International Partners
Brazil
RePORT (Regional Prospective Observational Research in Tuberculosis) Brazil is a joint venture between Brazilian and U.S. partners, with sites in Rio de Janeiro, Manaus, and Salvador. RePORT Brazil collaborates with Emory University on the Tuberculosis Genome-Wide Association Study (TB GWAS) to retrospectively identify household contacts who remain uninfected, despite a well-characterized, high degree of exposure to a TB index case, and compare them with household contacts who become infected with Mycobacterium tuberculosis. Emory also collaborates with the Instituto Brasileiro para a Investigacao da Tuberculose on validation of TB biomarkers in HIV-infected and HIV-uninfected patients with pulmonary and extrapulmonary TB.
Ethiopia
Emory has long-standing collaborations with several institutions in Ethiopia including the Armauer Hansen Research Institute (AHRI), a biomedical research facility; the Ethiopian Public Health Institute (EPHI), and Addis Ababa University (AAU); all are located in Addis Ababa. These collaborations were first established as part of the Ethiopia-Emory TB Training Program (EETB-RTP) funded by the NIH Fogarty International Center (D43TW009127). The EETB-RTP is focused on providing didactic and mentored research training to junior Ethiopian investigators with great potential to establish successful TB-related research careers. In 2017, AHRI became the primary international clinical research site for the NIH NIAID-funded Tuberculosis Research Unit site for the NIH U19 grant entitled, “Role of Antigen Specific T Cell Responses in the Control of TB” (TBRU-ASTRa project; U19AI111211). The central theme of the TBRU ASTRa study component in Ethiopia is to identify specific T cell signatures and their association with distinct states and outcomes of Mycobacterium tuberculosis infection and disease. The study aims to understand why some individuals categorized as having latent TB infection will progress to active TB disease, potentially identifying those at highest risk of progression and prioritizing them for preventive interventions.
Georgia
Emory has collaborated with the National Center for Tuberculosis and Lung Diseases (NCTLD) in the country of Georgia since the initial funding of the NIH Fogarty International Center-funded Emory-Georgia TB Research Training Program in 2004 (D43TW007124). Other Georgian collaborating institutions include the Georgian National Center for Disease Control and Public Health (NCDC) and the Georgian AIDS Center. The goal of the EGTB-RTP is to provide didactic and mentored TB-related research training to young Georgian investigations. A number of former EGTB-RTP Fogarty fellows have now taken leadership positions in TB research at the NCTLD, NCDC, AIDS Center and WHO. The NCTLD TB Research Unit has collaborated with Emory on multiple prospective studies of TB treatment and pathogenesis including a clinical trial of high-dose vitamin D for the treatment of pulmonary TB. Other ongoing collaborations include NIH-funded projects to examine antibiotic penetration into the cerebrospinal fluid in TB meningitis and lung tissue among patients with pulmonary TB, enhance research capacity to study the intersection of TB and non-communicable diseases, and the Emory-Georgia Clean Air Research and Education (CARE) Program. In addition to its Emory collaborations, NCTLD is actively participating in three anti-TB drug development clinical trials, one phase 2 trial (SimpliciTB) and two phase 3 trials (ZenixTB and STREAM 2).
India
RePORT India is a collaboration between Indian and U.S. partners with sites at Byramjee Jeejeebhoy Government Medical College (BJGMC) in Pune, the National Institute for Research in Tuberculosis (NIRT) in Chennai, Bhagawan Mahavir Medical Research Centre in Hyderabad and Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) in Puducherry. The purpose of RePORT is to “advance regional TB science that is also relevant in a global context; strengthen TB research capacity and infrastructure in high TB burden settings; and serve as an entity to foster research collaboration within each country and internationally, with the aim of carrying out a wide range of basic and clinical research that can lead to clinically important TB biomarkers, vaccines, drugs, and diagnostics.” The RePORT India consortium collaborates with Emory on the TB GWAS, which seeks to identify genetic traits associated with resistance to TB infection among those who are highly exposed. Other collaborations include projects seeking to validate biomarkers for TB diagnosis and treatment management as well as studies on pediatric TB immunology.
Kenya
Led by investigators at the University of Washington and Emory University, the study “The effect of HIV exposure and infection on immunity to TB in children” is conducted in western Kenya at sites in Kisumu and Bondo in collaboration with the Kenya Medical Research Institute laboratory in Kisumu and the Kenyatta National Hospital (R01AI142647). Kenyatta National Hospital is a public, tertiary referral hospital for the Kenya Ministry of Health and is the teaching hospital for the University of Nairobi College of Health Sciences. The major goals of this project are to (1) perform comprehensive analyses of the phenotype, function, epigenome and transcriptome of innate immune responses in HIV-exposed uninfected, HIV-infected, and HIV-unexposed uninfected Kenyan infants; and (2) determine the capacity of antiretroviral therapy to restore innate and adaptive anti-mycobacterial immune responses in HIV-infected children and identify immune correlates that predict acquisition of Mycobacterium tuberculosis infection.
Philippines
For over two decades, Emory faculty and CDC have collaborated with the Tropical Diseases Foundation and the De La Salle Medical & Health Sciences Institute in the Philippines on CDC- and NIH-funded research focused on MDR TB. The site joined the Emory-CDC Clinical Trials Unit in 2017 and has conducted ground-breaking studies, including several clinical trials, on MDR TB treatment and preventative therapy. With among the fastest growing rate of HIV infections worldwide, the site is also poised to participate in several additional studies with the ACTG on HIV treatment and cure.
South Africa
The PROBeX study, led by investigators at Albert Einstein College of Medicine and Emory University, is a NIAID/NIH-funded project (R01AI114304) examining the pharmacokinetics and the genetic mechanisms of resistance to the TB drug bedaquiline in patients with drug-resistant TB in South Africa. Collaborating international research partners include University of Cape Town, Stellenbosch University, National Institute for Communicable Diseases, and Radboud University (The Netherlands). This collaborative research group is now beginning a new R01-funded study which builds on the PROBeX study to examine the emergence of resistance to new TB medications in patients with multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR) TB. The new study uses next-generation, ultradeep sequencing to understand the complex interplay of bedaquiline and clofazimine’s pharmacokinetics on the risk of resistance during treatment interruption.
Additional collaborations between Emory investigators and Stellenbosch University include the DST/NRF Centre of Excellence in Biomedical Tuberculosis Research. This Center is dedicated to the understanding of the genetic and biomolecular basis of disease in South Africa and is housed within a sophisticated biomedical research facility. Ongoing collaborations are aimed at characterizing host immune responses induced by diverse clinical Mycobacterium tuberculosis isolates from TB patients and bioinformatics/computational approaches to host-pathogen interactions in TB.
The Perinatal HIV Research Unit (PHRU) is located within Chris Hani Baragwanath Hospital in Soweto, Johannesburg, South Africa. PHRU engages in research, training, policy creation and advocacy related to people with HIV and their children. The PHRU has partnered with Emory University since 2018 as part of the TB GWAS. The main objective of the TB GWAS in South Africa is to prospectively and retrospectively identify household contacts who remain uninfected, despite a well-characterized, high degree of exposure to a TB index case.
Working in collaboration with investigators from the University of Pennsylvania and Emory University, The Aurum Institute in Johannesburg, South Africa, is the site of the Lung function in TB-IRIS (LIFT-IRIS) study. This study explores lung inflammation and damage in the context of ART initiation and TB treatment among adults being treated for HIV and TB coinfection.
The University of KwaZulu-Natal (UKZN), in Durban, South Africa is the principal medical and specialty training institution for the region. In conjunction with the National Health Laboratory Service, the UKZN School of Laboratory Medicine manages the Tuberculosis laboratory at Inkosi Albert Luthuli Central Hospital (IALCH). This training and research laboratory serves as the provincial TB reference laboratory. Since 2018, UKZN has been a partner on the CONTEXT study, which is exploring the role of casual contact and migration in transmission of drug resistant tuberculosis in KwaZulu-Natal.
The Center for the AIDS Programme of Research in South Africa (CAPRISA) is an independent non-profit research organization established in 2002 as a multi-institutional collaboration and is based in Durban, South Africa. CAPRISA conducts globally relevant and locally responsive research in four key areas: prevention and epidemiology; microbicides; vaccines and pathogenesis; and HIV and TB treatment. Investigators from CAPRISA and Emory University have partnered since 2018 to conduct the CONTEXT Study, which will explore the role of casual contact and migration in transmission of drug resistant tuberculosis in KwaZulu-Natal Province.
The National Institute for Communicable Diseases (NICD), based in Johannesburg, South Africa, is a division of the National Health Laboratory Service. They provide national and regional expertise in communicable disease surveillance, epidemiology, and policy development. NICD’s Centre for Tuberculosis is the national TB reference laboratory, providing advanced laboratory-based surveillance including extended drug-resistance testing and genetic sequencing. NICD has a long-standing collaboration with Emory University investigators and is a partner on the CONTEXT study.