The University of Otago – Ōtākou Whakaihu Waka is part of a groundbreaking new international study set to investigate whether people with tuberculosis (TB) who show no symptoms are unknowingly spreading it - potentially changing the way the world tackles the disease.
Asymptomatic TB is one of the most complex issues hindering progress in the fight against the infection.
To address the critical gap in understanding transmission of TB, global charities the Gates Foundation and the Wellcome Trust have granted an international consortium of researchers USD$19.5 million to conduct the 'Asymptomatic TB Transmission in Indonesia and South Africa' study.
Among them is Professor Philip Hill, of the Otago Global Health Institute, who says it is a "great privilege" to work on such a project.
His role will be to co-lead the project's epidemiological research component with Professor Emily Wong, of the Africa Health Research Institute (AHRI) and University of Alabama Birmingham.
For the study, researchers from AHRI and Padjadjaran University will recruit 90,000 adult volunteers from households with children to take part in community-based TB screening in South Africa and Indonesia.
Among volunteering households, children will be tested for immune responses to Mycobacterium tuberculosis complex, the bacteria that causes TB, enabling the study team to assess whether asymptomatic TB in adults is contributing to transmission within families.
Professor Hill says TB kills about one million people worldwide every year and is essentially uncontrolled in high-burden countries.
"When we do surveys in the community, we find that half the cases that are diagnosed do not have symptoms of TB. There is increasing evidence that these people, who don't tend to go to the health facility unless they start to feel sick, are transmitting the pathogen to others.
"This study is trying to quantify the amount of TB transmission from these asymptomatic people," he says.
The project will also integrate innovative diagnostics and biological investigations. These include testing of exhaled breath and biobanking of blood samples to support cutting-edge research to help grow understanding about asymptomatic TB, and to detect the condition earlier. Mathematical modelling studies will extrapolate the findings to the global situation.
Professor Wong says TB is currently detected when people seek care at clinics and hospitals when they feel sick.
"If the ATTIS study shows that people who feel well have infectious asymptomatic TB, then we might have to flip the paradigm of global TB control away from clinics and screen people in their communities," she says.
Professor Hill and Dr Sue McAllister, of Otago's Centre for International Health, will support the project's Indonesian researchers, led by Professor Bachti Alisjahbana, to conduct their part of the study in West Java, and an Indonesian PhD student will be hosted by Otago as part of ongoing capacity building with Indonesian collaborators.
"Two years ago, our collaboration with Universitas Padjadjaran, with support also from Professor Reinout van Crevel's group at Radboud University, won another Gates Foundation grant of almost USD$6 million to study new diagnostic agents, so the work we have been doing together over the last 17 years is very much on the map and it is really satisfying for us," Professor Hill says.
