Theme 4: Treatment Delivery
Theme 4 investigates the factors that obstruct the provision of tuberculosis therapy and works to develop practical solutions to those problems. Through observational studies and operational research, the theme identifies individual and systemic barriers — regulatory, financial and health-system related — that limit optimal access to appropriate TB treatment or reduce the effectiveness of combination therapy.
The theme also develops and evaluates new ways to overcome these barriers, using interventional studies, policy analyses and cost-effectiveness research. This work includes improving how current TB treatment is delivered, such as novel models of observed therapy and behavioural interventions that strengthen treatment adherence, along with strategies to maximise the impact of new tools and drugs once they enter programmatic settings.
Theme 4 Lead
Prof. Nick Paton, National University of Singapore (NUS), Singapore
Projects
mTB Genomic Database
Project PI: A/Prof. Teo Yik Ying | Project lead: Dr. Rick Ong
This project is building a comprehensive genomic database of drug-resistant TB strains. The resource will allow genotype differences in the mTB genome to be correlated with known phenotypic drug resistance across South East Asia, and will help separate neutral phylogenetic polymorphisms from mutations associated with partial or complete drug resistance. mTB samples are gathered in partnership with collaborators in Singapore, Thailand, Vietnam, Malaysia, Indonesia, Myanmar and Cambodia.
Selected publications:
- Bioinformatics tools and databases for whole genome sequence analysis of Mycobacterium tuberculosis. Infect Genet Evol. 2016 Nov;45:359-368.
- Comparative whole-genome sequence analysis of Mycobacterium tuberculosis isolated from tuberculous meningitis and pulmonary tuberculosis patients. Sci Rep. 2018 Mar 20;8(1):4910.
MIST Study
Project lead: Dr. James Molton
Current approaches to optimising TB treatment adherence rely on Directly Observed Therapy (DOT), which can be inconvenient and costly for patients and creates logistical difficulties for remote rural populations. MIST (Mobile Interactive Supervised Therapy) is developing a smartphone-based platform for treatment supervision and patient reminders designed to improve adherence to TB treatment regimens. The study aims to evaluate the performance, acceptability and efficacy of an electronic system for monitoring and supporting adherence to oral medications.
Selected publication:
- Prospective single-arm interventional pilot study to assess a smartphone-based system for measuring and supporting adherence to medication. BMJ Open. 2016 Dec 20;6(12):e014194.
Theme 4 Collaborators
- London School of Hygiene and Tropical Medicine — Richard Coker
- School of Computing, National University of Singapore, Singapore — Wei Tsang Ooi
- University of Southern California, USA — Joanne Yoong
- NTP, Myanmar — Sithu Aung
- Yunnan CDC, China — Xu Lin
- University of Health Sciences, Cambodia — Vonthanak Saphonn
- National TB Control Program, Cambodia — Mao Tan Eng
