After HIV, tuberculosis is the single largest infectious killer of adults in the world today. Among the most important aspects of TB control in most low and middle-income countries is the airborne spread of drug resistant (DR) tuberculosis, substantially in institutions such as hospitals, clinics, jails, prisons, and refugee camps. Institutional airborne infection control is a public health problem that intersects with several oter disciplines: architecture, engineering, and medicine. However, there have been no real innovations in airborne infection control in many decades, perhaps since the adaptation of industrial respirators for health care worker use in the 1990s. This proposal seeks to build international research capacity to address the issue of airborne spread of infections in buildings. Of greatest concern is the DR TB epidemic, but most of the interventions that result from this research will be equally relevant to other infections with airborne potential, such as pandemic influenza. This proposal continues the air disinfection engineering research training conducted under a 1-year Stimulus Fogarty Innovations Framework grant in Boston and in South Africa. It expands that work to include research training for architects as well as engineers in Boston and South Africa, using as a Partners In Health (PIH) clinical sites around the world, as well as research sites accessible through our South African partners, the Council for Scientific and Industrial Research (CSIR) and the University of Pretoria (UP). Course work will be available through UP. Under expert multidisciplinary mentorship, our trainees will develop and test novel indicators of successful building designs and, with another partner, the Medical Research Council (MRC) of South Africa, quantitatively test novel air disinfection technology developed in Boston and Pretoria. Our trainees will perform testing at the Airborne Infections Research (AIR) Facility (Witbank, SA), an established collaborative project between the MRC, the US CDC, UP, and Brigham & Women's (BWH) Hospital. If these innovations show promise, we will work with our local partners and two transitional research partners (the National Institute of Design of Indi and Frog Design, Inc) to optimize and commercialize products for local manufacture so that implementation is sustainable. Our own research at the AIR facility has demonstrated the rapid and powerful effect of effective treatment on TB transmission, even for drug resistant strains. Therefore, another complementary approach to the airborne spread of DR TB will be to test the impact on TB transmission of active case finding through cough surveillance followed by rapid molecular testing and drug susceptibility testing that will allow patients to be rapidly placed on effective treatment. Our physician trainees will test this approach at a large general hospital in Lima, Peru that has carefully monitored TB cases among its workers over the years. Our partners in this clinical research and training project will be the National Institute of Health of Peru (INS) and Socios En Salud (SES), the Peru arm of PIH, with course work in epidemiology available through San Marcos University.
This proposal will build global capacity in airborne infection control research in the cross-disciplinary areas of architecture, engineering, and medicine by providing training and research opportunities in South Africa, Peru, and the USA. It will develop indicators for effective building designs including a new test for air movement, develop and test new germicidal UV fixtures, and test an entirely new approach to TB transmission control based on active case finding, rapid molecular diagnosis and effective treatment based on rapid drug susceptibility testing.
