Luke Davis, JR
|School||UCSF School of Medicine|
|Address||1001 Potrero Ave, SFGH 5|
San Francisco CA 94143
My research program focuses on clinical-translational and implementation research on tuberculosis (TB) diagnosis in both high-burden/low-income (Uganda) and low-burden/high-income (San Francisco) settings. I am interested in how diagnostic tests, including tests for monitoring and prediction of treatment outcomes, perform in different clinical and epidemiologic settings, and how they can be integrated into TB evaluation strategies to improve patient and public health outcomes. I am currently involved in the following studies:
Epidemiologic and Biomarker Research within the Mulago Inpatient Noninvasive Diagnosis (MIND) of Pneumonia Study. This longitudinal cohort study of patients hospitalized with pneumonia at Mulago Hospital in Kampala, Uganda, provides a robust platform for research on diagnosis and pathogenesis of acute respiratory illness in patients with and without HIV. In collaboration with a multidisciplinary team of Ugandan and US researchers, we are studying a variety of diagnostic and treatment response markers in TB and other HIV-related pulmonary infections. Two areas of current focus are biomarker studies using human exosomes and TB transcriptomics.
TB Biomarker Research in Exosomes. In collaboration with colleagues at Colorado State University and the University of Notre Dame, we are studying whether exosomes, which are small, circulating, host-derived vesicles which concentrate and sequester mycobacterial products in serum and other body fluids, can facilitate identification and development of novel, point-of-care, proteomic and nucleic acid biomarkers for TB diagnosis and treatment monitoring.
TB Biomarker Research in Host and Pathogen Transcriptomics. In collaboration with colleagues at the University of Colorado-Denver and Stanford University, we are studying whether longitudinal profiling of Mtb RNA in sputum and host RNA in whole blood can help better characterize the biology of Mtb persistence in patients undergoing TB treatment. New insights in this area could provide better biomarkers for treatment monitoring, novel therapeutic targets, and improved models for drug development.
Implementation Research within the Uganda Tuberculosis Surveillance Project (UTBSP). In partnership with the Uganda National TB and Leprosy Programme and collaborators at Makerere University and Johns Hopkins University, UTBSP is using real-time evaluation and monitoring systems and novel mobile phone technologies to identify barriers to high-quality TB evaluation in a network of rural and urban primary care clinics and their surrounding communities. Current studies include a randomized, controlled trial of novel interventions to improve the effectiveness of household TB contact investigation; a multi-center study of the comparative effectiveness of a novel molecular TB diagnostic assay, GeneXpert MTB/RIF; and a study to improve adherence to guidelines on evaluation and diagnosis of pediatric TB.
Implementation Research on GeneXpert MTB/RIF Testing at San Francisco General Hospital. We recently completed a series of studies examining the clinical and public health impact and cost-effectiveness of GeneXpert MTB/RIF for rapid TB evaluation in inpatient and outpatient settings in San Francisco. These studies have employed novel methods for describing the impact of new TB diagnostics, and are now informing how we are implementing this technology in our public health system. This project epitomizes how thinking globally can inform quality improvement locally - a process others have coined "reverse innovation" from low-income countries to high-income countries - and illustrates how researchers working in both settings can realize synergies that benefit vulnerable and underserved populations in both settings.
Working across the TB diagnostic spectrum on biomarker discovery, test development, evaluation, implementation, and dissemination provides a variety of opportunities for collaboration, mentoring, and capacity development. Through a Fogarty International Center AIDS International Research Training Program on Pulmonary Complications of HIV with Professor Art Reingold from UC Berkeley, we are supporting training for new and established investigators in Uganda with a goal of building better translational research teams in Uganda. Walimu, an NGO which U.S. and Ugandan colleagues and I established to improve care of patients with respiratory disease and other forms of severe acute illness in low-income countries, is another organization focused on implementation and capacity building.
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
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