Sonya Shin, M.D. has completed an Infectious Disease fellowship at Brigham and Women's and Massachusetts General Hospitals. She has served as a Clinical Consultant on a multidrug-resistant tuberculosis (MDR-TB) project in Peru since 1996. Drs. Paul Farmer, Edward Nardell, and Michael Hughes will serve as mentors for this study. Dr. Shin plans to develop her skills as an independent clinical investigator, while gaining further formal training in epidemiology and decision analysis research. She ultimately hopes to pursue an independent career in TB clinical trials and program management. Several sites at the Harvard Medical School will provide a research environment for the candidate. Both the Division of Social Justice and Health Inequalities at the Brigham and Women's Hospital and the Harvard School of Public Health, will provide ample environment for the candidate's professional development. Socios en Salud and the Ministry of Health in Lima, Peru will provide additional supervision and resources. MDR-TB remains a global health threat. Use of simple methods to rapidly identify multidrug-resistant tuberculosis strains will likely hasten treatment response.
The specific aims of this study are to compare the sensitivity and specificity of two rapid drug susceptibility testing (DST) methods, the Luciferase Reporter Mycobacteriophage (LRM) method and a nitrate-reductase colorimetric (Griess) method, to conventional DST; and 2) to compare time to culture conversion among MDR-TB patients among high-risk cases randomized to receive individualized treatment based on either 1) a novel rapid DST method (Griess or Luciferase), 2) BACTEC or 3) conventional DST. Our hypotheses are that 1) the LRM and Griess methods will provide acceptably sensitive and specific alternatives to conventional drug susceptibility testing; and 2) use of rapid drug susceptibility testing compared with conventional DST to screen subjects at high risk for MDR-TB and guide individualized therapy will shorten time to culture-conversion among MDR-TB cases.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Mentored Patient-Oriented Research Career Development Award (K23)
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Microbiology and Infectious Diseases B Subcommittee (MID)
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Jacobs, Gail G
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Brigham and Women's Hospital
United States
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Velásquez, Gustavo E; Cegielski, J Peter; Murray, Megan B et al. (2016) Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study. BMC Infect Dis 16:45
Magee, M J; Bloss, E; Shin, S S et al. (2013) Clinical characteristics, drug resistance, and treatment outcomes among tuberculosis patients with diabetes in Peru. Int J Infect Dis 17:e404-12
Lin, Hsien-Ho; Shin, Sonya S; Contreras, Carmen et al. (2012) Use of spatial information to predict multidrug resistance in tuberculosis patients, Peru. Emerg Infect Dis 18:811-3
Shin, S S; Asencios, L; Yagui, M et al. (2012) Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru. Int J Tuberc Lung Dis 16:1538-43
Lin, H; Shin, S; Blaya, J A et al. (2011) Assessing spatiotemporal patterns of multidrug-resistant and drug-sensitive tuberculosis in a South American setting. Epidemiol Infect 139:1784-93