Jain, Sanjay

Medicine - Pediatrics

Diagnosis of active tuberculosis in HIV infected and uninfected young children in India

Tuberculosis (TB) is the most common cause of morbidity/mortality in HIV-infected individuals in India, which has among the world's highest burden of HIV and TB. Since children acquire HIV/TB from their caregivers, active TB is highly prevalent (14-67.5%) among HIV-infected young children in India - a vulnerable population, where lack of early detection/prevention of TB often has fatal consequences.Diagnosis of TB is particularly challenging in young children. Due to similar clinical presentation, active TB cannot be reliably distinguished from HIV (or co-infections). Tuberculin skin test (TST) is unreliable and bacterial confirmation (culture), when available, does not provide a diagnosis for weeks to months. TSPOT.TB is more sensitive/specific than TST for the diagnosis of active TB especially in young children with high rates of HIV, malnutrition, BCG vaccination and non-tuberculous mycobacteria (NTB). Microscopic observation drug-susceptibility (MODS) is a rapid assay for bacteriologic diagnosis of drug-susceptible and multi-drug resistant (MDR)-TB. Neither tests have been evaluated in the Indian setting, and the approach combining T-SPOT.TB and MODS, has never been tested previously.We will build on an existing Indo-US collaboration with Byramjee Jeejeebhoy Medical College (BJMC), and King Edward Memorial Hospital (KEM) in Pune, India. Inpatient/outpatient facilities at these centers serve children with high burden of HIVITB. In this study we will test the hypothesis that combined use of T-SPOT. TB and MODS will be non-inferior to current best standard of care for the diagnosis of active TB in young children in this region, but will have significantly reduced time to detection (including MDR- TB strains).

Amita Gupta, MD, School of Medicine; Robert Bollinger, MD, MPH, School of Medicine; Robert Gilman, MD, School of Public Health

People

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program
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December 2017

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