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Fiji

Establishment of a new Communicable Diseases Research Centre, Fiji National University

Invesitgator:Professor Philip Hill
Funder: Mercy Hospital Dunedin. $97,500 over three years.
Status: Current (commenced 2021)

Supported by Mercy Hospital Dunedin, we are assisting Fiji National University, to establish their new Communicable Diseases Research Centre in Fiji. Philip Hill has been appointed an adjunct professor as part of the initiative and a first study funded by DFAT (Australia) is conducting sero-surveys of COVID-19 antibodies in across the population and after vaccine boosting.

Fiji Rheumatic Heart Disease Prevention and Control Programme

Co-invesitgator:Professor Philip Hill
Funder: Cure Kids. $3,000,000
Status: Current (commenced 2020)

This large project is led by Associate Professor Stephen Howie at the University of Auckland. Otago researchers are providing public health design and implementation expertise as coinvestigators, to improve pathways to care for children and adults with rheumatic heart disease in Fiji.

Indonesia

Are TB neighbourhoods a high-risk population for active infection?

Location: Bandung, Indonesia
Principal investigator:Dr Sue McAllister1
Co-invesitagors:Professor Philip Hill1, Bachti Alisjahbana2, Megan Murray3, Bony Wiem Lestari2, Panji Hadisoemarto2, Lidya Chaidir2, Chuan-Chin Huang3

  1. Centre for International Health, University of Otago, Dunedin, New Zealand
  2. TB Working Group, Infectious Disease Research Centre, Universitas Padjadjaran, Bandung, Indonesia
  3. Harvard Medical School, Boston, USA

Funder: HRC e-Asia. $450,000 NZD & $100,000 USD & 50,000 USD respectively over 3 years.
Status: Current – ongoing recruitment of study participants (commenced 2020)

Abstract

Indonesia has the second-largest tuberculosis (TB) burden globally. Attempts to scale-up TB control efforts have focused on TB households. However, in most high burden settings, considerable Mtb transmission occurs outside TB households. A better understanding of transmission dynamics in an urban setting in Indonesia will be crucial for the TB Control Program in scaling up efforts towards elimination of TB in a more targeted way. Therefore, the study aims to measure TB prevalence and incidence in household contacts and neighbourhoods in the vicinity of known TB cases and to assess their genomic and epidemiological relatedness.

Methods and analysis

Individuals (~1000) living in the same household as a case diagnosed with pulmonary TB (n=250) or in a neighbouring household (~4500 individuals) will be screened for TB symptoms and by chest x-ray. A sputum sample will be collected for microbiological analysis from anyone with a productive cough. Any person found to have TB will be treated by the National TB Control Program. All those with no evidence of TB disease will have a repeat screen at 12 months. Whole-genome sequencing (WGS) and social network analysis (SNA) will be conducted on Index cases and contacts diagnosed with TB.

Child contact management

Location: Bandung, Indonesia
Principal investigator: Merrin Rutherford
Funder: University of Otago; Mercy Hospital, Dunedin

In Indonesia as well as many other high-burden countries, child tuberculosis (TB) is marginalised and mismanaged. The Bandung team is conducting a situational analysis regarding management of children living with an infectious TB case.

A range of epidemiological tools has been employed to establish all possible gaps and reasons for these gaps between current practice and national policy. Using the findings, options for bridging these gaps will be investigated and interventions designed and implemented.

Furthermore, the Bandung team is creating generic web-based situational analysis tools for use in other high-burden settings.

Comparison of Quantiferon and Mantoux test for latent tuberculosis in Indonesian children

Principal investigator: Merrin Rutherford
Funder: University of Otago, Mercy Hospital Dunedin

We have conducted a formal comparison of the Quantiferon and Mantoux tests for latent tuberculosis infection in child contacts of adult sputum smear positive TB cases.

Both tests performed as predicted against an exposure gradient with neither test outperforming the other.

Given the cost of Quantiferon, there is no justification for introducing this test into routine practice in Indonesia.

Investigating dietary and activity changes due to the COVID-19 pandemic and its implications on health status of Adolescents and Adults in Bandung, Indonesia

Investigators:Dr Sherly Parackal1, Nanny NM Soetedjo2,3 , Bony Wiem Lestari2; Dr Novina4; Noormarina Indraswari2

  1. Centre for International Heath, Division of Health Sciences, University of Otago
  2. Endocrinology and Metabolism Division, Internal Medicine Department, Hasan Sadikin General Hospital, Bandung Indonesia
  3. Faculty of Medicine, Department of Public Health, Padjadjaran University, Bandung, Indonesia
  4. Faculty of Medicine, Department of Peadiatrics, Padjadjaran University, Bandung, Indonesia

Funding: Otago Global Health Institute Seed Grant
Status: Current

Abstract

Several studies have been fast tracked and published across the globe to understand the impact of COVID-19 lockdowns on dietary behaviour and activity levels. Observed changes include higher prevalence of inactivity, increased consumption of ultra-processed foods, “comfort foods”, sweets, crisps, sugary drinks, and cereals and reduced consumption of fruits and vegetables.

Such studies in Southeast Asian countries such as Indonesia are totally absent. As obesity and the associated complications such as diabetes is rampant in Indonesia, one of the countries with the largest number of people with diabetes in the world, documenting dietary and activity changes in the COVID-19 context would be critical to inform diabetes prevention strategies and policies, which was the aim of this project.

Student involved:

  • Noormarina Indraswari
    Co-designing a diabetes prevention program for urban communities in Bandung, Indonesia

Increasing notifications of tuberculosis from Private Practitioners: A randomised controlled trial (INSTEP2)

Investigators and affiliations:Professor Philip Hill1, Bachti Alisjahbana2, Megan Murray3
Other collaborators: Panji Hadisoemarto2, Bony Wiem Lestari2, Katrina Sharples4, Nur Afifah2, Lidya Chaidir2, Chuan-Chin Huang3, Dr Sue McAllister1, Reinout van Crevel5

  1. Centre for International Health, University of Otago, Dunedin, New Zealand
  2. TB Working Group, Infectious Disease Research Centre, Universitas Padjadjaran, Bandung, Indonesia
  3. Harvard Medical School, Boston, USA
  4. Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
  5. Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegan, The Netherlands.

Funder: HRC e-Asia
Status: Current

Background

A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public-private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public-private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia.

Methods

This is a cluster-randomized trial of a multi-component public health intervention. Thirty-six community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including: in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB reporting app developed in collaboration with the National TB programme.

The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs at the end of a one-year observation period and comparing to the one-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for one year pre- and one year post- intervention.

Expected results

The results from this study will provide valuable evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.

Students involved

  • Panji Hadisoemarto: PhD Candidate, University of Otago.
  • Bony Wiem Lestari: PhD Candidate, Radboud University Medical Centre, The Netherlands

Randomised trial of an intervention to increase tuberculosis notifications by private practitioners in Indonesia, plus sequencing and susceptibility sub studies

Location: Bandung, Indonesia
Investigator:Professor Philip Hill
Funders: NZ Health Research Council and National Institutes of Health (USA) and RISDEK Indonesia. $450,000 NZD & $100,000 USD & 50,000 USD respectively over 3 years.
Status: Current (commenced 2019)

This e-Asia collaborative project primarily is exploring whether a public health combined intervention with private practitioners in Bandung, Indonesia, can lead to increased notifications. An interlocking study is exploring contact networks of diagnosed cases using social network analyses and whole genome sequencing.

Student involved

  • Lupe Isaia (PhD)

Studies of tuberculosis in health care workers in Bandung, Indonesia

Co-investigator: Professor Philip Hill
Funder: Foundation Trust, University of Otago ($45,000)
Status: Complete (commenced 2018)

This was a series of studies in health care workers and nursing and medical students on TB infection control and epidemiology. Opportunities were identified for intervention in this high risk group, leading to a planned trial of re-vaccination with BCG.

Student involved

  • Lika Apriani (PhD)

Treatment default cohort

Funder: Mercy Hospital Dunedin

Delayed treatment seeking and incomplete treatment completion remain two major barriers to successful TB control. The Bandung team has been conducting a cohort study over the past 18 months, cross-sectionally documenting treatment seeking behaviour and longitudinally following up treatment completion of 300 TB outpatients.

Risk factors for early, temporary and permanent default will be evaluated using information gathered at baseline, and interventions to reduce defaulting and increase prompt treatment seeking will be developed in collaboration with the study clinic.

Samoa

Molecular epidemiology of antibiotic resistance of critical pathogens according to the World Health Organization (WHO) priority list, in Samoans in New Zealand and in Samoa

Principal Investigator:Professor Philip Hill
Funder: Maurice Wilkins Centre (NZ). $31,195
Status: Current (commenced 2019)

Prevalence of Chlamydia and infertility in Samoa

Funder: NZAID, Mercy Hospital Dunedin, South Pacific Commission, University of Queensland, University of Otago

Professor Philip Hill with project partners in Samoa

Studies in Antenatal clinics have suggested the Samoa has one of the highest prevalences of Chlamydia infection in the world. However, it is now known what the prevalence is in the general community.

This project, a partnership with the National University of Samoa and other key partners in Samoa, uses a cluster sampling method to obtain a representative sample of sexually active 20–29-year-old women across Samoa, interview them, and test them for Chlamydia.

It will provide, for the first time, a robust estimate of the prevalence of present and past Chlamydia infection and provide a basis for further intervention at the nationwide level.

Timor Leste

The prevalence of smoking among adolescent students aged 13–15 in the municipality of Dili in 2020, and factors influencing the uptake of smoking

Investigators and affiliations: Joāo Martins1, Richard Edwards2, Natalia Pereira3, Livio da Conceição Matos3, Dr Sue McAllister4, Frederico dos Santos5

  1. Director of Postgraduate in Clinical Areas, Universidade Nacional Timor Lorosa'e, Timor Leste
  2. Department of Public Health, University of Otago, Wellington, New Zealand
  3. School of Midwifery, Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Timor Leste
  4. Centre for International Health, University of Otago, Dunedin, New Zealand
  5. Department of the Non Communicable Diseases, Ministry of Health, Timor-Leste

Funder: Otago Global Health Institute Seed Fund

Status: Completed and report written. Further analysis and manuscript preparation is in progress.

Abstract

Smoking in young people and adolescents is important as initiation to smoking often occurs among this age group, and initiation rates are the main determinants of the future prevalence of smoking. Timor-Leste has very high smoking rates that are much higher in men than in women. Similarly, previously recorded smoking in school students was found to be high.

Our cross-sectional study focussed on adolescent students aged 13-15 years in the Dili Municipality and aimed to measure the prevalence of smoking and explore factors that may influence the risk of students starting to smoke.

A total of 1121 students from 18 schools participated. The overall prevalence of students having ever tried cigarette smoking was 29.7%, and 38.3% of students having experimented with any form of tobacco or smokeless tobacco (higher in males than in females). The prevalence of current smoking (at least one cigarette in the past 30 days) was 19.8%, with males having a higher prevalence (32.6%) than females (6.0%).

The most common place of smoking for current smokers was at a friends' house (35.4%), smoking at home (27.6%), or in public places (17.1%). Purchase or access of cigarettes was mostly from Kiosks (51.0%), or obtained from someone else (23.8%). The purchase in the form of individual cigarettes was common (39.1%). One in ten never users of tobacco products (9.8%) were susceptible to smoking. Exposure to smoking in the school environment was also very high at 55.7%.

Receiving spending money, exposure to second hand smoke in the home, parental smoking, exposure to smoking in the school and to any four settings (home, public transport, enclosed public place or outdoor public place) and reporting that there were cigarette sellers close to their school were all associated with higher current smoking prevalence and therefore subject to possible intervention strategies or policies.

Australia

Ending Tuberculosis. A cluster RCT of community-wide universal testing and treatment for latent TB infection in high prevalence settings

Investigator: Professor Philip Hill
Funder: NHMRC (Australia). $6,458,051.90 AUD
Status: Current (commenced 2020)
Student involved: Lupe Isaia (PhD)

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