Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Tuberculosis (TB) is the second leading cause of death from an infectious disease worldwide. TB causes disease in over 9 million persons and kills more than 1.5 million each year. While the estimated numbers of new TB infections and TB-related deaths have been falling since 2002, the worldwide emergence of strains that are resistant to the two most effective TB drugs - INH and Rifampin - threatens the progress made. These strains, known as multidrug-resistant tuberculosis (MDR-TB), cause between 8-9% of all TB deaths globally. More than half a million patients were estimated to develop MDR-TB in 2010. This drug-resistant strain of TB requires more costly, lengthy and toxic treatment that is often ineffective. Existing research suggest there are many socioeconomic and health factors driving the MDR-TB epidemic, however it remains unclear which of these factors are most influential, and what the priority areas for programmatic changes should be in countries where the epidemic is rapidly growing. There has been an enormous increase in MDR-TB over the past couple decades in South Africa and Peru. Between 2002 and 2008, the proportion of all reported TB cases in South Africa with MDR-TB increased from 3.1% to 9.6%. Meanwhile, the notification rate of MDR-TB in Peru has been increasing at approximately 4.3% per year since 1996. Although existing research has suggested many factors that contribute to the MDR-TB epidemic, there has been limited research exploring the social determinants of MDR-TB in any country, and even fewer modelling of how social dynamics may contribute to the epidemic. This project will use a mixed-methods approach consisting of ethnographic studies in Peru and South Africa, and disease simulation modelling to identify common pathways to the transmission and development of MDR-TB, and help identify key opportunities for intervention in both countries, and potentially globally.