Grant: Project Grant

A proven strategy to reduce tuberculosis (TB) incidence is to screen entire populations and treat identified cases; however, this is often too costly and complicated. A better strategy is to focus on populations that we know have a higher rate of TB, known as targeted TB screening. In our recent field work in India, we found women to be almost twice as likely to have multi-drug resistant (MDR) TB than men. We hypothesize that this could be because women are often the caretakers of people with MDR-TB (and therefore could be infected that way), or because of exposure in confined spaces (such as slums) due to lower employment prospects. In addition, MDR-TB risk may be even greater for women because of higher rates of malnutrition and new HIV infections. We will recruit TB patients of all genders in Pune, India, over 4 years: 600 will be patients with drug-resistant TB, and 600 with non-drug resistant TB. We will analyze the samples to identify the strains of TB, as well as the demographics of the patients (caretaking activities, crowding, gender, etc.), and we expect to find higher rates of transmission of MDR-TB to women, compared to men or non-MDR-TB. For a portion of these participants, we will investigate their close contacts, and test them for malnutrition, vitamin deficiencies, HIV and diabetes as well as test for TB (for up to 2 years). We expect women exposed to MDR-TB to have higher rates of malnutrition, HIV and TB than women exposed to non-MDR-TB, and men exposed to MDR-TB. Studying MDR risk factors by gender is novel and will inform efforts in targeted active case finding in India, the country with the highest global burden of MDR-TB.