Impact in Kenya
The HDSS reported IMR to be 110/1000 live births. However, provision of ancillary care and sick visits reduced mortality to 39/1000 live births. TB diagnosis in infants is challenging; At the Siaya District Hospital, capacity has been created to collect sputum from babies. Through this the incidence of TB in this age group has been shown to be 3X the national prevalence rates, showing that babies are at risk of death and serious illness from TB
The study will be able to provide insights on improving TB diagnosis and infant mortality in settings with high HIV and malnutrition rates
148 infants have participated in the first ever multi-site TB vaccine trial in over 80 years (since BCG was discovered)
The Ministry of Health has expanded active case finding for TB partially based on these findings of the TB Prevelance Survey.
Tuberculosis Research Factsheet
The Tuberculosis Branch officially became part of the KEMRI/CDC Research and Public Health Collaboration in 2008 although KEMRI/CDC had been carrying out TB projects for several years prior to that time. The TB Branch has activities in Asembo, Gem and Karemo divisions in Bondo and Boro division in Siaya Districts.
TB Prevalence Survey
This prevalence survey was conducted from 2006-2009 and estimated the pervasiveness of pulmonary tuberculosis in Asembo and Gem (a high HIV prevalence setting) to be 6.0 per 1000 for bacteriologically confirmed disease and 2.5 per 1000 for smear positive disease. Notably, the vast majority of patients with TB (both persons with and without HIV) were not on TB treatment and had not been diagnosed with TB. This suggests that there is a large reservoir of undiagnosed TB in the community, and that active case finding is needed.
Observational Cohort Studies:
TB-R-VAC activities in the TB branch are building the capacity of the KEMRI/CDC Research and Public Health Collaboration and preparing to conduct phase II & III TB vaccine trials. To prepare for these trials the TB branch is conducting two prospective observational cohort studies with no experimental intervention. In Siaya district, western Kenya 2,900 infants and 5,004 adolescents were enrolled and followed for at least 1 year. The studies are:
Adolescent Cohort Study: A study among 12 to 18 year old adolescents
• The annual and cumulative one (and if possible 2) year incidence of TB disease as diagnosed by two sputum smears positive for AFB and/or a positive mycobacterial culture
• The prevalence of TB infection as evidenced by the tuberculin skin test (TST) and disease
• The annual risk of infection with M. tuberculosis
• The most efficient way to access and follow an adolescent population in the study area
• The rates of hospitalization and mortality events through record review and verbal autopsy
• Out-migration and cohort retention
• The prevalence of HIV infection in adolescents aged between 12 and 18 years.
• The adolescent study close-out was in December 2010. Manuscript writing is in progress.
Funding: Approximately $ 2.7 million
Staffing: 1 U.S. staff
109 Kenyan KEMRI/CDC staff