TB Epidemiology and Intervention Research Unit

Martie van der Walt
Interim Director
E-mail: martie.van.der.walt@mrc.ac.za

Mandate
The mandate of the Tuberculosis Epidemiology and Intervention Research Unit had not change since the previous budget period. The unit was established in 2006 with the amalgamation of the TB Research Lead Program and the Group for TB Operational and Policy Research. The Unit has grown to a dynamic and progressive research entity with a both national and international research agenda, participation and standing. Extensive networking with central tuberculosis laboratories in the Southern Africa Development Countries (SADC) takes place under the tuberculosis diagnostic laboratory, which functions as the WHO Supranational Reference Laboratory for Africa.  Formal links with international agencies on collaborative programmes for operational research have been established, notably with the CDC Division for Tuberculosis Elimination (DTBE) on multidrug-resistant (MDR) tuberculosis and TB-HIV collaborative research. The Unit is also involved in TB control activities of various Sub-Saharan African countries through strengthening laboratory capacity. In South Africa its involvement in supporting the TB Control programme ranges from programmatic support to the drug-resistant tuberculosis and assisting in evaluation of Control Program tools.

The mandate of the Unit is to study the epidemiology of tuberculosis, and linking it with the design, development and evaluation of appropriately targeted interventions, with the aim to translate outputs into policy, practice, health promotion, treatment programs and products. These activities will be guided by national and international TB control priorities {which are:

1. expanding DOTS delivery for TB control based on universal standards of TB care;
2. addressing the adverse impact of HIV on the TB epidemic; and
3. containing the spread of drug-resistant TB in South and Southern Africa, with particular emphasis on the emergence of extensively drug-resistant TB (XDR-TB)}.

Containment and control of multi-drug and extensively drug-resistant TB (MXDR-TB), both in South Africa and in the SADC region, continues to dictate research of the Unit, and is addressed by almost all of the research focus areas. Research and involvement of programmatic aspects of drug-resistant TB in South Africa has been ongoing since 2000 when the Unit was involved in the development and roll out of standardized management for MDR-TB cases by the National Department of Health. Knowledge acquired on drug-resistant TB in South African through this involvement continues to contribute to international initiatives, as can be seen by the Unit’s ongoing involvement on international level. These activities range from policy formulation, serving on international committees, and participating in expansion of laboratory services for containment of drug resistance TB in the face of expanding HIV services. The exposure and interaction on international level are again to the benefit of local research, the NTCP and other activities.  Ongoing activities, as in the past period, will again be defined as service-based (laboratory support, expert consultations by staff and capacity development (training)) and research- or program evaluation -based.

Service-based activities are mostly those offered by the laboratory’s role as the World Health Organization’s Supranational Reference Laboratory for TB (SRL) and the ITRC (International Training and Research Center for TB/HIV and infection control). The laboratory, the only WHO SRL available to counties in sub-Saharan Africa, is on an ongoing basis involved in training and quality assurance programmes for SADC, assists Ministries of Health with epidemiological expertise for conducting drug-resistance surveys, and gives laboratory support, training and capacity strengthening to SADC countries. Additional service-based activities are the training provided by the ITRC; during the past period it focused on offering and international infection control course. Another course had been developed for management of MDR-TB/HIV side effect management.

Specific strategic objectives for the period 2009 – 2013:

1. Exploring synergies among other MRC Units for collaborative research.
2. Capacity development of staff, on both post-graduate level as well as on skill and competency level, e.g. in research methodology.
3. Expansion of the drug and delivery evaluation platform, through collaboration with established networks in the country on drug and vaccine development. This initiative will have to be supported by certification, accreditation and a full Laboratory Quality Management Plan.
4. Maintaining a presence in the epidemiology of tuberculosis, on a national scale as well as regional, and thereby also globally.
5. Application of the new technology of information communication and technology (e-health) for combating drug-resistant TB. This will be approached through linkages to the open MRS software system and the eHRIP platform of MRC.
6. Renewed collaboration with the National Tuberculosis Control Program, to conduct research and other activities targeted towards policy support and decision-making.

Please see Under Item 2 the detailed information on the above strategic objectives.  The Unit is actively pursuing the strategic objectives, and progress is reported elsewhere.