Background: Today, tuberculosis remains one of leading causes of death in many poor and developing countries. Africa, home to 12% of the world’s population, contains almost a quarter of the TB disease burden, largely due to issues stemming from poverty, the rise of multi-drug resistant (MDR) strains, and the deadly intersection of TB and HIV/AIDS. Tanzania, with over an estimated 26,000 deaths in 2006, declared TB to be a national public health emergency. In order to combat this public health threat, new diagnostic tools, drugs and vaccines are urgently needed.
Objectives: The proposed TB epidemiology cohort study will promote the understanding of the molecular epidemiology of TB in the study areas and will assess TB care and treatment outcomes, with particular emphasis on the HIV/TB interrelation, TB transmission pattern and on TB drug resistance.
Methodology: To address these aims, Ifakara Health Institute (IHI) intends to establish and maintain surveillance of TB patients and their contacts in Bagamoyo, Dar es Salaam, Rufiji, Ifakara and other areas where the Institute will be working in the future. The surveillance will be embedded in the current National TB program and will enhance this program in the participating sites. Patients will be recruited, consented and interviewed to gather information about social background, risk factors and co-morbidities. Sputum samples from all patients will be treated for smear microscopy, culture, and when indicated, drug susceptibility testing. M. tuberculosis isolates collected during the study will be genotyped using standardized molecular typing methods. This information, combined with geo-reference data, will allow detailed mapping of disease transmission characteristics in the study areas. In addition, the study will monitor household contacts of all enrolled TB patients, allowing for active case detection and collection of valuable information on strain transmission.