Strengthening regional tuberculosis response systems for health security and better quality patient care

Strengthening regional tuberculosis health systems

Tuberculosis (TB) remains an important public health issue in northern Australia, and is a leading cause of illness and death in neighbouring countries. My fellowship will build on and enhance the existing work of the Menzies School of Health Research TB program by helping to deliver TB control projects in eastern Malaysia, Indonesia and Timor Leste. Additionally, I will work with the team to build a new Australian-based program of TB research to link Menzies more solidly with the Northern Territory Centre for Disease Control, and the Australasian Clinical Tuberculosis Network.

A catchphrase in TB research is to ‘know your epidemic; know your response’. This highlights that every epidemic is different and that there are a range of issues which drive high TB rates, including, poverty, drug resistance and HIV. Menzies-based work to date has shown that at the Malaysian field research site in Sabah, high TB rates are due to late presentation and high transmission in migrant populations who lack access to health care; but in nearby eastern Indonesia, high HIV rates drive TB, and drug-resistant (DR)-TB is increasing. Conversely in Australia, we are closer than most countries to achieving the World Health Organization goal of elimination, but innovative approaches are needed to reach that goal.

My proposed 2-year fellowship will undertake a program of work on and offshore. Specific components will include: (1) operational research to roll out shorter regimens for treatment of latent TB in the Northern Territory; (2) a study to deliver new knowledge on TB epidemiology in eastern Malaysia, to guide next steps in local TB prevention; (2) health system strengthening research to support DR-TB prevention in Indonesia and improved diagnosis, surveillance and management in Timor Leste.

There aims, while broad, are feasible since they link closely with existing programs of funded work.

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