Infectious Disease
Infectious Disease and Social Change
Infectious diseases are the leading killers of people living in poverty. Complex, sometimes chronic, infectious diseases pose major challenges to improving the health of poor populations and have a profound impact on economic development. Because these diseases are fundamentally both biological and social in nature, understanding them and intervening effectively in their control require an analytic lens that is also both biological and social.
Investigators are clinicians, anthropologists, epidemiologists, and public health specialists who apply the disciplines of social medicine in two priority disease areas: drug-resistant tuberculosis and HIV disease. Current research aims to address questions including:
- how can effective treatment be best delivered and health systems strengthened?
- how can treatment regimens be optimized and quality of care improved?
- how can acquired resistance be prevented?
- how can transmission be prevented and disease risk reduced?
- how does the lived experience of poverty and disease impact global policy?
Faculty are active in teaching undergraduate and graduate students, as well as residents and fellows. The Program in Infectious Disease and Social Change is closely affiliated with the public charity Partners In Health, which provides free medical care to poor patients, and collaborates with the World Health Organization and other international agencies in Latin America and the Caribbean, Africa, and Eastern Europe.
Program faculty approach the study of infectious diseases from the vantage point of multiple and complementary disciplines. Investigators apply ethnographic and other social science methods to understand these diseases and the responses to them at the local and global levels—from the experience of patients and families confronting illness and inadequate health care to the construction of national and global health policies. Program faculty apply epidemiologic methods to understand the factors affecting treatment outcomes, and to improve treatment through clinical trials of existing and new compounds. These investigators use their research to improve local health care delivery approaches and to guide the design and implementation of health policies. The Program has more than 20 years of experience engaging these problems through applied research and teaching.
HIV/AIDS Research
The Latin America and Caribbean Prenatal Testing Initiative for HIV and Syphilis, Arachu Castro, PI
Assessing and Improving the Quality of Life of Cuban AIDS Patients, Arachu Castro, PI
Evaluation of Vertical Transmission of HIV in the State of São Paulo, Brazil, Arachu Castro, Co-investigator
Prenatal Testing for HIV and Syphilis in Colombia, Arachu Castro, PI
Prenatal Testing for HIV and Syphilis in Peru, Arachu Castro, PI
The Challenge of Adherence to Antiretroviral Therapy in Puerto Rico: Inequality and Social Relations in Urban San Juan, Arachu Castro, PI
Scale up of HIV services and integration with primary care, Haiti, Joia Mukherjee, PI
Psychosocial intervention in HIV-affected children in Haiti: A feasibility study, Mary C. Smith-Fawzi and Joia Mukherjee, Co-PIs
Perinatal outcomes and novel HIV assessment in infants, Joia Mukherjee, PI and Mary C. Smith-Fawzi, Co-Investigator
Comparative Ethnographic Study of Influences on Adherence to Antiretroviral Therapy in Jos, Nigeria and Dar es Salaam, Tanzania, Norma Ware, PI
Influences on ARVs in Uganda, Norma Ware, PI
CyberSenga: Harnessing the power of the internet to prevent HIV in Ugandan youth, Norma Ware, Co-investigator
“Scale Out: Expanding Access to Community-Based HIV Treatment and Care in Sub-Saharan Africa”, Norma Ware in collaboration with Jos University Teaching Hospital, Jos, Nigeria; Muhimbili University of Health and Allied Sciences/Dar es Salaam City Council/Harvard School of Public Health, Dar es Salaam, Tanzania
MDR TB Research
Extensively drug-resistant tuberculosis (XDR-TB) in at-risk households, Mercedes Becerra, PI
Epidemiology of multidrug-resistant tuberculosis, Mercedes Becerra, PI
Epidemiology and transmission dynamics of MDR/XDR tuberculosis, Mercedes Becerra, Co-investigator
Non-Governmental Organizations and Transnational Technology Transfer: Controlling Drug-Resistant Tuberculosis in Post-Soviet Siberia, Salmaan Keshavjee, PI
Centers for MDR-TB Translational Research and Training in Tomsk and Boston, Salmaan Keshavjee and Edward Nardell, Co-PIs
Building an integrated program to treat patients co-infected with multi-drug resistant tuberculosis and HIV disease in Lesotho: A model for sub-Saharan Africa and global scale-up, Salmaan Keshavjee, Jennifer Furin, K.J. Seung, Co-PIs
Improving TB diagnosis in high HIV Primary Care Settings, Salmaan Keshavjee, Co-Investigator
Centers for MDR-TB Translational Research and Training in Tomsk and Boston, Salmaan Keshavjee and Edward Nardell, Co-PIs
Observational study of individualized treatment regimens for MDR-TB & XDR-TB, Carole Mitnick, PI; Mercedes Becerra, Co-Investigator
- Effect of previous treatment exposure on outcomes
- Identification of early indicators of relapse and failure
- Predictors of sputum culture conversion
- Defining effective regimens
Observational study of individualized and standardized treatment for MDR-TB & XDR-TB, Mercedes Becerra & Carole Mitnick, Co-PIs
- Clinical outcomes of standardized and individualized therapy for MDR-TB: applying marginal structural models (funded through NIAID K01)
- Cost-effectiveness of MDR-TB treatment strategies
Multi-site, pooled observational study of individualized treatment for MDR-TB & XDR-TB, Carole Mitnick, Co-Investigator
Randomized trial of high-dose rifampin in patients with new, smear-positive pulmonary tuberculosis (planning grant), Carole Mitnick, PI
Research Excellence to Stop TB Resistance (RESIST-TB), Salmaan Keshavjee, Carole Mitnick, founding Steering Committee Members
Development of monitoring and evaluation tools for TB control in Russia, Joia Mukherjee, Co-investigator
Expanding a model of community based care from Haiti to Rwanda, Lesotho and Malawi, Joia Mukherjee, Co-investigator
THE LATIN AMERICAN AND CARIBBEAN INITIATIVE FOR THE INTEGRATION OF PRENATAL CARE WITH THE TESTING AND TREATMENT OF HIV AND SYPHILIS (ILAP)
The Latin American and Caribbean Initiative for the Integration of Prenatal Care with the Testing and Treatment of HIV and Syphilis (ILAP) has the goal to identify existing barriers for testing and treatment of HIV and syphilis during pregnancy in Latin America and the Caribbean and to design an intervention aimed at universalizing the integration of prenatal care with the testing and treatment of HIV and syphilis and strengthening health systems. The development of an operational research strategy oriented towards increasing and improving the diagnosis and treatment of HIV and syphilis during pregnancy has the potential of having enormous implications for public health. ILAP contributes to the early diagnosis and timely treatment of HIV and syphilis in women, to decrease the numbers of mother-to-child transmissions of HIV and congenital syphilis, to provide better care for large numbers of women and children, and to strengthening health systems in an important number of Latin America and the Caribbean countries.
ILAP is conducted collaboratively between the National AIDS Programs from Brazil, Colombia, Cuba, Dominican Republic, Nicaragua, Paraguay, Peru, and Uruguay, the Regional Office of UNICEF for Latin America and the Caribbean, the Regional Support Team of UNAIDS for Latin America, and Harvard Medical School. Experts in each country drive the agenda, set the goals, and commit their own national resources to provide opportunities for families to access quality health care. As a country with a very low mother-to-child transmission of HIV and no congenital syphilis, the role of the Cuban National AIDS Program is to provide advice and technical support, based on their experience providing high-quality care in a low-resource setting. The UN agencies provide technical and logistical assistance and Harvard Medical School coordinates the methodological and analytical development and provides research support at the request of country teams.
When ILAP was launched in Panama City, Panama in November 2007, country teams and institutions pledged to support one another technically by sharing results and strategies. The group outlined a plan and timetable with a common methodology. At the second meeting, held in Bogotá, Colombia in March 2008, each country team presented their detailed plan of action along with their priority areas.
Each participating country is represented by a country coordinator who works closely with the director of the National AIDS Program. Each country team selected a number of regions in their country with the purpose of seeking as much variability as possible in terms of differential access to prenatal care, the epidemiology of HIV and syphilis, and social, economic, and political considerations. In each country, the research starts with a situation analysis of current barriers that preclude the integration of prenatal care with the care for HIV and syphilis (Phase 1A), based on which country teams and Harvard Medical School develop a research instrument that is administered to pregnant women (Phase 1B). The instrument is a closed questionnaire that includes a core component similar for all the countries and an additional section that is adapted to the health care situation of each country.
The operational research of Phase 2 has the objective of informing, supporting, and monitoring the required changes to reach the integration of prenatal care with the testing and treatment of HIV and syphilis.
The ILAP team:
Brazil: Mariângela Simâo, Luiza Matida (coordinadora de país), Paulo Teixeira. Colombia: Ricardo Luque, Sidia Caicedo (country coordinator). Cuba: Jorge Pérez, Longina Ibargollen. Nicaragua: Aurora Soto (country coordinator). Paraguay: Nicolás Aguayo, Alma María Barboza (country coordinator), Zully Suárez. Peru: José Luis Sebastián, José Calderón (country coordinator), Jaime Bayona. Dominican Republic: Félix Báez, Gustavo Rojas, Claudia Bautista (country coordinator), Osvaldo Lorenzo. Uruguay: María Luz Osimani, Libia Cuevas (country coordinator). UNICEF: Mark Connolly, Vivian López, Cecilia Sánchez, Geoffrey Ijumba, NohoraCorredor, José Ramón Espinoza, Sara Menéndez, Álvaro Arroyo, Mario Tavera, Amado Lovera, Daniela Ligiéro, Odalys Rodríguez. UNAIDS: César Núñez, Ricardo García, Renate Ehmer, Patricia Bracamonte. Harvard Medical School: Arachu Castro (project director), Sonya Shin, Kedar Mate, Mary C. Smith Fawzi, and students.