to Bedside; and (7) TB Vaccine: Concept & Progress.
Abstract submission deadline: November 30, 2011. Abstracts dealing with
track areas can be submitted to with the words: TB
Abstract, in the subject of the email.
For more information, visit http://www.eventsbot.com/events/eb662245306 .
*7. 3rd Global Symposium on IGRAs 2012 *
Sponsor: UC San Diego School of Medicine
Dates: January 12 - 15, 2012
Locations: Waikoloa, Hawaii
Students of TB have been interested in the immune response to *M.
tuberculosis* since the modern understanding of the clinical disease. For
decades, the skin test response to tuberculin (TST) was the primary tool
clinicians have had for study. With the development of Interferon Gamma
Release Assays (IGRA) the recurrent question has been -- which is better,
the TST or an IGRA? Many papers have been written on this topic, and
numerous guidelines have been issued. The conference will provide a solid
framework for assessing this rapidly moving field, and will provide a basis
for making clinical decisions.
The meeting will present basic and developing information that will be of
interest to academic physicians and practicing physicians, such as those
who practice infectious disease, pulmonary medicine, and pediatrics. It
will also be of interest to public health physicians, dermatologists,
rheumatologists, gastroenterologists, and epidemiologists.
For registration and more information, visit http://cme.ucsd.edu/igras/.
* *
*8. Engaging the Private Sector in TB Prevention: A National Webinar *
Sponsor: The Curry International Tuberculosis Center
Date: January 25, 2012
Location: Nationwide, USA
Application deadline: January 6, 2012
This webinar's target audience is public health personnel who are working
to transition the diagnosis and care of LTBI patients to community/private
health providers. The goal of the course is to provide tools, strategies,
and other resources to assist State and local health departments get
community/private health providers prepared to diagnose and care for LTBI
patients.
Enrollment is limited, and pre-registration is required. Application
deadline: January 6, 2012. Registration is free of charge. Continuing
education credits are available.
For more information, including the participant application, group viewing
information, and system requirements, visit the Web site at
http://www.currytbcenter.ucsf.edu/training/nationalwebinar.cfm .
*9. Best Practices in TB Control #1: TB Among the Homeless: Dealing with
Unique Challenges *
Sponsor: New Jersey Medical School, Global Tuberculosis Institute
Date: February 7, 2012
Location: Nationwide, US
This web-based seminar will address the need for effective strategies in
working with homeless persons. The format will include an overview of
homelessness and TB in the US, perspectives from a TB control program and
an agency that provides services to homeless persons, as well as a case
study.
For more information, contact Bill Bower, E-mail: ; or
access the Web site:
http://www.umdnj.edu/globaltb/courses/brochures/2012/tbamonghomeless.html .
*10. Tuberculosis Clinical Intensive *
Sponsor: Curry International Tuberculosis Center
Dates: February 14 – 16, 2012
Location: San Francisco, California
Application deadline: January 9, 2012
This three-day course is designed for physicians and other licensed medical
professionals who diagnose and treat TB. The course will cover epidemiology
of TB; diagnosis, management, and treatment of TB; transmission and
pathogenesis; TB and HIV coinfection; TB targeted testing and laboratory
testing; pediatric TB; treatment of latent TB infection; multiple drug
resistance; legal and ethical issues in TB control; and TB radiology.
Enrollment is limited, and pre-registration is required. There is no fee
for this course. Continuing education credits are available.
For a complete course description and application information, visit
http://www.currytbcenter.ucsf.edu/training/tb_clinical_intensive.cfm .
*11. Advances in the Diagnosis and Treatment of Tuberculosis: 16th
Conference of the Union North America Region Pre-Workshop *
Sponsors: International Union Against Tuberculosis and Lung Disease - North
America Region (IUATLD-NAR). Heartland National TB Center. Curry
International Tuberculosis Center.
Date: February 22, 2012
Location: San Antonio, Texas
The goal of the pre-conference is to enhance the expertise of providers in
the diagnosis and treatment of their patients with, or at risk of, TB. This
course is intended for clinicians who diagnose and treat active TB and
LTBI. The following topics will be covered: cost-effectiveness of short
course treatment for LTBI; clinical predictors of TB relapse; molecular
detection of drug resistance; effective collaboration between the
clinician, the program, and the lab in diagnosis of MDR TB; and the impact
of automated molecular diagnostics on the initiation of TB treatment.
Information on NAR's 16th annual conference is available at
http://www.bc.lung.ca/association_and_services/union.html .
For more information about workshop content, e-mail: ;
about registration issue, e-mail ; or access the
Website at
http://www.heartlandntbc.org/temp/RTMCC-NSTC%20Brochure%202012.pdf.
*12. The Union North America Region Meeting: 16th Annual Conference *
Sponsor: The Union Against Tuberculosis and Lung Disease (The Union)
Dates: February 23 – 25, 2012
Location: San Antonio, Texas
The 16th Annual Conference of the International Union Against Tuberculosis
and Lung Disease will be held February 23-25, 2012, in San Antonio, Texas,
USA. The secretariat welcomes the submission of abstracts for poster and
oral presentations of research
on all aspects of TB control, including epidemiologic, clinical, basic
science, nursing, social, behavioral, psychosocial, and educational
studies, or outcomes of
program initiatives.
For more information, visit
http://www.bc.lung.ca/association_and_services/union.html .
*13. NYC Annual TB Conference *
Sponsor: New Jersey Medical School, Global Tuberculosis Institute
Date: March 23, 2012
Location: Queens, New York
This one day conference will be held in commemoration of World TB Day to
address TB prevention and control efforts in New York City. Nurses and
physicians will receive updates on TB in foreign-born persons, laboratory
diagnosis of TB, new modalities in the treatment of latent TB infection, as
well as other special topics.
For more information, contact Anna Sevilla, E-mail: ; or
access the Web site:
http://www.umdnj.edu/globaltb/courses/brochures/2012/nycannualconf.html .
*14. The Denver TB Course *
Sponsor: National Jewish Health
Dates: April 11 – 14, 2012
Location: Denver, Colorado
The purpose of this course is to present knowledge about the management of
TB to general internists, public health workers, infectious diseases and
chest specialists, registered nurses, and other healthcare providers who
will be responsible for the management and care of patients with TB. The
course content includes Clinical TB, Public Health, and Bacteriology.
Pre-registration is required. Early registration is advised because the
courses are frequently fully subscribed. Continuing education credits are
available.
For more information, contact Nicole Austin Ross, National Jewish Health.
E-mail ; phone (303) 398-1110; fax (303) 270-2239; or
access the Web site at
http://www.nationaljewish.org/education/pro-ed/events/tb-course/ .
*15. Maryland TB Today*
Sponsor: New Jersey Medical School, Global Tuberculosis Institute
Dates: April 17 – 18, 2012
Location: Marriottsville, Maryland
This two-day course will cover new and emerging topics related to TB
prevention and control. It is intended for health care providers who have
at least 4-6 months experience in TB control, but veteran staff from low
incidence areas may attend to update their knowledge and skills. Topics
will be covered by locally recognized TB experts from local TB clinics,
health departments, academic institutions, laboratory, and research
settings. Lectures will be combined with interactive discussions and
exercises as well as ample opportunity for networking.
For more information, contact Nickolette Gaglia, E-mail: ;
or access the Web site:
http://www.umdnj.edu/globaltb/courses/brochures/2012/mdtbupdate.html .
*16. ATS 2012 International Conference *
Sponsor: American Thoracic Society (ATS)
Dates: May 18 – 23, 2012
Location: San Francisco, California
The 2012 American Thoracic Society International Conference will take place
May 18-23, 2012 in San Francisco, California. More than 400 sessions will
provide a comprehensive review of the latest information on the diagnosis
and treatment of respiratory diseases, critical illnesses, and sleep
disorders. In addition, more than 5,500 scientific research abstracts and
clinical case reports will be presented, giving attendees new perspectives
on the clinical, basic science, and translational discoveries that will
shape the future of adult and pediatric respiratory care.
For more information contact ATS, E-mail: ; Phone:
(212) 315-8652; or access the Web site: http://conference.thoracic.org/2012/.
*17. The Denver TB Course *
Sponsor: National Jewish Health
Dates: October 10 – 13, 2012
Location: Denver, Colorado
The purpose of this course is to present knowledge about the management of
TB to general internists, public health workers, infectious diseases and
chest specialists, registered nurses, and other healthcare providers who
will be responsible for the management and care of patients with TB. The
course content includes Clinical TB, Public Health, and Bacteriology.
Pre-registration is required. Early registration is advised because the
courses are frequently fully subscribed. Continuing education credits are
available.
For more information, contact Nicole Austin Ross, National Jewish Health.
E-mail ; phone (303) 398-1110; fax (303) 270-2239; or
access the Web site at
http://www.nationaljewish.org/education/pro-ed/events/tb-course/ .
--
Sophie G. Beauvais
Communications & Web Content Manager
The Global Health Delivery Project at Harvard University
globalhealthdelivery.org | ghdonline.org |
@ghdonline<http://twitter.com/ghdonline>
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