Clinical Mycobacteriology and Epidemiology (CLIME) Group
Improving TB diagnosis and treatment through basic, applied and health systems research (BAR-TB)
The BAR-TB study aims to improve the diagnosis and treatment of TB through four primary aims:
AIM 1. To integrate primary health care services with a specialist
Mycobacterium tuberculosis molecular biology laboratory to develop a world-class platform for the evaluation of new diagnostics.
AIM 2. To test the hypothesis that the implementation of a rapid diagnostic will ensure the implementation of appropriate treatment, thereby limiting default and improving treatment outcomes of both drug susceptible and drug resistant TB and identify barriers and facilitators to reaching these goals.
AIM 3. To test the hypothesis that the introduction of new diagnostics requires re-alignment and re-organisation of different health service components at different levels of the health system.
AIM 4. To build a biobank or repository of clinical specimens that will serve as a rich resource for both applied and basic research, including biomarker discovery, research on the microbiome in the context of TB, and commercial collaboration with contract research organisations.
The major accomplishments of BAR-TB fall under four domains:
1. Establishment of a physical laboratory and patient recruitment infrastructure at three under-served communities in the northern suburbs of Cape Town (Scottsdene Clinic, Wallacedene Clinic and Kraaifontein Community Health Centre).
Scottsdene Clinic: is comprised of a laboratory (with onsite latest generation PCR-testing capacity), patient consultation room, staff offices and a sputum induction booth.
Wallacedence Clinic and
Kraaifontein CHC: consist of similar facilities and operate within mobile caravans.
The net effect of this physical infrastructure development is access to different vulnerable populations of patients (e.g., HIV-positives, children).
2. Service delivery to TB patients and their communities.
As a direct result of BAR-TB:
- almost 1000 patients have received a standard of care superior to that available within the TB programme.
- have had most of the costs required for their care borne by BAR-TB.
- are diagnosed for TB faster and can then be put on treatment faster.
- the household contacts of TB patients, who would normally not be tested, also receive TB diagnosis and treatment.
3. Our biorepository currently contains over 30 000 of the following sample types which are available to researchers:
- Serum, sputum, saliva, stool, urine, blood and clinical strains of
- Coupled to these samples is patient information relating to demographics, co-morbidities, socioeconomic status, time to treatment, response to treatment, medical history.
4. This study has attracted several new international academic (Norwegian Institute of Public Health, Stanford University, Northwestern University, and Harvard University) and commercial (Quidel Diagnostics, Vision Biotech) research partners, as well as strategic partners, namely FIND and City of Cape Town Department of Health. This allows for access to leading edge technologies and new knowledge.