Uganda

The overarching goal of this proposal is simple: to reduce the burden of tuberculosis in sub-Saharan African, in particular Uganda. To reach this goal, we believe that we need new metrics for tuberculosis burden that lead to actionable steps to reduce transmission or prevent progression of infection to disease. The current proposal is built upon the premise that digital mobile technologies, that were not developed with health purposed in mind, may be leveraged in imaginative and novel ways to provide useful information about tuberculosis transmission, infection, and disease. To realize the full potential of digital mobile technologies in measuring useful health information, we propose to build a critical mass of researchers with expertise across two or more disciplines who are dedicated to applying new methods to study the longstanding and stubborn questions about the persistence of tuberculosis in Africa. To create this critical mass of researchers in Uganda, we propose the following Specific Aims: 1. To train two Ugandan pre-doctoral trainees at the University of Georgia (UGA) in epidemiology, one with a special focus on geography of tuberculosis and the other with focus on machine learning and artificial intelligence to enhance digital adherence technology; 2. To train two to three master’s students per year enrolled at Makerere University by supporting their master’s thesis research in topics related to tuberculosis and geography, computer science, or modern digital technologies; 3. To conduct non-degree training to build and strengthen research capacity in digital mobile technologies and tuberculosis through annual recess-term short courses on relevant topics, monthly research seminars, and modern digital health technologies symposia at the Ugandan Society of Health Scientists’ annual conference.

Tuberculosis is a disease of disparities. Worldwide, it is more common in countries with low socioeconomic status or in settings overwhelmed by the HIV epidemic. But there is another disparity with tuberculosis that is not fully appreciated nor well understood: that is the disparity of tuberculosis between men and women. The World Health Organization, among others, has highlighted the untoward effects of tuberculosis on women, largely attributed to access to care and treatment, effects of pregnancy, and gender roles which diminish their social capital. Yet men have a higher incidence and prevalence of disease and may have worse outcomes with treatment compared to women. We hypothesize that total body energy stores, and the balance of that energy, determine the outcomes of tuberculosis, whether treated or not. Since the balance of fat and lean tissue differ in men and women, we further hypothesize that there will be differences in total energy stores between men and women at the time of diagnosis of tuberculosis. Finally, we hypothesize that the immune activation caused by infection with M. tuberculosis is modified by the hormonal milieu to affect metabolism of fat and proteins in patients. We proposed to compare metabolic, immune, and hormonal profiles between men and women at the time of tuberculosis diagnosis. The Specific Aims of the supplement are: 1. Compare immune and metabolic measures between men and women and relate them to total body energy as measured by body composition. 2. Discover new biomarkers by comparing RNA expression profiles between men and women presenting with tuberculosis.