Tuberculosis

Chest X-ray TB

Pulmonary Tuberculosis: Chest x-ray showing alveolar infiltrates in both lungs due to Mycobacterium tuberculosis disease. credit: Dreamstime

Tuberculosis (TB) is the leading cause of infectious death worldwide, afflicting over 10 million people each year. TB is particularly concentrated in vulnerable populations, with large sub-epidemics found among persons living with HIV (PLHIV), young children and the urban poor. Drug-resistant TB, still untreatable in many communities around the world and now spreading from person to person, is a looming threat to recent gains in the control of drug-susceptible TB and HIV-TB. In addition to these epidemics of active TB disease, one-third of the world’s population have latent TB infection, and are at high risk of progression to active TB at some point in their lifetimes. In most cases, TB is highly preventable and curable, but gaps in both our basic understanding of TB and our translation of existing knowledge into public health practice make TB one of the world’s most daunting and dangerous infectious diseases.

Faculty at Yale School of Public Health are actively working to answer many of the most important scientific and public health questions related to TB using the tools of epidemiology, clinical research and the translational sciences. Particular areas of methodical interest and expertise include quantitative modeling and implementation science. Focus countries include Moldova, South Africa and Uganda, with additional projects ongoing in Brazil, Colombia, Kenya, Pakistan, Peru and Vietnam, among others.

The research of Associate Professor Ted Cohen seeks to understand how TB drug-resistance and medical comorbidities such as HIV frustrate current efforts to control epidemics, with an ultimate goal of developing more effective approaches to limit the morbidity caused by this pathogen. His work includes mathematical modeling, fieldwork and analysis of programmatic data.

The research of Associate Professor Luke Davis focuses on improving diagnosis, treatment monitoring and active case-finding strategies for active TB. His current work seeks to use implementation science to improve how case-finding strategies are developed, introduced and evaluated. Other projects seek to identify novel biomarkers to improve the way novel drug regimens are evaluated during clinical trials and implemented for clinical monitoring.

Professor Albert Ko, an expert on infectious diseases that have emerged as a consequence of rapid urbanization and social inequity, co-directs studies that seek to understand and intervene upon TB transmission in correctional settings in Brazil. Assistant Professor Reza Yaesoubi, an expert in model-based evaluation of health policies based in the Department of Health Policy and Management, is designing adaptive decision-making techniques to help policy makers more efficiently and effectively control the spread of infectious diseases including tuberculosis. Mari Armstrong-Hough, an Associate Research Scientist, is a sociologist with expertise in the use of mixed methods to design and evaluate community-based interventions for TB case finding, and is interested in research to better understand TB-diabetes co-infection.

A number of secondary faculty are global leaders in TB research. Professor Gerald Friedland is an internationally renowned expert on HIV-TB co-infection, and helped lead one of the first studies showing the benefits of early anti-retroviral therapy in PLHIV and active TB. He was also among the first to describe and respond to the emerging epidemic of extensively drug-resistant (XDR) TB in South Africa through research on diagnosis, transmission, and infection control. Professor Rick Altice, a pioneer in developing clinical and public health interventions at the interface between substance abuse and infectious diseases, is incorporating TB screening, prevention and treatment into work in correctional and substance abuse treatment settings in Eastern Europe, Central Asia, Southeast Asia and Latin America. Professor Richard Bucala, an expert in how the genetic variability of host immune responses influences the pathogenesis of infectious and autoimmune diseases, is co-directing studies of susceptibility to active TB in sub-Saharan Africa.

Faculty at Yale School of Public Health also collaborate and consult with faculty in the Yale School of Medicine with interests in TB, including Lloyd Friedman, John MacMicking, Hesper Rego, Sheela Shenoi and James Shepherd.