Working Together to Understand the Consequences of TB for Patients and Communities- the TB Sequel Project

What happens once patients diagnosed with tuberculosis (TB) receive treatment and what the long term consequences are for the health of their lungs but also the welfare of their families is not well understood.

The TB Sequel team will explore these issues in an international collaborative research project funded by the German government, and The Gambia, through MRC Unit The Gambia, was chosen as the only project partner site in West Africa. Over the next 4 years, the project will research the risk factors that contribute to the long-term impact of TB disease and link work in Gambia, Tanzania, South Africa, Mozambique and the University of Munich in Germany as the main partners.

At MRC, the project is led by Prof Beate Kampmann, Theme Leader, Vaccines and Immunity Theme and Principal Investigator (PI) and Dr Jayne Sutherland Head, TB Research/Immunology, co-PI. It will enrol 400 patients newly diagnosed with TB in the Greater Banjul Area (GBA) and follow them up clinically for at least 2 years. This will include detailed measurements of their lung health and aim to understand mechanisms of the disease from specimens sent to the labs at MRCG and abroad. There will also be a socio-economic angle. The project will benefit from the long-term experience of the Tuberculosis Case Contact Platform (TBCC) team and all the laboratory support available at MRCG.

The TB-Sequel project at MRCG is an integral part of an overall strategy to fill a knowledge gap to further improve TB treatment. In order to fully prepare the site for all partners, a site initiation visit was organised from 18-21 July 2017 and engaged local and international stakeholders.

The 3-day meeting brought together partners from Germany with collaborators from the University of Witwatersrand (WITS) Johannesburg in South Africa, National Institute of Medical Research (NIMR) Mbeya Medical Research Centre (MMRC), MRCG, the Gambian Government and local community leaders, including LTIs, NLTP and the Ministry of Public Health.

Participants during the TB-Sequel site initiation visit

Participants during the TB-Sequel site initiation visit

Speaking at the event, Prof Umberto D’Alessandro warmly welcomed all participants present and said “TB is one of the most important diseases of global health importance. Many TB projects look at the resistance to anti TB drugs but rarely do they look into the sequelae. Therefore, the TB Sequel project at MRCG is very important, as it will look into what happens to TB patients once they have been treated. “

Prof Beate Kampmann said, “The project is organised into five main research tasks namely; Clinical Cohort, Host immunology, Pathogen, Socio Economic and Therapeutic Intervention. The core of the current project is a prospective cohort of up to 1,600 patients (400 each from the above-mentioned countries) and the overall goal of the cohort is to describe and analyse the basis of the long term clinical consequences of pulmonary TB with a particular focus on lung injury.”

Abdou K Sillah, Research Clinician, Childhood TB Programme Grant, stated, “TB is a major problem in The Gambia.” He added that between 2011 and 2013, a nationwide multi-site cluster survey and screening process was conducted for active pulmonary TB. The nationwide prevalence is 128/100,000 population. He pointed out that, “The socio-economic impact of adult TB on their households in the greater Banjul area of the country has never been addressed.” In conclusion, he said that the study will also evaluate the socio-economic and health impact of adult TB on children in their households in the greater Banjul area in The Gambia.