UCSF Profiles

search, discover, network

My research focuses on improving diagnosis and treatment monitoring of tuberculosis (TB) in low- and high-income settings. We are working in a variety of clinical research areas, including basic-translational studies aimed at discovery of novel TB biomarkers; clinical validation studies of new diagnostic tests and strategies; systematic reviews for policy development; and health services and implementation research. My international projects are based in Uganda, where I work with colleagues from Mulago Hospital, Makerere University (MU), and the Uganda National TB and Leprosy Programme under the umbrella of the MU-UCSF Research Collaboration (www.muucsf.org). Our basic-translational studies are using M. tuberculosis (M.tb) transcriptomics and human exosome biology to learn more about mycobacterial pathogenesis while identifying new targets for novel diagnostic and prognostic assays. Our clinical-translational activities are currently evolving from validation and demonstration studies of smear microscopy, TB culture, and nucleic acid amplification testing into implementation research on how these and other new diagnostic strategies can best be introduced in Uganda and other high TB-burden countries. To understand what interventions work in routine practice, we have established the Uganda TB Surveillance Project, a network of governmental, primary health-care clinics equipped with a novel electronic monitoring and evaluation system (www.mu-ucsf.org/tb/). Finally, mentoring trainees in both Uganda and the U.S. is a core aspect of all of our research activities.

In the U.S., we have two implementation research projects studying how Xpert MTB/RIF, an automated nucleic acid amplification testing for TB, could impact clinical and public health decision-making and patient-important outcomes in San Francisco if implemented following regulatory approval. Along with colleagues from the San Francisco TB Control Program, the Department of Public Health Lab, and the San Francisco General Hospital Clinical Lab, these studies are enrolling inpatients and outpatients to identify more efficient, patient-centered, and cost-effective strategies for evaluating patients suspected of TB in low TB-incidence settings.

Finally, through our research experiences, we’ve found frequent gaps in translating evidence into clinical practice, especially in low-income settings. In response, we hve recently founded an organization called Walimu (www.walimu.org) which will develop and support adoption of evidence-based practices in pulmonary medicine and critical care in Uganda.

Implementation Science, Socioeconomically marginalized groups, Global populations, Clinic, Hospital, International (public health), Audit and feedback, Team science, TB, HIV/AIDS, Pneumonia, Mentoring junior faculty or trainees, Interdisciplinary research collaboration, Brief implementation science training courses, Works-in-progress seminars