Georgia CTSA-supported Research Confirms Cost-effectiveness of WHO-recommended Algorithms for Tuberculosis (TB) Screening in Ethiopia

Cost-effectiveness of WHO-recommended Algorithms for TB Case Finding at Ethiopian HIV Clinics, published in Open Forum Infectious Diseases, found that “combining a WHO-recommended symptom screen with Xpert for TB diagnosis among people living with HIV was highly cost-effective…” Xpert M. tuberculosis and rifampin assay (Xpert) is a rapid molecular diagnostic test that can detect M. tuberculosis and rifampin resistance in less than two hours. Corresponding author, Max Adelman, MD, MSc, graduated with a dual Medical and Master of Science in Clinical Research (MSCR) Degree as part of the Georgia Clinical & Translational Science Alliance (Georgia CTSA) TL1-predoctoral and postdoctoral clinical and translational research training program at Emory University in 2015. The MD/MSCR dual degree program is funded by the TL1 component of the Research Education program of the Georgia CTSA.

According to the World Health Organization (WHO), tuberculosis is the leading cause of death among people living with HIV globally. 90% of global TB cases appear in 30 “high-TB burden” countries, including Ethiopia. Ethiopia’s number of TB cases, coupled with having one of the world’s lowest-income countries and a $73/person government health care budget, led the study to be done at HIV clinics in Ethiopia. The study compared the cost-effectiveness of WHO-recommended TB screening combined with Xpert and current recommended practice among people living with HIV.

The WHO offers two recommendations for detecting TB among this group. One recommendation is through active TB case findings which involves symptom-based screening for TB, followed up by a diagnostic work-up for those who tested positive for TB. The second recommendation is through Xpert which detects M. tuberculosis. Adelman’s study concluded that in combination with the WHO-recommended symptom screen and Xpert, TB screening was more cost-effective than the current screening practice among people living with HIV.

“The CTSA was crucial in helping me carry out my research project, studying the effect of novel diagnostic tests for tuberculosis in people living with HIV in Addis Ababa, Ethiopia. They provided me grant money and research tools, but most importantly a community of researchers to discuss my ideas with and get feedback from. My project would not have been nearly as successful without the Georgia CTSA, and the experience has been incredibly formative as I think about the rest of my career,” says Adelman 

This study was in collaboration with the Georgia CTSA and the National Institutes of Health through the Fogarty International Center and the National Institute of Allergy and Infectious Diseases.

The Georgia CTSA established this NIH-supported TL1 medical scientist training program which includes two tracks: a MD/MSCR track and a PhD/MSCR track. The goal is to equip trainees with the skills required to develop a career in multidisciplinary clinical and translational research. The TL1 program uses a team-science approach and provides mentored and didactic training for predoctoral students performing clinical and/or translational research in health-related fields. The TL1 program supports a select group of trainees as they embark on careers as outstanding patient-oriented researchers, teaching them how to design and conduct clinical research, analyze data, consider relevant ethical and legal issues, write manuscripts and grants, develop and present scientific grants, develop and present scientific posters, and compete for research funding. The goal of the program is to increase the number of well-trained clinical and translational scientists who can lead the design and oversight of future clinical investigations critical to the overall mission of the National Center for Advancing Translational Sciences (NCATS) and the National Institute of Health (NIH). Georgia CTSA is a state-wide partnership between Emory, Morehouse School of Medicine, Georgia Tech, and University of Georgia, and all partners are eligible for the educational programs.

The Emory MSCR degree program, from the Laney Graduate School at Emory University, provides didactic and mentored clinical and translational research training. The degree is designed for participants at Georgia CTSA’s academic institutions – Emory, Morehouse School of Medicine, Georgia Tech, and University of Georgia – who hold a doctorate or equivalent degree (such as physicians and PhD-level scientists) or predoctoral trainees (medical students or PhD students) enrolled in a dual degree program (MD/MSCR and PhD/MSCR tracks) and have demonstrated a commitment to a career in clinical investigation.

The Georgia CTSA is an inter-institutional magnet that concentrates basic, translational, and clinical research investigators, community clinicians, professional societies, and industry collaborators in dynamic clinical and translational research projects. Georgia CTSA is one of nearly 60 in a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences (NCATS) and the National Institutes of Health’s Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators.