Research
My research focuses on using epidemiological and implementation science methods to mitigate the long-term health impacts of tuberculosis. I have experience conducting epidemiological investigations, working with large linked administrative databases, and translating knowledge into action.
For my doctoral research, I am developing a theory-informed, evidence-based post-tuberculosis care package in collaboration with the BC Centre for Disease Control Provincial TB Services. The aim of this care package is to help link people completing treatment for tuberculosis disease to primary care providers, provide basic testing to inform care, and inform their primary care providers of known post-TB complications.
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As a starting point for this work, I created an infographic highlighting the importance of linking TB survivors to primary care.
Next, I conducted a scoping review of interventions to mitigate common non-communicable diseases among people with tuberculosis. I found that we need more robust evidence demonstrating the feasibility and effectiveness of interventions at addressing common non-communicable diseases is needed before scale-up to ensure resources are well invested, and the cascade of chronic disease care is addressed.
Developing a post-tuberculosis care package
The long-term mortality of people treated for tuberculosis
In this systematic review and meta-analysis, we found that people treated for TB have significantly increased mortality following treatment compared with the general population or matched controls. Overall, the pooled standardized mortality ratio for people treated for tuberculosis was almost three times higher than that for the control population. Approximately 20% of post-treatment deaths were attributed to either cardiovascular disease, cancer, or respiratory disease.
Predicting tuberculosis relapse
In this individual patient data meta-analysis, we analyzed clinical and microbiological factors associated with relapse in patients with new pulmonary TB treated with the WHO Standard Regimen.The most notable finding of our study was that the presence of cavitary disease with 2-month positive smear status was associated with increased odds of relapse. Moreover, the strength of this association was similar to that of commonly accepted determinants of relapse: HIV co-infection and cavitary disease with 2-month positive culture.
Chronic kidney disease and tuberculosis
The link between chronic kidney disease and TB has been known for more than 40 years, but the interaction between these two diseases is still poorly understood. In the review article, we discuss the global tuberculosis - chronic kidney disease syndemic.
In 2012, British Columbia began the roll-out of a latent tuberculosis screening program for people initiating dialysis using interferon-gamma release assay (IGRA) and treating when appropriate. In this study, we compared the rate of active TB in people who initiated dialysis and were screened using an IGRA compared with those not screened during the same period. We found that, in multivariable analysis, latent TB screening and treatment was associated with a significant reduction in the rate of active TB.