My research uses translational and implementation science to improve diagnostic evaluation and case finding for tuberculosis (TB) in low- and middle-income countries. Through interdisciplinary collaborations with scientists from the biological, engineering, behavioral, and population sciences, I strive to develop better ways of finding and treating the more than 10 million individuals living with TB around the world, using a patient-centered approach. Mentoring and advising trainees is a core aspect of all of my projects:
TB Biomarker Research in the Mulago Inpatient Novel Diagnostics (MIND) for Pneumonia Study. MIND, a longitudinal cohort study started in 2005 with colleagues from Makerere University and UCSF has now enrolled over 4000 inpatients with pneumonia at Mulago National Referral Hospital in Kampala, Uganda. MIND provides a robust platform for research on diagnosis and pathogenesis of TB and other acute respiratory illnesses, and includes a bio-specimen repository. Several notable MIND studies have included the early evaluation of the GeneXpert MTB/RIF assay, a real-time automated nucleic acid amplification test for TB; studies of human exosome-derived peptide biomarkers for TB diagnosis and prognosis; and gene-expression studies seeking biomarkers of M. tuberculosis persistence and TB relapse.
TB Diagnostic Evaluation and Case Finding within the Uganda Tuberculosis Implementation Research Consortium (U-TIRC). In 2008, in collaboration with colleagues from Makerere University, the Uganda National TB and Leprosy Programme, and other overseas universities, I established a TB implementation research network at primary health centers across Uganda focused on high-quality, patient-centered care. Ongoing studies include an R01-funded randomized, controlled trial of mobile health-supported, home TB and HIV contact investigation in Uganda, and a study to improve the quality and effectiveness of TB education and counseling in Uganda and South Africa.
Implementation of GeneXpert MTB/RIF to Guide Triage of Airborne Infection Isolation Rooms in the United States. I recently completed several studies evaluating the clinical and public health impact of GeneXpert MTB/RIF on rapid TB evaluation strategies in clinic and hospital settings. These studies applied novel methods for assessing impact of new TB diagnostics and contributed to the evidence base supporting National TB Controllers' Association recommendations that this test be used to guide triage out of airborne-infection isolation rooms in hospitals.
Training and Capacity Building in Uganda. Building human capacity for research and patient care in Uganda is an important aspects of all projects. A Fogarty International Center-supported Pulmonary Complications of AIDS Research Training (PART) Program that I lead with Dr. Achilles Katamba of Makerere University and Professor Art Reingold from UC Berkeley is training Ugandan researchers in translational research in HIV-associated lung diseases, including TB. I am also founder and research director of Walimu (www.walimu.org), a US- and Uganda-registered non-profit which uses implementation science to improve care for severe acute illness in low-income countries.