Carole Mitnick, ScD
Carole Mitnick is assistant professor of global health and social medicine at Harvard Medical School. Dr. Mitnick’s research centers on the improvement of clinical management and programmatic policy for tuberculosis and multidrug-resistant tuberculosis (MDR-TB) globally. Dr. Mitnick is a founding investigator of a new movement to conduct randomized controlled clinical trials to improve treatment of drug-resistant TB (RESIST-TB). Dr. Mitnick’s work also includes applying marginal structural modeling to MDR-TB treatment data to assess the effect on outcomes of different types of therapy in observational studies. Dr. Mitnick is the Principal Investigator of an NIAID grant to plan a Phase II clinical trial examining the potential of high-dose rifampin to shorten standard TB therapy. Her research questions are strongly influenced by the mission of Partners In Health, with which Dr. Mitnick has worked since 1996: she strives to conduct research that will effect changes in global policy to ensure the highest standard of care and best treatment outcomes for patients suffering from all forms of tuberculosis, regardless of where they live.
This influence has also driven Dr. Mitnick’s involvement in global policy efforts. She contributed to the original and revised Guidelines for the Programmatic Management of MDR-TB. She sought, through the publication, Randomized trials to optimize treatment of MDR-TB: the time for action is now (PLoS Medicine, 2007), to generate increased support for controlled examination of anti-mycobacterial agents for the treatment of MDR-TB. Through participation in working groups, sub-groups, and task forces of the STOP-TB Partnership, she has co-authored two articles which define research agendas for MDR-TB (Gupta et al., IJTLD, 2003; Cobelens et al., PLoS Medicine 2008) and one that proposed standardized definitions for analysis of MDR-TB treatment outcomes (Laserson et al., IJTLD, 2005). She has recently begun consulting for the Green Light Committee of the World Health Organization for francophone countries implementing programmatic management of MDR-TB. Her efforts extend to capacity building for recording and reporting on the management of drug-resistant TB, as well as to clinical and operational research in Latin America and beyond. She develops and participates in post-graduate trainings, network-building activities, and trial protocols to be implemented within settings of National TB Programs around the world.
Dr. Mitnick graduated cum laude from the University of Rochester in 1988 with a B.A. in political science and French. She spent 1986-1987 in Paris, France studying at L’Institut d’Etudes Politiques and L’Université de Paris IV. In 1996, she received a Masters in international health epidemiology and ecology from the Harvard School of Public Health, and in 2001 she completed a Doctor of Science in international health epidemiology and ecology, also at the Harvard School of Public Health.
Contribution to Courses
Harvard Medical School
- Tutor, Introduction to Social Medicine
- Tuberculosis in Prisons in the Former Soviet Union, Social Roots of MDR-TB: Case Study from Peru (Social Roots of Disease)
- Physicians in Community
- Culture, Poverty, and Disease
Harvard School of Public Health
- Epidemiologic Methods for Tuberculosis, Applied Tuberculosis Epidemiology: Outcomes Evaluation, When DOTS isn’t enough: case study from Peru, Epidemiology of drug-resistant tuberculosis (Tuberculosis, the Organism, the Host, and the Global Threat)
- Conducting Research within Complex Health Interventions in Resource-Poor Settings (Takemi Seminar in Population and International Health)
- Epidemiology of Infectious Diseases of Importance in Developing Countries
- Evaluation and Monitoring of Public Health Interventions in Developing Countries
- Observational clinical outcomes research in MDR-TB
- Clinical trials to shorten standard TB treatment
- Clinical trials to improve and simplify treatment of drug-resistant TB
Current Research Projects
- Developing Phase III trials of individualized treatment for MDR-TB
- Observational studies of clinical outcomes of individualized treatment for MDR-TB and XDR-TB
- Applying marginal structural modeling to observational studies of MDR-TB treatment to assess the effect on outcomes of different types of therapy
- Developing a Phase II clinical trial to investigate the potential of high-dose rifampin to shorten standard TB treatment
- Furin JJ, Mitnick CD, Shin SS, Bayona J, Becerra MC, Singler JM, Alcántara F, Castañeda C, Sánchez E, Acha J, Farmer PE, Kim JY. Occurrence of serious adverse effects in patients receiving community-based therapy for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2001; 5(7): 648-55.
- Gupta R, Espinal M; Stop TB Working Group on DOTS-Plus for MDR-TB. A prioritised research agenda for DOTS-Plus for multidrug-resistant tuberculosis (MDR-TB). Int J Tuberc Lung Dis 2003; 7(5): 410-4.
- Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcántara F, Sánchez E, Sarria M, Becerra M, Fawzi MC, Kapiga S, Neuberg D, Maguire JH, Kim JY, Farmer P. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 2003; 348(2): 119-28.
- Chávez Pachas AM, Blank R, Smith Fawzi MC, Bayona J, Becerra MC, Mitnick CD. Identifying early treatment failure on category I therapy for pulmonary tuberculosis in Lima Ciudad, Peru. Int J Tuberc Lung Dis 2004; 8(1): 52-8.
- Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V, Zarovska E, Rich ML, Fraser HS, Alarcon E, Cegielski JP, Grzemska M, Gupta R, Espinal M. Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2005; 9(6): 640-5.
- Rich ML, Socci AR, Mitnick CD, Nardell EA, Becerra MC, Bonilla C, Bayona J, Seung KJ, Furin J, Farmer PE, Mukherjee JS. Representative drug susceptibility patterns for guiding design of retreatment regimens for MDR-TB. Int J Tuberc Lung Dis 2006; 10(3): 290-6.
- Mitnick CD, Castro K, Harrington M, Sacks L, Burman W. Randomized trials to optimize treatment of MDR-TB: the time for action is now. PLoS Med 2007; 4(11):e292.
- Franke MF, Appleton SC, Bayona J, Arteaga F, Palacios E, Llaro K, Shin SS, Becerra MC, Murray MB, Mitnick CD. Risk factors and mortality associated with default from multidrug-resistant tuberculosis treatment. Clin Infect Dis 2008 Jun 15;46(12):1844-51.
- Cobelens F, Heldal E, Kimerling M, Mitnick C, Podewils L, Ramachandran R, Rieder H, Weyer K and Zignol M, on behalf of the Working Group on MDR-TB of the Stop TB Partnership. Scaling up programmatic management of drug-resistant tuberculosis: A prioritized research agenda. PLoS Medicine 2008; 5(7): e150.
- Mitnick CD, Shin SS, Seung KJ, Rich ML, Atwood SS, Furin JJ, Fitzmaurice GM, Alcántara F, Appleton SC, Bonilla C, Chalco K, Choi S, Franke MF, Fraser HSF, Guerra D, Hurtado RM, Jazayeri D, Joseph K, Llaro K, Mestanza L, Mukherjee JS, Muñoz M, Palacios E, Sánchez E, Bayona J, Becerra MC. Comprehensive treatment of extensively drug-resistant tuberculosis. N Engl J Med 2008;359(6):563-74.