Past NEWAID Fellows: Molly Franke
ByMolly Franke was awarded a Masters Research grant in 2007, with continuing support for her PhD research in 2008. Molly’s initial work went on for publication in the journal Clinical Infectious Diseases. The abstract of her project “Risk Factors and Mortality Associated with Default from Multidrug-Resistant Tuberculosis Treatment” can be found below:
Background. Completing treatment for multidrug-resistant (MDR) tuberculosis (TB) may be more challenging than completing first-line TB therapy, especially in resource-poor settings. The objectives of this study were to (1) identify risk factors for default from MDR TB therapy (defined as prolonged treatment interruption), (2) quantify mortality among patients who default from treatment, and (3) identify risk factors for death after default from treatment.
Methods. We performed a retrospective chart review to identify risk factors for default from MDR TB therapy and conducted home visits to assess mortality among patients who defaulted from such therapy.
Results. Sixty-seven (10.0%) of 671 patients defaulted from MDR TB therapy. The median time to treatment default was 438 days (interquartile range, 152–710 days), and 27 (40.3%) of the 67 patients who defaulted from
treatment had culture-positive sputum at the time of default. Substance use (hazard ratio, 2.96; 95% confidence interval, 1.56–5.62; Pp.001), substandard housing conditions (hazard ratio, 1.83; 95% confidence interval, 1.07–3.11; Pp.03), later year of enrollment (hazard ratio, 1.62, 95% confidence interval, 1.09–2.41; Pp.02), and health district (Pp.02) predicted default from therapy in a multivariable analysis. Severe adverse events did not predict default from therapy. Forty-seven (70.1%) of 67 patients who defaulted from therapy were successfully traced; of these, 25 (53.2%) had died. Poor bacteriologic response, !1 year of treatment at the time of default, low education level, and diagnosis with a psychiatric disorder significantly predicted death after default in a multivariable analysis.
Conclusions. The proportion of patients who defaulted from MDR TB treatment was relatively low. The large proportion of patients who had culture-positive sputum at the time of treatment default underscores the public
health importance of minimizing treatment default. Prognosis for patients who defaulted from therapy was poor. Interventions aimed at preventing treatment default may reduce TB-related mortality.
Her other project “Helminth infection and the risk of tuberculosis infection in children” is currently starting enrollment. The abstract for that project is as follows:
In the year 2000, an estimated 884,019 children less than 15 years of age became ill with tuberculosis. Despite the existence of curative therapy, the World Health Organization (WHO) has estimated that approximately one third of TB cases among children in this age group result in death. The paucity of data describing TB risk factors in children poses a challenge to the design of interventions that could decrease TB disease progression in this group. The identification of modifiable risk factors might lead to interventions that could substantially decrease TB-related morbidity and mortality in children. Helminth infection, including round worm and hookworm infection, may be one such risk factor. Several recent case-control studies in adults and adolescents suggest that TB disease is associated with both helminth infection and immunological responses consistent with helminth infection. Other studies have found no association between helminth infection and tuberculosis. To date, no studies have examined the association between TB endpoints and helminth infection in children, the group most vulnerable to helminth infection and about which the least is known regarding risk factors for progression to active TB disease. The general objective of this study is to examine whether helminth infection increases susceptibility to TB disease in children. We will pursue the following specific aims: (1) To determine whether helminth infection among children is associated with an increased risk of TB disease; and (2) To examine whether there is a dose-response relationship between the total burden of helminths and/or the number of helminth species with which a child is infected and progression to active TB disease. We will conduct a matched case-control study in Lima, Peru. We will compare the prevalence of helminth infection among children with and without TB disease. Cases will be matched to controls by age, neighborhood, and TB contact history.
Molly is currently working with the Department of Global Health and Social Medicine at Harvard Medical School on projects that collaborate with Partners in Health.
