Drs. Richard Garfein, Antonino Catanzaro and Coworkers Report More Rapid Tests for Drug-Resistant TB

Researchers at University of California, San Diego School of Medicine have documented the accuracy of three new tests for more rapidly diagnosing drug-resistant forms of tuberculosis (TB), which are much harder and more expensive to treat and which, experts say, represent a major threat to global public health. … Read the full story from the UC San Diego Newsroom


DrAntoninoCatanzaro_100x122

Department of Medicine co-authors of the report are emeritus professor Antonino Catanzaro, MD, of the Division of Pulmonary and Critical Care Medicine; and professor Richard Garfein, PhD, MPH, and associate professor Timothy C. Rodwell, MD, PhD, MPH, of the Division of Global Public Health.

Dr. Richard GarfeinPictured are Drs. Catanzaro (top left) and Garfein (left).

Read the study report here.

Richard Garfein and Kevin Patrick Named M2M Pioneers

Applying Machine-to-Machine (M2M) Technology to Verify Compliance with Tuberculosis Treatment Regimen

Dr. Richard Garfein

Dr. Richard Garfein

UC San Diego’s Richard Garfein and Kevin Patrick have been named M2M Pioneers for 2013 for their Video Directly Observed Therapy (VDOT) Program for tuberculosis.

The honor comes from Connected World magazine, which presents the M2M Pioneer awards to a small number of outstanding innovators in machine-to-machine technology each year.

The VDOT program uses smartphone video to verify that tuberculosis patients comply with the painstaking six-month regimen of antibiotics required for a cure. Incomplete treatment fails to cure the TB and raises the risk that antibiotic-resistant strains of TB will develop.

Richard Garfein, PhD, MPH, an infectious disease epidemiologist, is professor of medicine in the Division of Global Public Health. The inspiration for the VDOT program came to him as he watched his children use smartphones to send videos to their friends.

Dr. Kevin Patrick

Dr. Kevin Patrick

Kevin Patrick, MD, MS, is director of the Center for Wireless and Population Health Systems at the Qualcomm Institute (the San Diego division of Calit2) and professor of family and preventive medicine in the Division of Preventive Medicine.

In their NIH-funded pilot study in San Diego and Tijuana in 2011-2012, Garfein and Patrick demonstrated that the VDOT program was an effective tool for ensuring that patients adhered to their treatment regimens.

They also showed that VDOT could reduce costs for the local public health agency; in the pilot study, the San Diego County Health and Human Services Agency. The agency’s only previous option had been to send health workers to patients’ homes to watch them take their medications.

Garfein and Patrick reported their results in an mHealth Summit Meeting abstract published in the Journal of Mobile Technology in Medicine.

Now, Garfein and colleagues are working on implementing the program on a larger scale through a public/private partnership with the Verizon Foundation, which provides funding and in-kind assistance.

The Garfein-Patrick team included other faculty and staff of the Global Public Health division and a number of specialists from the Qualcomm Institute.

Steffanie Strathdee, PhD

Dr. Steffanie Strathdee. Image ©International AIDS Society/Marcus Rose/Workers’ Photos. Used with permission.

“Congratulations to them both, and to Ramesh Rao and their team from the Qualcomm Institute, for this fantastic achievement and excellent teamwork,” said Steffanie Strathdee, PhD, Harold Simon Professor, Associate Dean of Global Health Sciences and chief of the Division of Global Public Health.

Ramesh Rao, PhD, director of the San Diego division of the Qualcomm Institute, holds the QUALCOMM Endowed Chair in Telecommunications and Information Technology. He is professor of electrical and computer engineering in the Jacobs School of Engineering at UC San Diego.

Said Garfein, “Working with Kevin and collaborating with the expert programmers at the Qualcomm Institute has been one of the highlights of my academic career.

“Although they are not included in the article because of the magazine’s information technology focus, we wouldn’t have been as successful if it weren’t for all the hard work by Jazmine Cuevas-Mota, Kelly Collins, and Fatima Muñoz in the Division of Global Public Health, and the dedicated employees of the San Diego County TB Control Program led by Dr. Kathleen Moser,” he said.

In the Division of Global Public Health, Cuevas-Mota is a project coordinator for Garfein, Collins is an assistant project coordinator and Muñoz is a postdoctoral fellow on the project.

“This has been a terrific project and it’s been a true pleasure to work with Richard and his team on it,” said Patrick.

“With a bit of luck, this could have world-wide impact on the health of the public. When all is said and done, this is why we are in this game.”

“This is very exciting and well deserved,” said Susan Taylor, PhD, UC San Diego professor of chemistry and biochemistry and pharmacology. She is a Howard Hughes Medical Institute investigator in biophysics and structural biology.

“It has been so much fun for me to watch these amazing things unfold and to realize how much we can achieve by working together and building bridges across the boundaries of our campus. This is much of what makes UCSD so special.

UC San Diego Health Sciences Video: VDOT Technology Eases Monitoring for Patients with Tuberculosis

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UC San Diego and Verizon Team to Improve Tuberculosis Care

Verizon Foundation to provide grant and in-kind technology solutions to scale up novel approach to monitoring adherence to TB treatment

As part of an innovative philanthropic health care program targeting reduction of health care disparities in diverse communities around the United States, the Verizon Foundation has provided the University of California, San Diego School of Medicine with a $300,000 grant, as well as important in-kind health information technology solutions.

The support from Verizon will allow researchers from the University to more quickly scale-up a mobile phone-based solution that they developed to overcome the high cost and other barriers to monitoring tuberculosis patients throughout their treatment…. Read the full story from the UCSD Newsroom


Dr. Richard GarfeinLeading the program is Richard Garfein, PhD, MPH, left, professor of medicine in the Division of Global Public Health. Dr. Garfein, an infectious disease epidemiologist, joined the UC San Diego faculty from the Centers for Disease Control and Prevention in 2005.

He is conducting the project in collaboration with the California Institute for Telecommunications and Information Technology (Calit2).

Demonstration of "video directly observed therapy"At right, Dr. Garfein’s daughter demonstrates a smartphone video app that makes it possible for a distant clinician to confirm that a patient has taken a dose of tuberculosis medication.

The approach is called “video directly observed therapy” (VDOT). Dr. Garfein and collaborators have demonstrated the feasibility, acceptability and potential efficacy of VDOT in an NIH-funded pilot study in San Diego and Tijuana. Their mHealth Summit Meeting abstract for the project is published in the Journal of Mobile Technology in Medicine.

In the next six months, with the Verizon Foundation’s assistance, they will expand the VDOT smartphone app for broader use.

Dr. Steffanie Strathdee“This is a new and exciting direction and a new funding source for UCSD,” said Steffanie Strathdee, PhD, Associate Dean of Global Health Sciences and Harold Simon Professor and Chief of the UC San Diego Division of Global Public Health.

She directs the UC San Diego Global Health Initiative and is founding co-director of the UC Global Health Institute’s Center for Migration and Health.

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Burden of HIV/TB Infections Increasingly Falling on Hispanic Community

Division of Global Public Health researchers Timothy Rodwell, MD, PhD, MPH, Steffanie Strathdee, PhD, Richard Garfein, PhD, MPH, and coworkers conducted the study described in the UCSD Newsroom story, “Burden of HIV/TB Infections Increasingly Falling on Hispanic Community.”

The story has been featured in media including KPBS, the North County Times, and BusinessWeek.

Read the story from the UCSD Newsroom.

Dr. Antonino Catanzaro Wins Funding for 5-Year Study of Extensively Drug Resistant TB

Dr. Antonino CatanzaroAntonino Catanzaro, M.D., has received nearly $2.5 million in funding from the National Institute of Allergy and Infectious Diseases (NIAID) for a 5-year international collaborative study of extensively drug resistant tuberculosis.Dr. Catanzaro, Professor of Medicine in the Division of Pulmonary and Critical Care Medicine, specializes in chronic pulmonary diseases, particularly tuberculosis.

Extensively drug resistant tuberculosis, which has a high fatality rate, is considered a global threat to tuberculosis control. Rapid detection and treatment are crucial, but current detection methods can take as long as three months.

Dr. Catanzaro and his multidisciplinary team of investigators will develop and evaluate three rapid new testing methods. In addition, they will analyze samples to correlate genetic variations with resistance to anti-tuberculosis drugs in populations in India, South Africa, Moldova, and the Philippines.

The project is “Rapid Tests for Drug Resistance to Detect Extensively Drug-Resistant Tuberculosis.”   I  Read the abstract of Dr. Catanzaro’s grant

Early Successes: Global Medicine Update from Mozambique

Since it began last summer, the Global Medicine Program at UC San Diego has sent 11 internal medicine residents to Mozambique, sparked several new research projects, and stimulated learning on both sides of this unique international partnership.

The Republic of Mozambique. Map from CIA: The World Factbook.

The Republic of Mozambique.
Map from CIA: The World Factbook.

The Global Medicine Program is a two-way exchange of faculty and residents between UCSD and the Universidade Eduardo Mondlane in Maputo, Mozambique. It is part of the Department of Medicine’s efforts to expand its involvement in global health.

“I think the program has made absolutely incredible progress,” said Dr. Constance Benson, Professor of Medicine and Director of UCSD’s Fellowship Training Program in Infectious Diseases.

Dr. Benson is a faculty director of the program.

During their 3-week stay, the UCSD internal medicine residents rotate through four different wards at Maputo General Hospital. Dr. Michael Preziosi, Clinical Director of the program, serves as faculty attending physician on site in Maputo.

Mozambican internal medicine residents

Mozambican internal medicine residents (left to right) Drs. Clotilde Tilwene, Neusa Jessen, Marilia Vida. Photo by Mike Preziosi, MD

Working together with the Mozambican doctors, the UCSD residents are encountering diseases they have never seen before and far more advanced stages of diseases frequently seen in San Diego; schistosomiasis, for example, and full-blown tuberculosis.

In one 24-hour period, Dr. Preziosi said, his patients included one who had tetanus with lockjaw, one with a liver cancer caused by a fungus that grows on peanuts, and one who had an advanced case of pellagra.

Broadening UCSD’s Internal Medicine Residency Training Program is one of the goals of the Global Medicine Program. Promoting collaborative global health research is another.

Mozambican residents at a presentation

U.S. and Mozambican residents at a presentation. Photo by Mike Preziosi, MD.

In the past six months, UCSD residents, fellows, and faculty members have begun to partner with Maputo researchers in new studies of tuberculosis and other endemic diseases.

UCSD is also introducing tools and practices that will strengthen the medical education program at Universidade Eduardo Mondlane.

A weekly journal club, instituted by UCSD residents, has been very well received.

“On the wards with the Mozambican residents, what’s going on has been really inspiring,” said Dr. Preziosi. “We’re seeing them get excited about medicine again.”This, in turn, refreshes the American residents, he said.

“I think they are getting a renewed sense of the purpose and value of the educational activities they are helping to introduce,” Dr. Preziosi said, “and are participating in them with renewed energy.”

Mozambican and American residents

Mozambican resident Marilia Vida (left) with Dr. Sarah Fox, second-year UCSD resident. Photo by Mike Preziosi, MD.

Mozambican residents will begin rotations at UCSD later this year.

“What makes our program unique,” said Dr. Robert “Chip” Schooley, “is that the transfer of capacity is being done in a peer-to-peer fashion by people who are transferring knowledge about jobs they do all the time.“The Mozambican residents see our residents as counterparts who are sharing their own experiences.”

Dr. Schooley, a Faculty Director of the program, is Professor of Medicine and Chief of the Division of Infectious Diseases. “I think this program will break a lot of ground,” he said.

UCSD faculty appointments have been granted to Drs. Emilia Noormahomed and Sam Patel, the faculty leaders on the Universidade Eduardo Mondlane side of the Global Medicine Program.

UCSD is assisting with material needs in Maputo as well.

Last summer, a UCSD team brought a supply of modern tuberculosis protective masks for the Mozambican residents’ workroom at the hospital. There is a great shortage of other basic clinical supplies.

To help meet such needs and to sustain the Global Medicine Program, Dr. Schooley and colleagues are stepping up their fundraising efforts.

“We can make a real impact on the health of this country with a very modest investment,” said Dr. Kenneth Kaushansky. Dr. Kaushansky, Helen M. Ranney Distinguished Professor and Chair of the Department of Medicine, is Director of the Global Medicine Program.

As the U.S. and Mozambican residents care for patients and pursue their studies together, they lay groundwork for stronger healthcare systems in both nations. In the face of overwhelming need in Maputo, they press forward with the resources available.

Drs. Benson and Schooley are veterans of many successful efforts to improve healthcare delivery in Africa.

“You overcome,” said Dr. Benson. “One day at a time, one patient at a time.”

* * *

The Global Medicine elective rotation is open to second- and third-year residents and to Department of Medicine faculty members from all specialties.

For more information on the Global Medicine Program,
visit http://imresidency.ucsd.edu/GlobalMed.shtml.

Read our news story about the launch of the Global Medicine Program here.

Give to our Global Medicine Program.

Study Confirms High Rate of TB Infection in Tijuana Injection Drug Users

A new research report from the Division of Global Public Health is pointing up the need for tuberculosis screening and treatment programs for injection drug users in the San Diego-Tijuana border region.Dr. Richard Garfein and his coworkers at UCSD and in Mexico have found that up to 67 percent of injection drug users in Tijuana test positive for TB infection.

This population, at risk for HIV, is vulnerable to the dangerous combination in which an HIV-weakened immune system allows a latent TB infection to become active.


Read the full story
from UCSD News


The data come from Proyecto el Cuete, a collaborative study that includes researchers from UC San Diego and two institutions in Tijuana.Principal investigator in the study is Richard Garfein, Ph.D., M.P.H., Associate Adjunct Professor of Medicine in the Division of Global Public Health.

Other Department of Medicine investigators in the study are Steffanie Strathdee, Ph.D., Professor and Chief of the Division of Global Public Health and Associate Dean of Global Health Sciences; and Antonino Catanzaro, M.D., Professor in the Division of Pulmonary and Critical Care Medicine.

The report is released in the May issue of the International Journal of Tuberculosis and Lung Disease.

More Information

 

Global Public Health Division joins the Department of Medicine

Steffanie A. Strathdee, Ph.D.The UCSD School of Medicine’s highly respected academic team of global public health specialists has joined the Department of Medicine.

The Division of Global Public Health, headed by Steffanie A. Strathdee, Ph.D., conducts research and education programs to address healthcare problems that transcend political borders.

Formerly known as the Division of International Health & Cross-Cultural Medicine, the division was a part of the Department of Family and Preventive Medicine.

Division Chief Dr. Steffanie Strathdee is a top researcher, educator and thought leader in global health issues. She was recently appointed UCSD’s first Associate Dean for Global Medicine. Read the UCSD press release

“We are delighted to join outstanding leaders in academic medicine in the Department of Medicine,” Dr. Strathdee said.

“Our combined efforts will focus on reducing global health disparities and promoting training and education on global health issues that know no borders.”

Dr. Strathdee holds the Harold Simon Chair in Global Public Health and a professorship in the Department of Medicine.

The Division of Global Public Health has 16 full-time and many affiliated faculty members.

Kenneth Kaushansky, M.D., M.A.C.P.“By joining the Department of Medicine, Steffanie and her colleagues have expanded our global reach to four continents,” said Dr. Ken Kaushansky, Helen M. Ranney Distinguished Professor and Chair of the Department of Medicine.

“Now, the Medicine faculty, fellows, residents and students have the opportunity to participate in the Global Public Health Division’s cutting-edge clinical research and innovative and insightful educational programs, and to deliver badly needed health care and self-help skills to citizens of the world.”

Robert Schooley, M.D.Dr. Robert Schooley, Professor and Chief of the Division of Infectious Diseases, commented, “There has been a major increase in interest in international activities within the Department of Medicine over the last 5 years.

“Dr. Strathdee and her group will provide a new dimension to scholarly activities in global medicine within the Department of Medicine –in terms of both content and geography.

“The synergy between the internationally recognized epidemiology, public health and prevention programs in Dr. Strathdee’s group and the biomedical research activities in other divisions throughout the Department will greatly increase the productivity and visibility of global medicine activities at UCSD,” Dr. Schooley said.

Programs both global and local

The education and research programs of the UCSD Division of Global Public Health extend from the San Diego-Tijuana region to communities and institutions across the world.

“Of particular interest are the public health efforts of Steffanie and her group in the California-Mexico border region,” said Dr. Kaushansky. “They’ve been a model of how proactive public health programs can provide new insights into the origins of health care disparities.

“They also demonstrate how interventions based on careful study can make an important impact on the health of both our neighbors and the citizens of California.”

The division’s local projects include three NIH-sponsored research studies based in Tijuana and other cities situated on the Mexico-US border. The projects focus on HIV, tuberculosis, and sexually transmitted infections.

The division currently offers three research training programs focusing on prevention of HIV and related infections and substance use:

In addition, the Division of Global Public Health has just completed a TIES (Training, Internship, Exchange, Scholarships) program, a United States Agency for International Development (USAID)-sponsored effort to prevent HIV infection in Tijuana and northwest Mexico.

In local education at the postgraduate level, Dr. Strathdee is the Co-director of the Global Health track of the doctoral program in public health that is offered jointly with the San Diego State University Graduate School of Public Health.

More about Dr. Strathdee

Dr. Steffanie Strathdee is a renowned infectious disease epidemiologist. Her research efforts have focused on preventing blood-borne infections such as HIV and removing barriers to healthcare delivery in underserved populations around the world.

Dr. Strathdee, who co-directs the International Core of the UCSD Center for AIDS Research, has published more than 300 scholarly reports on HIV/AIDS alone.

She joined the UCSD faculty from Johns Hopkins University five years ago. She holds an adjunct professorship in the Department of Epidemiology in the Johns Hopkins Bloomberg School of Public Health.

For more information about the Division of Global Public Health, its faculty and activities, please visit the division’s website at http://gph.ucsd.edu.

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MISSION OF THE DIVISION OF GLOBAL PUBLIC HEALTH

Working Together to Improve Global Health

The mission of the Division of Global Public Health is to:

  • Increase awareness, skills and research capacity relating to international health and cross-cultural issues through educational activities directed to faculty, students, fellows and the community;
  • Conduct high-caliber research on health-related issues and service utilization facing populations in international settings, U.S. minorities and migrants to the U.S.;
  • Provide opportunities for students to experience clinical and research activities in international settings and diverse communities;
  • Initiate, participate and foster collaborations on international health activities within and between departments in the UCSD School of Medicine, the general UCSD campus, organized research units, and U.S.-based and international agencies and institutions;
  • Offer advice and consultation on international health topics as needed by local, regional, national and international organizations.

Med Into Grad “Makes it All Real,” Says UCSD Doctoral Researcher

From basic science laboratory to Peruvian TB clinic: Scarlet Shell, UCSD doctoral candidate in Biomedical Sciences and graduate of the Med Into Grad program.

Scarlet Shell, UCSD graduate researcher and Med Into Grad participantWhen Scarlet Shell leaves UCSD this year, she’ll have a new doctorate in biomedical sciences and an unforgettable grounding in the real world of infectious disease.

Deeply interested in tuberculosis diagnosis and treatment, she’s headed for postdoctoral research in a TB laboratory at Harvard.

And, thanks to the Med Into Grad program, she knows exactly what it’s like to diagnose and treat TB with scant resources, time-consuming tests, and trial-and-error antibiotic therapy.

Last year, UCSD’s Med Into Grad program took her to clinics and laboratories in Peru, where TB is a major health problem.

She accompanied healthcare workers to remote clinics, assisted Peruvian laboratory researchers, and met patients face to face.

“It makes it all real,” she says, “in a way that never quite happens from reading about it or hearing about it.”

Peru

Med Into Grad is a science education program that gives basic scientists a clinical experience during their doctoral training. The goal is to help medical researchers focus directly on improving patient care in their future work.

Each student is placed for three to six months in a clinical setting that matches his or her research interests.

“My Med Into Grad experience has provided a big picture view of the problem of TB and all its different facets,” Scarlet says.

“I think it’s important for setting research priorities: what questions can we ask to get the information we need to tackle this problem?”

She says the experience confirmed her decision to change her research focus and intensified her desire to find better ways to detect and treat TB.


“I was in the right place
at the right time –
or Med Into Grad was.”


Scarlet did most of her graduate studies in Dr. Richard Kolodner’s cancer research laboratory investigating DNA mismatch repair.

Dr. Kolodner is Professor of Medicine, Adjunct Professor of Cellular and Molecular Medicine and head of the Cancer Genetics program at the Moores UCSD Cancer Center.

As time went on, Scarlet became increasingly interested in infectious disease, particularly tuberculosis and malaria.

She read extensively about TB and decided she wanted to change her research focus, but didn’t know how the transition was going to happen.

Then she heard about Med Into Grad. “I was in the right place in the right time,” she says. “Or the Med Into Grad program was.”

Last April, she left her laboratory bench on the UCSD campus for Peru. The opportunity came through Dr. Joseph Vinetz, Professor of Medicine in the Division of Infectious Diseases at UCSD.

Dr. Vinetz is an expert in tropical infectious diseases including malaria and leptospirosis. In addition to his UCSD laboratory, he collaborates with Peruvian and other U.S. investigators in a lab in Iquitos, a rural city in the Peruvian Amazon rain forest.

Scarlet spent several weeks in Dr. Vinetz’s malaria laboratory in Iquitos.

She visited the local hospital with nurses and other health workers. There, she had her first up-close encounters with infectious disease patients.

“I got to see what kinds of diseases people came in for, how they were diagnosed, and how they were treated,” she said.

She went on to Lima, the capital city, where she worked in laboratories operated by collaborators of Dr. Vinetz under the auspices of the Universidad Peruana Cayetano Heredia.

The laboratories conduct basic and clinical research in improving TB diagnosis and drug sensitivity testing. The aim is to find techniques that do not require costly equipment or extensive resources, so that they can be used in underdeveloped countries.


“Being in that environment
made the barriers to treatment
really obvious.”


Until she went to Peru, her career had involved an entirely different kind of interaction – with yeast, the organism used as a model system in her laboratory studies.

Now she had the chance to see how Peruvian mothers juggled transportation and child care issues as they went through the slow and arduous process of TB testing and treatment.

“Being in that environment made the barriers to treatment really obvious,” she says.

She watched how patients and doctors wrestled with logistics. TB diagnosis takes several clinic visits, and often takes many weeks. Drug therapy has to be given several times a week for at least 6 months.

“Most people don’t have cars,” she said. “The patients face choices day by day – do I go to the clinic for my treatment, or do I go to work?”

She saw how greatly the situation would improve if there were a way to diagnose TB more rapidly, and treat it with a shorter course of medicines.

In Lima, Scarlet took part in clinical research in the laboratory and she helped analyze a large database of experimental results from a clinical study.

She worked with Dr. Carlton A. Evans, an English infectious disease researcher from Imperial College London, who spends most of his time in the field in Peru.

Last November, she presented some of the Peruvian TB research data at the annual meeting of the American Society of Tropical Medicine and Hygiene in Philadelphia.


On to Harvard
with “another level of motivation”


At Harvard, Scarlet will choose her research studies in light of her Med Into Grad experience. She’s considering investigations of how TB evades the immune response to persist inside the host, or why treatment takes so long.

Med Into Grad has given her “another level of motivation,” she says.

It has also given her research connections and projects to help establish her career.

She helps with data analysis for the Lima laboratory on her own time now. It’s part of her own connection with a healthcare effort that has become personally significant to her.

“I got to see how they did what they do,” she says. “It was a really cool experience to actually get to participate.

“It makes it all real. TB is a disease that causes so much death and so many problems. There is a need for better diagnosis and better treatment.”

About Med Into Grad at UCSD

“The Med Into Grad program gives a basic science student the chance to witness firsthand the opportunities where science can improve clinical medicine,” says Dr. Ken Kaushansky.

Dr. Kaushansky and Dr. Mark P. Kamps are founders and co-directors of the Med Into Grad program at UCSD.

Dr. Kaushansky is Helen M. Ranney Distinguished Professor and Chair of the Department of Medicine. Dr. Kamps is Professor and Director of the Graduate Program in the Department of Pathology.

UCSD is one of several leading universities to offer Med Into Grad. The program is funded by a science education grant from the Howard Hughes Medical Institute (HHMI), a nonprofit research institution.

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