Lightning Talk about Tuberculosis by Luke Davis

Transcript

• 00:02<v ->Well, good afternoon everyone.</v>
• 00:03I want to talk today a little bit about my interest,
• 00:06and it looks like I need to pick up a different clicker,
• 00:11which is tuberculosis.
• 00:12So tuberculosis is the leading
• 00:14infectious cause of death worldwide.
• 00:16And we believe that last year
• 00:17it affected around 10.6 million people.
• 00:20The World WHO TB report comes out every year
• 00:23around this time,
• 00:24so the latest data that that we have is from 2021.
• 00:27And following the pandemic,
• 00:28there was a big decline in the number of people
• 00:30having access to quality assured diagnosis
• 00:35and initiation of treatment.
• 00:37But it's long been the case
• 00:38that a large proportion of people living with TB
• 00:41go undiagnosed.
• 00:42We think more than 4 million people.
• 00:43So one of the things that we're interested in
• 00:45is how can we identify those people?
• 00:47There's many reasons why they aren't diagnosed.
• 00:49One challenge of course, is that TB is often asymptomatic.
• 00:52So we need to identify better ways of screening
• 00:55and identifying people in the community
• 00:56who don't know they have symptoms.
• 00:58And then we need to improve access
• 00:59for people who do have his symptoms
• 01:00and encourage them to seek care
• 01:03in clinics where they can get diagnoses.
• 01:06The tool that we use in our laboratory for doing this work
• 01:08is called implementation science.
• 01:10I know there are probably a number of people in this room
• 01:11that have heard of this field,
• 01:14and there's a course that I teach in the fall,
• 01:16for those who are thinking about
• 01:17their courses for next fall,
• 01:19which goes over what implementation science is.
• 01:22But in short it is a systematic approach
• 01:26for the design, delivery and evaluation of strategies
• 01:28to improve the uptake of proven interventions
• 01:31into routine practice.
• 01:32And we think of it as a translational research discipline.
• 01:35Translational research
• 01:36involving multidisciplinary collaborations
• 01:38that move ideas from their foundational basis,
• 01:42whether that's in the laboratory,
• 01:43in fundamental biology
• 01:44as we were hearing about a little bit earlier from Brian.
• 01:47Or more on the other end of the spectrum
• 01:49here where our group works,
• 01:50which is thinking about how do we move
• 01:51from patients to practice
• 01:53and ultimately to public health.
• 01:55And it turns out that that discipline doesn't happen
• 01:58just when good ideas get published in journals
• 02:00showing that they're effective.
• 02:01It's really necessary to think about
• 02:03how would those ideas be adapted to a real world setting.
• 02:07So in the contexts of TB, I wanna talk about
• 02:09three different types of studies that we've done.
• 02:11Formative work to help us understand
• 02:13what the nature of the barriers are
• 02:14to delivering these evidence-based services for TB.
• 02:18Actual implementation studies
• 02:19where we introduce these ideas.
• 02:22And then evaluation studies
• 02:23where we try to figure out what works
• 02:25and why or why it doesn't work.
• 02:27And a lot of the work that I've done
• 02:29is in the area of contact investigation.
• 02:31So contact investigation,
• 02:32I think as everybody in the room is probably familiar,
• 02:34is a strategy where we look for high risk populations
• 02:37of having a disease like tuberculosis,
• 02:39among those that are close contacts
• 02:41to people with tuberculosis,
• 02:42knowing that to tuberculosis is transmitted
• 02:44from person to person through respiratory aerosols.
• 02:49And that work that we've done in the area
• 02:50of contact investigation
• 02:52has spanned different parts of the globe,
• 02:53because we know in different contexts
• 02:55there may be different reasons.
• 02:57We're interested in understanding
• 02:58both the generalizable reasons,
• 02:59why it's hard to do contact investigation,
• 03:02and also some of the setting specific regions.
• 03:05So for example here on the far left,
• 03:06in Columbia one of our scholars, Gustavo Diaz,
• 03:09who was a postdoctoral fellow at the GHS program,
• 03:12used routine public health data to map the barriers
• 03:15and characterize those.
• 03:17Here below, this is a qualitative research study
• 03:20that was looking at another aspect of TB care
• 03:22which is education and counseling,
• 03:23which is very important
• 03:25to get people newly diagnosed with TB
• 03:27to be willing to share the contact information
• 03:30of their close contacts,
• 03:30and also for them to be able to achieve
• 03:32good treatment outcomes on their own
• 03:34and get initiated in other therapies
• 03:36that may be important like HIV treatment.
• 03:39And so this is work that was carried out
• 03:40with Alisse Hannaford,
• 03:41who was a medical student at the time.
• 03:43Then the third example was looking at these similar methods,
• 03:46not just for TB case finding
• 03:48in the community that it's searching,
• 03:50but also for treatment of TB and for prevention
• 03:53as work that was done by Christina Parisi,
• 03:56who was an EMD student a few years back
• 03:58and is now a PhD student at the University of Florida.
• 04:01We're also interested in taking this information
• 04:03about barriers to delivery of care and try to combine it.
• 04:06So taking qualitative information,
• 04:08taking quantitative information,
• 04:09and developing strategies to try to change that.
• 04:12One of the strategies that we're very excited about
• 04:15is the use of collaborative design approaches,
• 04:18specifically human-centered design,
• 04:21where we try to come up with solutions
• 04:22that work for the communities that we're working with.
• 04:24And so here's an example in the middle of (indistinct)
• 04:27who's a laboratory manager in one of our projects in Uganda.
• 04:30We're using the human-centered design approach
• 04:32with the post-it notes to try to come up with good ideas.
• 04:36And than we've developed those
• 04:37into a couple of different types of strategies.
• 04:39So these are described in publications by Amanda Gupta,
• 04:42who's a research coordinator in our laboratory
• 04:45and a PhD student.
• 04:46And also by Joseph Tita,
• 04:49who's one of our qualitative scientists in Uganda.
• 04:52We're also a lot of times interested,
• 04:53even at the design phase,
• 04:54in thinking about what the costs are.
• 04:56A lot of times we wait until the end of a study
• 04:58to evaluate that.
• 04:59But in this particular project,
• 05:00we knew we learned from our prior work
• 05:02that it's very expensive to kind of develop strategy.
• 05:06So we looked at the cost strategy,
• 05:08and this was work led by Patricia Turimumahoro,
• 05:11who is currently a GHES scholar.
• 05:14So I'll just close by kind of describing
• 05:16the most exciting aspect of this work
• 05:18was actually evaluating where these strategies work.
• 05:20And we just recently completed a pragmatic trial
• 05:23using a stepped-wedge cluster-randomized design
• 05:25where we took a human-centered design approach
• 05:28that include multiple components.
• 05:29And these components include things
• 05:31that ease the multi-step process of contact investigation
• 05:35to kind of help participants, namely household contacts,
• 05:38better be able to engage in these services.
• 05:40Things like a motorcycle rider, to take them to the clinic.
• 05:44Educational strategies and also instructional information
• 05:47to help them produce sputum.
• 05:49And combining that with strategies of quality improvement
• 05:52to help community health workers better deliver that.
• 05:54And we are are just now looking at that preliminary data.
• 05:57It looks very promising
• 05:59that these strategies can be in fact impactful.
• 06:01And we're now testing those
• 06:02to other aspects like TB prevention.
• 06:05So with that, I'll close and see if there's any questions,
• 06:08or I can take them at the end.
• 06:09Thank you.
• 06:10(audience applauding)