The Latest Research News

NIH clinical trial of tuberculous meningitis drug regimen begins

NIH, December 16, 2023 A trial of a new drug regimen to treat tuberculous meningitis (TBM) has started enrolling adults and adolescents in several countries where tuberculosis (TB) is prevalent. The Improved Management with Antimicrobial Agents Isoniazid Rifampicin Linezolid for TBM (IMAGINE-TBM) trial will compare a six-month regimen of four drugs with the nine-month, standard-of-care regimen for TBM. The study aims to generate evidence that could improve treatment for people with TBM.

World AIDS Day: Safe Zindagi, an e-platform that provides HIV services to hard-to-reach populations, young online users

Indian Express, December 01, 2023 Safe Zindagi, an online portal funded by US President’s Emergency Plan For AIDS Relief (PEPFAR), and the US Agency for International Development (USAID) provides HIV care and services to hard-to-reach populations in India. The platform is implemented by Johns Hopkins University through Project ACCELERATE, in partnership with India’s National AIDS Control Organization.

Common antibiotic can prevent drug-resistant TB in exposed kids, says study. But is it safe?

Indian Express, November 20, 2023 Two clinical trials show how Levofloxacin, given once daily to children over six months, prevented infection in five-year-olds exposed to MDR-TB by 56 per cent and in adolescents by 45 percent.

Shaping the future of India's HIV response

ACCELERATE, October 11, 2023 Earlier this fall, public health experts and government officials gathered in Visakhapatnam, Andhra Pradesh to discuss the latest in HIV research and begin developing evidence-based technical briefs that will guide and inform India’s national HIV response.

Global Health Fellowship Program

UJMT, September 30, 2023 The UJMT consortium's application portal is now officially open for the upcoming cycle until November 1st, 2023. This one-year program provides mentor-guided research training within affiliated institutions across the globe. This immersive experience enables awardees to conduct research in international settings, with comprehensive coverage for expenses, including research funding, stipends, travel, educational allowances and health insurance.

1-Year Incidence of Tuberculosis Infection and Disease Among Household Contacts of Rifampin- and Multidrug-Resistant Tuberculosis

Clinical Infectious Diseases, September 18, 2023 Tuberculosis infection (TBI) and TB disease (TBD) incidence remains poorly described following household contact (HHC) rifampin-/multidrug-resistant TB exposure. We sought to characterize TBI and TBD incidence at 1 year in HHCs and to evaluate TB preventive treatment (TPT) use in high-risk groups.

New study aims for best strategy to find recurrent cases of Tuberculosis

The Indian Express, September 15, 2023 Dr. Vidya Mave, principal investigator from Johns Hopkins University, India programme, said the study can provide an evidence base for designing strategies to identify recurrent TB. “This trial is part of the government’s effort to develop strategies to find patients who have been cured and identify, who are at most risk of a relapse,” she said.

Neonatal, Infant, and Child Mortality in India: Progress and Future Directions

Indian Journal of Pediatrics, September 11, 2023 In India, considerable progress has been made in reducing child mortality rates. Despite this achievement, wide disparities persist across and socio-economic strata, and persistent challenges, such as malnutrition, poor sanitation, and lack of clean water. This paper provides a comprehensive review of the state of child health in India, examining key risk factors and causes of child mortality, assessing the coverage of child health interventions, and highlighting critical public health programs and policies.

Timing of maternal isoniazid preventive therapy on tuberculosis infection among infants exposed to HIV in low-income and middle-income settings: a secondary analysis of the TB APPRISE trial

Lancet Child Adolescent Health, August 24, 2023 Infants born to women with HIV in settings with a high tuberculosis burden are at risk of tuberculosis infection and rapid progression to active disease. Maternal isoniazid preventive therapy might mitigate this risk, but optimal timing of therapy remains unclear. The TB APPRISE trial showed that initiation of isoniazid during pregnancy resulted in more frequent adverse pregnancy outcomes than when initiated postpartum. We aimed to determine the proportion of infants testing positive for tuberculosis infection born to mothers who initiated isoniazid therapy antepartum compared with postpartum using two commonly used tests, the test agreement, and predictors of test positivity.

Association of Pregnancy and HIV Status With Molecular-Bacterial Vaginosis in Indian Women

J Acquir Immune Defic Syndr ., August 15, 2023 There was a high prevalence of molecular-BV (30%) in this cohort. We found that pregnancy was associated with decreased odds of molecular-BV (adjusted OR = 0.35, 95% CI: 0.14 to 0.87), while HIV was associated with increased odds of molecular-BV (adjusted OR = 2.76, 95% CI: 1.33 to 5.73), even when controlling for multiple relevant factors such as age, number of sexual partners, condom use, and douching.

Respondent-driven sampling is more efficient than facility-based strategies at identifying undiagnosed people who inject drugs living with HIV in India

Drug Alcohol Depend, August 01, 2023 There were 10,759 ICC clients and 6012 RDS participants; 40% of RDS participants were also ICC clients resulting in 14,397 unduplicated PWID. PWID identified by RDS vs. ICC only were more likely to be male (adjusted odds ratios [aOR] RDS only: 6.8, both: 2.7) and living with HIV but undiagnosed (aOR RDS only: 2.5, both: 1.5). Overall, the RDS NNR was 11 and the ICC NNR was 26. The RDS identification rate (18.6/week) was faster than the ICC identification rate (2.7/week) overall and in all cities.

Effects of a LPG stove and fuel intervention on adverse maternal outcomes: A multi-country randomized controlled trial conducted by the Household Air Pollution Intervention Network (HAPIN)

Environ Int ., August 01, 2023 Household air pollution from solid cooking fuel use during gestation has been associated with adverse pregnancy and birth outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial of free liquefied petroleum gas (LPG) stoves and fuel in Guatemala, Peru, India, and Rwanda. A primary outcome of the main trial was to report the effects of the intervention on infant birth weight. Here we evaluate the effects of a LPG stove and fuel intervention during pregnancy on spontaneous abortion, postpartum hemorrhage, hypertensive disorders of pregnancy, and maternal mortality compared to women who continued to use solid cooking fuels.

Impact of Domestic Violence on Maternal and Child Health and Well-Being in Rural India

Journal of Family Violence , July 08, 2023 The impact of DV on women was identified in multiple adverse outcomes such as poor physical health, miscarriages, abortions, and multiple pregnancies due to forced childbearing and preference for a male child. The impact on born children was identified in areas such as lack of care, abuse, and neglect. Barriers to the utilization of care included factors such as restricted access to care by husbands and in-laws.

Maternal Colonization Versus Nosocomial Transmission as the Source of Drug-Resistant Bloodstream Infection in an Indian Neonatal Intensive Care Unit: A Prospective Cohort Study

Clin Infect Dis ., July 05, 2023 Among 952 enrolled women who delivered, 257 neonates required NICU admission, and 24 (9.3%) developed BSI. Among mothers of neonates with GN BSI (n = 21), 10 (47.7%) had rectal, 5 (23.8%) had vaginal, and 10 (47.7%) had no colonization with resistant GN organisms. No maternal isolates matched the species and resistance pattern of associated neonatal BSI isolates. Thirty GN BSI were observed among neonates born to unenrolled mothers. Among 37 of 51 BSI with available NGS data, 21 (57%) showed a single nucleotide polymorphism distance of ≤5 to another BSI isolate.

Leading from the frontlines: community-oriented approaches for strengthening vaccine delivery and acceptance

BMC Proc, June 30, 2023 Through this unique intervention to strengthen vaccine uptake that incorporated the needs, interests, and expertise of local community members, we developed a community-driven approach to strengthen vaccine acceptance in a population with low uptake. This comprehensive approach is essential to amplify local voices, identify local concerns and advocates, and leverage bottom-up strategies to co-design successful interventions to facilitate long-term change.

Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial

JMIR Form Res, June 23, 2023 We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74% (77/104) diagnostic concordance and 79.8% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker-doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95% concordance; Cohen kappa=0.93) and diabetes (14/15, 93% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33%) and patients presenting with nonspecific symptoms (3/10, 30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols.

'All my co-workers are good people, but…': collaboration dynamics between frontline workers in rural Uttar Pradesh, India

Health Policy Plan, June 16, 2023 Multisectoral collaboration has been identified as a critical component in a wide variety of health and development initiatives. For India's Integrated Child Development Services (ICDS) scheme, which serves >100 million people annually across more than one million villages, a key point of multisectoral collaboration-or 'convergence', as it is often called in India-is between the three frontline worker cadres jointly responsible for delivering essential maternal and child health and nutritional services throughout the country: the Accredited Social Health Activist (ASHA), Anganwadi worker (AWW) and auxiliary nurse midwife (ANM) or 'AAA' workers. Despite the long-recognized importance of collaboration within this triad, there has been relatively little documentation of what this looks like in practice and what is needed in order to improve it.

The feasibility of using of a comprehensive unit-based safety program (CUSP) for improving antimicrobial stewardship at a tertiary care hospital in national capital region of India: A prospective quasi experimental study

Indian J Med Microbiol, June 02, 2023 A prospective quasi-experimental design was used to operationalizing the CUSP intervention. The project considered the data of 482 patients from two mixed Medical ICUs admitted during June 2019 to April 2020. The information was collected on antimicrobials prescription pattern and practices for identification of inappropriate use as well as app adoption trend with respect to Electronic Medical Record (EMR) Orders Placed, Clinical Notes and Checklist Filled. The intervention in the study comprised of development of an antibiotic monitoring stewardship (AMS) data collection app for ease of use and for Clinical Decision Support System (CDSS) to identify the cases of inappropriate use of antibiotics.

Effect of the relationship between anaemia and systemic inflammation on the risk of incident tuberculosis and death in people with advanced HIV: a sub-analysis of the REMEMBER trial

E Clinical Medicine, June 02, 2023 Tuberculosis (TB) is an infectious morbidity that commonly occurs in people living with HIV (PWH) and increases the progression of HIV disease, as well as the risk of death. Simple markers of progression are much needed to identify those at highest risk for poor outcome. This study aimed to assess how baseline severity of anaemia and associated inflammatory profiles impact death and the incidence of TB in a cohort of PWH who received TB preventive therapy (TPT).

1-Year Incidence of Tuberculosis Infection and Disease Among Household Contacts of Rifampin- and Multidrug-Resistant Tuberculosis

Clinical Infectious Diseases, May 25, 2023 Tuberculosis infection (TBI) and TB disease (TBD) incidence remains poorly described following household contact (HHC) rifampin-/multidrug-resistant TB exposure. We sought to characterize TBI and TBD incidence at 1 year in HHCs and to evaluate TB preventive treatment (TPT) use in high-risk groups.

A multi-center, prospective cohort study of whole blood gene expression in the tuberculosis-diabetes interaction

Nature, May 12, 2023 Diabetes mellitus (DM) has been associated with increased risk for tuberculosis (TB) progression and adverse TB treatment outcomes in most clinical studies1. Mirroring the human data, animal models combining chronic hyperglycemia with Mycobacterium tuberculosis challenge showed higher lung bacterial burden and more TB immune pathology2. The global population-attributable fraction of TB associated with DM is comparable to that of HIV/AIDS3. Despite its significance as a barrier to TB elimination4, the mechanisms whereby DM impairs host defense against M. tuberculosis are not well understood5.

Mycobacterium tuberculosis disease associates with higher HIV-1-specific antibody responses

iSCIENCE, May 19, 2023 Mycobacterium tuberculosis (Mtb) is the most common infection among people with HIV (PWH). Mtb disease-associated inflammation could affect HIV-directed immune responses in PWH. We show that HIV antibodies are broader and more potent in PWH in the presence as compared to the absence of Mtb disease. With co-existing Mtb disease, the virus in PWH also encounters unique antibody selection pressure. The Mtb-linked HIV antibody enhancement associates with specific mediators important for B cell and antibody development. This Mtb humoral augmentation does not occur due to cross-reactivity, a generalized increase in all antibodies, or differences in duration or amount of antigen exposure. We speculate that the co-localization of Mtb and HIV in lymphatic tissues leads to the emergence of potent HIV antibodies. PWH’s Mtb disease status has implications for the future use of HIV broadly neutralizing antibodies as prophylaxis or treatment and the induction of better humoral immunity.

Efficacy and safety of three antiretroviral therapy regimens started in pregnancy up to 50 weeks post partum: a multicentre, open-label, randomised, controlled, phase 3 trial

The Lancet HIV, May 08, 2023 Drugs taken during pregnancy can affect maternal and child health outcomes, but few studies have compared the safety and virological efficacy of different antiretroviral therapy (ART) regimens. We report the primary safety outcomes from enrolment up to 50 weeks post partum and a secondary virological efficacy outcome at 50 weeks post partum of three commonly used ART regimens for HIV-1.

Challenges with the use of Xpert HPV as a screening tool for oral HPV among people living with HIV (PLHIV): experiences from Pune, India

BMC Infectious Diseases, April 17, 2023 People living with HIV (PLHIV) are at higher risk for human papillomavirus (HPV)-related oropharyngeal cancers compared to the general population. Xpert HPV test is a polymerase chain reaction (PCR) assay capable of rapid HPV detection. Performing the assay requires minimal intervention by laboratory personnel. Its use could improve oropharyngeal cancer screening among PLHIV living in low-and middle-income countries (LMICs) with limited diagnostic capacities. However, Xpert HPV performance for oral samples has not been evaluated. Here, we describe our experience with Xpert HPV and compare its results with traditional PCR, for oral samples.

Integration of a geospatially targeted community-based testing approach with respondent-driven sampling to identify people who inject drugs living with HIV and HCV in Patti and Gorakhpur, India

Drug and Alcohol Dependency, April 14, 2023 Respondent-driven sampling (RDS), a network recruitment approach, is effective at reaching people who inject drugs (PWID), but other strategies may be needed to reach PWID at risk or living with HIV and/or Hepatitis C (HCV). We examined the impact of integrating geospatially targeted community-based HIV/HCV testing with an RDS survey.

Combatting Childhood Pneumonia

GUPTA-KLINSKY INDIA INSTITUTE, February 28, 2023 Senior investigators and PREVAIL researchers–including laboratory personnel, clinical research officers, and data analysts–met in Greater Noida, UP, on 11-12 February 2023 to discuss the preliminary results of the study.

Hypertension treatment capacity in India by increased workforce, greater task-sharing, and extended prescription period: A modelling study

Lancet: Southeast Asia, March 01, 2023 The worldwide control rate for hypertension is dismal. An inadequate number of physicians to treat patients with hypertension is one key obstacle. Innovative health system approaches such as delegation of basic tasks to non-physician health workers (task-sharing) might alleviate this problem. Massive scale up of population-wide hypertension management is especially important for low- and middle-income countries such as India.

Pharmacokinetic analysis of linezolid for multidrug resistant tuberculosis at a tertiary care centre in Mumbai, India

Frontiers in Pharmacology, January 04, 2023 Linezolid is an oxazolidinone used to treat multidrug-resistant tuberculosis (MDR-TB), including in the recently-endorsed shorter 6-month treatment regimens. Due to its narrow therapeutic index, linezolid is often either dose-adjusted or discontinued due to intolerance or toxicity during treatment, and the optimal balance between linezolid efficacy and toxicity remains unclear. India carries a significant burden of MDR-TB cases in the world, but limited information on the pharmacokinetics of linezolid and minimum inhibitory concentration (MIC) distribution is available from Indian MDR-TB patients. We enrolled participants from a tertiary care centre in Mumbai, India, treated for MDR-TB and receiving linezolid daily doses of 600 or 300 mg.

Characterising cause of death among people treated for drug-susceptible TB in India

The International Journal of Tuberculosis and Lung Disease, January 01, 2023 Annually, 1.5 million people die of TB.1 India has the highest burden of TB, and in 2020, the case fatality ratio (CFR) among people with drug-susceptible TB was 4.3%. Even after treatment, mortality is more than two-fold higher among people with prior TB compared to the general population. However, information about cause of death, particularly in India, is limited. Thus, we sought to characterise cause of death among individuals who accessed TB care. From 2013 to 2018, we enrolled individuals within 1 week of being diagnosed with drug-susceptible TB at public clinics in Pune and Chennai, India, into two pooled prospective cohorts. Participants received care according to India’s standard guidelines andwere followed up to 18 months post-treatment. Sociodemographic and clinical data were collected at enrolment and microbiological results were tracked. Considering low paediatric mortality, participants, <18 years were excluded.

A Message From the Next Generation: I Believe in You—Take Control of Your Health

JACC: Advances, January 11, 2023 South Asian individuals (ancestry from Bhutan, Bangladesh, India, the Maldives, Nepal, Pakistan, and Sri Lanka) carry a disproportionately higher burden of atherosclerotic cardiovascular disease (ASCVD) and proportional mortality from ischemic heart disease when compared with other racial and ethnic groups.

Factors influencing the prioritization of vaccines by policymakers in low and middle income countries: A scoping review

Health Policy and Planning, October 31, 2022 Vaccination decision making in low-and-middle-income countries (LMICs) has become increasingly complex, particularly in the context of numerous competing health challenges. LMICs have to make difficult choices on which vaccines to prioritize for introduction while considering a wide range of factors such as disease burden, vaccine impact, vaccine characteristics, financing, health care infrastructures, whilst being adapted to each country's specific contexts. Our scoping review reviewed the factors that influence decision-making among policymakers for the introduction of new vaccines in LMICs. We identified the specific data points that are factored into the decision-making process for new vaccine introduction, while also documenting whether there have been any changes in decision-making criteria in new vaccine introduction over the last two decades.

Effect of hybrid immunity, school reopening, and the Omicron variant on the trajectory of the COVID-19 epidemic in India: a modelling study

Lancet: Southeast Asia, October 13, 2022 The course of the COVID-19 pandemic has been driven by several dynamic behavioral, immunological, and viral factors. We used mathematical modeling to explore how the concurrent reopening of schools, increasing levels of hybrid immunity, and the emergence of the Omicron variant affected the trajectory of the pandemic in India, using Andhra Pradesh (pop: 53 million) as an exemplar Indian state.

Developing tuberculosis vaccines for people with HIV: consensus statements from an international expert panel

The Lancet, October 11, 2022 New tuberculosis vaccine candidates that are in the development pipeline need to be studied in people with HIV, who are at high risk of acquiring Mycobacterium tuberculosis infection and tuberculosis disease and tend to develop less robust vaccine-induced immune responses. To address the gaps in developing tuberculosis vaccines for people with HIV, a series of symposia was held that posed six framing questions to a panel of international experts: What is the use case or rationale for developing tuberculosis vaccines? What is the landscape of tuberculosis vaccines? Which vaccine candidates should be prioritised? What are the tuberculosis vaccine trial design considerations? What is the role of immunological correlates of protection? What are the gaps in preclinical models for studying tuberculosis vaccines? The international expert panel formulated consensus statements to each of the framing questions, with the intention of informing tuberculosis vaccine development and the prioritisation of clinical trials for inclusion of people with HIV.

Antiretroviral Drug Resistance in HIV Sequences From People Who Inject Drugs and Men Who Have Sex With Men Across 21 Cities in India

Open Forum Infectious Diseases, September 17, 2022 Drug resistance testing is limited in public-sector human immunodeficiency virus (HIV) care in India, and there are few systematic samplings for prevalent drug resistance mutations (DRMs), particularly among men who have sex with men (MSM) and people who inject drugs (PWID). We conducted genotypic resistance testing on 915 HIV sequences sampled from viremic self-reported antiretroviral therapy (ART) experienced and naive PWID and MSM recruited from 21 cities across India in 2016-2017. We analyzed factors associated with resistance using logistic regression and evaluated evidence for transmitted resistance using phylogenetic analyses.

Faculty Receive Grant to Narrow Health Equity Gap in Chandigarh, India

Bloomberg School of Public Health, August 09, 2022 Ligia Paina, PhD ’14, MHS ‘08, an assistant professor in the Department of International Health’s Health Systems Program at the Johns Hopkins Bloomberg School of Public Health, and her co-PI Meng Zhu, PhD, MS, a professor at the Johns Hopkins Carey Business School, were awarded an Impact Grant from the Johns Hopkins Alliance for a Healthier World for their work aimed at narrowing the health equity gap in urban slums in Chandigarh, India.

The paradox of antimicrobial resistance in India

Fogarty International Center, June 15, 2022 India, home to one in every six people on the planet, has one of the highest rates of antimicrobial resistance (AMR) in the world. As a Fogarty Global Health Fellow, Dr. Matt Robinson worked in Pune, India, to characterize the burden of antimicrobial resistance among hospitalized patients with fever illnesses. “Fever is the most common reason why people in India seek medical care and we found that almost every patient hospitalized with fever received antibiotics—despite mosquito-borne diseases, which are not treated by antibiotics, being the cause of most of these illnesses,” said Robinson.

Alcohol reduction study in TB and HIV persons to commence in April in Pune

The Indian Express, March 26, 2022 US-based National Institutes of Health has funded a hybrid trial for alcohol reduction among people with TB and HIV in India (HATHI) that is set to begin in April in Pune. Johns Hopkins University in collaboration with Pune’s B J Government Medical College and Dr. D.Y. Patil Medical College, Hospital, and Research Center have developed a behavioral intervention to reduce alcohol use among TB/HIV patients.

Shorter Treatment for Nonsevere Tuberculosis in African and Indian Children

New England Journal of Medicine, March 10, 2022 Two thirds of children with tuberculosis have nonsevere disease, which may be treatable with a shorter regimen than the current 6-month regimen.

Study: Plasma Therapy Effective At Early Stage

The Times of India, December 26, 2021 Days after the World Health Organization (WHO) recommended against the use of plasma therapy for Covid-19, a multi-centre clinical trial led by Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health has reiterated the treatment is beneficial indeed.

Johns Hopkins Receives Award for Antimicrobial Resistance Surveillance and Infection Control Partnership in India

Johns Hopkins India Institute, December 13, 2021 Drs. Matthew Robinson and Trish Simner of Johns Hopkins School of Medicine are collaborating with five Indian medical institutions with which JHU has longstanding research ties

News Release: CDC Launches Two Global Networks, Awards $22 Million to Combat Antimicrobial Resistance and Infectious Diseases

US Centers for Disease Control and Prevention, December 07, 2021 These two new networks, paired with additional short-term research projects, will span more than 50 countries worldwide and build programs that focus on preventing infections in health care through proven infection control; build laboratory capacity to detect antimicrobial-resistant organisms in healthcare, the community, and environment; and develop new and innovative ways to more rapidly detect and respond to threats like AR and COVID-19.