Innovative public health interventions are necessary to combat the syngergistic devastation emerging from the dual TB and HIV epidemics in many regions of the world. This proposal will build upon a strong, long-standing working relationship between the Johns Hopkins Center for TB Research and the Rio de Janeiro Health Department to train a highly qualified epidemiologist to become an independent public health researcher in international TB and HIV research and to become proficient at designing and conducting clustered randomized trials (CRTs). Through close mehtorship with two exceedingly qualified investigators, specific coursework, and leadership of a large scale clustered randomized trial, this training will be structured and substantial. The faculty at the Center for TB Research is highly distinguished and the epidemiologic instruction available at the Bloomberg School of Public Health is world renowned. The proposed study will determine if the routine detection and treatment of latent TB in HIV-infected patients in HIV clinics in Rio de Janeiro, Brazil, will reduce TB incidence in those clinics; and, determine the independent and combined effectiveness of isoniazid prophylactic therapy (IPT) and antiretroviral (ARV) therapy to reduce TB incidence in HIV-infected patients. The intervention will consist of implementing a comprehensive policy of screening for and treating latent TB in all HIV-infected patients. Approximately 20,000 patients in 29 HIV clinics will be followed for 5 years and the CRT will take a phased-implementation approach to ensure that all participating clinics will eventually have full coverage. TB incidence will be compared between clinics receiving the intervention and those not yet receiving the intervention. The impact of combined ARV and IPT programs is not known, but together these strategies could potentially reduce TB risk to extremely low levels. Mastering the techniques associated with clustered randomized trials will provide the candidate with important tools for exploring new approaches to reducing TB incidence and transmission. This K01 award will provide the epidemiological training and experience necessary to become a successful, independent public health investigator.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01AI066994-02
Application #
7082873
Study Section
Special Emphasis Panel (ZAI1-RB-A (M1))
Program Officer
Huebner, Robin E
Project Start
2005-07-01
Project End
2010-05-31
Budget Start
2006-06-01
Budget End
2007-05-31
Support Year
2
Fiscal Year
2006
Total Cost
$110,222
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Lima, Juliana Figueirêdo da Costa; Guedes, Gabriela de Moraes Rêgo; Lima, Juliana Falcão de Araújo et al. (2015) Single-tube nested PCR assay with in-house DNA extraction for Mycobacterium tuberculosis detection in blood and urine. Rev Soc Bras Med Trop 48:731-8
Golub, Jonathan E; Cohn, Silvia; Saraceni, Valeria et al. (2015) Long-term protection from isoniazid preventive therapy for tuberculosis in HIV-infected patients in a medium-burden tuberculosis setting: the TB/HIV in Rio (THRio) study. Clin Infect Dis 60:639-45
Dowdy, David W; Golub, Jonathan E; Saraceni, Valeria et al. (2014) Impact of isoniazid preventive therapy for HIV-infected adults in Rio de Janeiro, Brazil: an epidemiological model. J Acquir Immune Defic Syndr 66:552-8
Azadi, M; Bishai, D M; Dowdy, D W et al. (2014) Cost-effectiveness of tuberculosis screening and isoniazid treatment in the TB/HIV in Rio (THRio) Study. Int J Tuberc Lung Dis 18:1443-8
Saraceni, Valeria; Cohn, Silvia; Cavalcante, Solange C et al. (2014) Prevalent tuberculosis at HIV diagnosis in Rio de Janeiro, Brazil: the TB/HIV in Rio (THRio) Cohort. J Acquir Immune Defic Syndr 67:98-101
Unis, Gisela; Ribeiro, Andrezza Wolowski; Esteves, Leonardo Souza et al. (2014) Tuberculosis recurrence in a high incidence setting for HIV and tuberculosis in Brazil. BMC Infect Dis 14:548
Saraceni, Valéria; Talhari, Carolina C; Pereira, Gerson F et al. (2013) AIDS-related Kaposi's sarcoma in Brazil: trends and geopolitical distribution. Int J Dermatol 52:1525-9
dos Santos, A P G; Pacheco, A G; Staviack, A et al. (2013) Safety and effectiveness of HAART in tuberculosis-HIV co-infected patients in Brazil. Int J Tuberc Lung Dis 17:192-7
Durovni, Betina; Saraceni, Valeria; Moulton, Lawrence H et al. (2013) Effect of improved tuberculosis screening and isoniazid preventive therapy on incidence of tuberculosis and death in patients with HIV in clinics in Rio de Janeiro, Brazil: a stepped wedge, cluster-randomised trial. Lancet Infect Dis 13:852-8
Miranda, Angelica Espinosa; Lima, Bettina Moulin Coelho; Giami, Alain et al. (2012) Behavior assessment of women attending a sexually transmitted disease clinic in Vitória, Brazil. An Bras Dermatol 87:197-202

Showing the most recent 10 out of 35 publications