Multidrug-Resistant Tuberculosis Treatment and Policy

Faculty on this project are involved in the following research, teaching, and service areas:

  • Design, implementation, and evaluation of programs that provide treatment for multidrug-resistant tuberculosis (MDR-TB)
  • Treatment outcomes research
  • Transmission dynamics of drug-resistant tuberculosis
  • Clinical trials to optimize existing tuberculosis drugs and new antituberculosis therapies, including novel drug-delivery mechanisms and leadership of the RESIST-TB clinical trials network
  • Tuberculosis infection- and transmission-control research
  • Development of local and international guidelines and policy for drug-resistant tuberculosis
  • Provision of technical assistance for international agencies to more than 50 countries
  • Training of health workers at all levels in Africa, Asia, Eastern Europe, and the Americas
  • International course for engineers and architects to build capacity for scaling up global efforts to address MDR-TB

Social and Behavioral Dimensions of HIV Treatment and Prevention

This active program of research on the social, behavioral, and psychosocial dimensions of HIV treatment and prevention in sub-Saharan Africa and Haiti involves extensive collaborations between project faculty and clinicians, program directors, and policymakers in Haiti and sub-Saharan Africa. These efforts include:

  • Basic and operational research projects in Nigeria, Tanzania, and Uganda addressing key questions of health care delivery in a number of domains; for example, adherence to antiretroviral treatment for HIV/AIDS, retention in care, decentralization of health care, and health systems integration and strengthening.
  • Training in social science concepts and methods for HIV research in low-income countries.
  • The implementation of a family-centered psychosocial support group model in Haiti with HIV-affected youth and their caregivers; this effort includes research into the effectiveness of such a support group model.
  • Development of monitoring and evaluation systems, including HIV/TB monitoring, for programmatic efforts, such as the Village Health Works initiative in Burundi.
  • Clinical trial research aimed at identifying effective prevention of HIV infection in Tanzania.
  • Mentorship of Harvard Medical School students and contribution to Harvard classes.

Information Technology and Disease Control

Since 2000, project faculty have been collaborating with the medical informatics team from the nonprofit Partners In Health (PIH) to develop Web-based electronic-medical-record (EMR) systems to support the management of MDR-TB and other diseases.

Beginning in Lima, Peru, the team built the first Web-based EMR system to support the treatment of MDR-TB in a resource-poor environment. This system is used to manage the clinical data on all MDR-TB patients treated by the Peruvian National TB program, including clinical history, drug regimens, laboratory data, and outcomes. It includes tools to forecast drug requirements based on a model of the typical patient’s treatment time and regimens.

  • Laboratory data management. The PIH-EMR was extended to add a module for laboratory data collection and reporting. The team also implemented a laboratory data collection system for small labs without Internet access using personal digital assistants.
  • OpenMRS-TB. Development of a new EMR system for MDR-TB clinical management and reporting based on the open source model. It is now in used in Haiti, Pakistan, and Rwanda, with ongoing efforts to implement it in additional countries.
  • Pharmacy and drug forecasting. Development of a pharmacy and supply-chain management system in Haiti to manage TB and MDR-TB drugs as well as the full range of other products used in the clinics. A similar tool for MDR-TB has been created and implemented in Peru.
  • New initiatives with Indus Hospital in Pakistan. Development of community-based data-transfer systems using cellular phones.