To commemorate World TB Day on Thursday 24 March, each day this week we will feature a different aspect of the fight against TB
As a leading learning and teaching institution in the UK, LSTM ensures that postgraduate students have a sound and comprehensive understanding of all aspects of Tuberculosis. The Diploma course for Tropical Medicine and Hygiene (DTM&H) dedicates a full week to TB with lectures and a practical, to provide hands-on knowledge and skills to its 172 participants. In addition, LSTM has introduced a short course focussing solely on TB. As part of the Masters programmes at LSTM, experts from the field share their experience and discuss recent clinical and public health developments in TB during tutorials and student-centred learning activities. Modules such as ‘Current clinical challenges’ and ‘Disease control ‘ link TB-related learning and teaching with research at LSTM. Currently, 86 students attend Masters Courses at LSTM.
World TB Day Case Study: LSTM student Nyanda Ntinginya undertaking TB diagnosis pilot study in Tanzania
Nyanda’s study involves active case finding among household contacts using GeneXpert® MTB/RIF in Mbeya, Tanzania, which has one of the highest rates of TB in the world. This research forms part of LSTM’s Masters in Tropical and Infectious Diseases programme.
Nyanda’s background as a medical doctor exposed him to the reality of Tanzania’s TB burden. In 2006 he took an internship which led to a position with the Mbeya Medical Research Programme in Tanzania conducting TB clinical research, investigating diagnostic techniques and conducting clinical trials.
Tanzania is among the top 22 high TB burden countries worldwide, suggesting that TB cases continue to go undetected by the existing diagnostic approaches, which makes TB control more difficult. If untreated, a person with active pulmonary disease is considered to infect an average of 10 to 15 people per annum. Household members of sputum smear-positive TB patients are especially at increased risk of infection. Rapid diagnosis is therefore essential in reducing the number of positive cases.
National TB programmes in high burden countries, including Tanzania, rely on self-reporting of TB symptomatic patients to the health authorities. Studies on active case finding have been conducted using conventional diagnostic methods such as smear microscopy. Currently, no data is available on new rapid TB diagnostics in the context of active case finding in the community. GeneXpert® MTB/RIF is an automated rapid molecular test that has demonstrated high sensitivity and specificity among TB suspects who presented at the health care point/clinic.
Its diagnostic yield amongst household contacts of index TB cases however remains largely unknown. Furthermore, active case finding in general has not been studied in Tanzania.
Nyanda’s research is a cross-sectional pilot study among household contacts of smear positive TB patients, to determine prevalence of the disease using smear microscopy and Xpert MTB/RIF and to investigate the additional impact of Xpert MTB/RIF regarding early detection of pulmonary TB, compared to standard diagnostic methods. The information obtained in this study will be used primarily for possible planning of TB control interventions but also provide baseline information for further studies on prevalence data and utility of rapid tests in active case finding in high TB burden settings.
“Currently, we have just submitted the proposal for ethical approval both at the Liverpool School of Tropical Medicine Research Ethics committee in UK as well as the Mbeya Medical Research and Ethics Committee in Tanzania. So far the study is expected to take almost 10 weeks commencing on 18-27 April 2011, thereafter study findings will be made available.”
TB Consultancy
Through its consultancy company, Liverpool Associates in Tropical Health (LATH), LSTM has been involved in a number of successful capacity building projects in tuberculosis (TB) control. Recently Malawi has been supported by a team from LATH/LSTM to conduct the first national multi drug resistant tuberculosis (MDR TB) survey which was completed in February this year. The team supported Malawi to produce the study protocol, improve laboratory support and access high quality drugs for the treatment of MDR TB. This was a huge achievement for a country with limited infrastructure and critically low levels of trained staff. The results from this survey will, for the first time, allow Malawi to assess the degree of MDR TB in its population and lay the foundation for further studies of the burden of tuberculosis in one of the world’s poorest countries. This work was funded by the United States Agency for International Development.
LATH has also supported tuberculosis control team of Kano state in Nigeria to improve access to TB services and develop a five year plan for how to expand and improve those services. The pilot of this intervention indicated that access was improved for individuals who had previously found it difficult to access TB services due to the long distances they had been forced to travel. Kano and Jigawa states in Nigeria were also supported to improve the quality of their diagnostic services to help ensure that those with TB were properly identified. Additionally LATH has been involved in supporting White Nile State in Northern Sudan to improve its laboratory based diagnosis of TB by working with senior national and state level laboratory and clinical staff. These interventions were supported by the UK Department for International Development and the Norwegian Heart and Lung Foundation respectively.
Jean Chung