Tuberculosis (TB) is caused by the /Mycobacterium tuberculosis/ and spread through the air.  Treating patients sick with TB is highly effective, prevents deaths, and prevents transmission of new infections.  During the 1990s, multidrug-resistant TB emerged as a threat to TB control in the United States and worldwide.  Multidrug-resistant TB treatment requires second-line drugs that are less effective, more toxic, and costlier than first-line TB regimens.  Based on close collaboration in Peru of more than a decade with the NGO Socios En Salud and the Ministry of Health, the Harvard Department of Social Medicine has led a global effort to build community-based programs that can effectively treat patients with multidrug-resistant TB. 

In 2006-2007, with DRCLAS support a team led by Mercedes C. Becerra has begun the preparatory work to launch a major new study that will be run with NIH support.  The study team will recruit a large cohort of persons exposed at home to a patient with drug-sensitive or drug-resistant TB.  Persons living with someone with active TB are at high risk for becoming infected and sick with TB themselves within a 1-2 year period; thus, the household presents a prime opportunity for early case detection and treatment.  As part of the study, the field workers will visit these at-risk household members at month 6 and month 12 to determine whether they have become latently infected with TB. 

With Collaborative Research Grant Support from DRCLAS in 2006 and 2007 the team was able to begin to recruit, hire and train staff, and to prepare the study protocol, study instruments, and other study-related procedures. This support has also permitted the addition of a specific activity to the study, namely the detection of active TB in the household members at the follow-up visits.  The aim is to identify risk factors associated with the development of XDR-TB in individuals exposed to an infectious TB patient in the home.

Participating Harvard faculty: Mercedes C Becerra, Assistant Professor of Social Medicine, Department of Social Medicine

Collaborator: Leonid Lecca, Socios En Salud Sucursal Perú    

Collaborative Institutions: NGO Socios en Salud, Ministry of Health, Peru