Ongoing Global Health Research

East Africa Training Initiative (EATI)

The goal of the East Africa Training Initiative (EATI) is to develop and support a Pulmonary/Critical Care Medicine training program for Ethiopian physicians in Addis Ababa.  Under the leadership of Dr. Neil Schluger, and with active support of Columbia Pulmonary, Allergy, and Critical Care Medicine faculty (as well as faculty from Brown and other US institutions) this initiative was launched in January 2013 graduating the first class of pulmonary fellows at Addis Ababa University School of Medicine in January 2015. 

EATI is the only pulmonary fellowship program in Ethiopia and has the support of the highest levels of Addis Ababa University and the Ministry of Health.  The co-director of the program is Dr. Chuck Sherman, a pulmonary physician at Brown who has worked in East Africa for many years. Prior to this training program, there were no trained pulmonary physicians in Ethiopia. This extraordinary opportunity to build a clinical training program has opened up numerous research opportunities to study the epidemiology of communicable and non-communicable lung disease in Ethiopia.

The program’s mission is to train pulmonologists in Ethiopia who will remain practicing pulmonary physicians in Ethiopia and ultimately these pulmonary physicians will independently sustain the pulmonary training program at Addis Ababa University. From January 2017, the program will have graduated 8 fellows all of whom have stayed in Ethiopia as practicing pulmonary critical care physicians, the majority staying on as faulty at the program or as leaders in pulmonary medicine in other Ethiopian hospitals and medical schools.

 

Research Projects

Implementation Science to Improve Medication Adherence to Drug-Resistant Tuberculosis and HIV Treatment (PRAXIS Study, O’Donnell, Padayatchi)

Sited in Durban, South Africa, this NIH R01 funded study seeks to use a mixed methods approach to characterize challenges and facilitators to medication adherence for patients with multidrug resistant TB and extensively drug resistant TB (M/XDR-TB) and HIV co-infection.  We expect to use a combination of electronic pillbox with real-time monitoring, self-report and other measures to predict TB culture conversion as well as to compare antiretroviral therapy and second-line TB medication adherence. We will also use qualitative research to develop a contextualized understanding of adherence and retention in care.  Subsequently data from this first Aim will be used to design an implementation science community support intervention to improve adherence for this vulnerable population.  Dr. Nesri Padayatchi from the Centre for AIDS Programme of Research in South Africa (CAPRISA) is the co-PI for this project, and other collaborators include faulty from Yale, Harvard, University of Toronto and University of Michigan.

 

Advanced Phenotyping and Genotyping to Detect Emergent Drug Resistance on Treatment and Predict Tuberculosis Treatment Response (O’Donnell)

Sited in Durban, South Africa at Albert Einstein in the Bronx and at Columbia, this NIH R01 and Doris Duke Clinical Foundation funded clinical and translational study is an attempt to use a viral vector (phage) with a fluorescent reporter protein to detect viable MTB, and emergent TB drug-resistance in TB patients on treatment.  Combining this reporter phage approach with fluorescence activated cell sorting (FACS) and whole genome sequencing is a powerful approach to detect and characterize genetically and metabolically distinct MTB populations.  Key collaborators for this project include Dr. Bill Jacobs, Dr. Michelle Larsen and Dr. Paras Jain (Albert Einstein College of Medicine) (The Jacobs Lab) and Dr. Alex Pym (K-RITH).

 

Next generation sequencing and inferential forecasting to characterize and predict epidemic severe acute respiratory infection in Uganda (O’Donnell)

At the center of this project is a multidisciplinary collaboration between clinical epidemiologists, experimental virologists, and computational biologists at Columbia University and a well-resourced epidemiology and surveillance unit in Uganda, an emerging infectious disease ‘hotspot.’ Our collaborators at the Ian Lipkin Lab, a very highly regarded and resourced virology group, are using a next generation viral probe library to enhance the sensitivity of whole genome sequencing for viral genomes from clinical samples from severe acute respiratory illness (SARI) patients from Uganda, while epidemiologists from the Jeffrey Shaman group are using inferential forecasting to predict epidemics of flu and unknown SARI in Uganda.  

The project is sited at the Uganda Virus Research Institute (UVRI) in Entebbe, Uganda with 12 clinical sites throughout the country.