TB-DM

Impact Of Diabetes On Tb Disease And Treatment Outcome In Ghana

Tuberculosis (TB), which has killed more humans than any other infectious disease, is still a major global health problem. Established risk factors for TB include the HIV pandemic and the occurrence of strains resistant to anti-TB drugs. Diabetes mellitus (DM) is also increasingly becoming a worldwide chronic health condition, which can be attributed to increases in obesity, changing patterns of diet and physical activity as well as ageing. DM has been associated with reduced T cell response and neutrophil functional activity. Reports of many studies in different parts of the world indicated a higher DM prevalence among newly diagnosed TB cases compared to the general population. However, unlike HIV/AIDS, the relationship between TB and DM has not requires more attention, especially in low-income countries where 75% of diabetic patients live and are also battling with TB. This proposed study aims to determine the effect of DM on incidence and treatment outcome of TB in Ghana, the pharmacokinetics of anti-TB drugs, the association of TB-DM and drug resistance and evolution of distinct TB lineages. TB cases will be recruited from both the chest clinic and the diabetic clinic following the national guidelines from the respective health facilities. Every case will have a baseline HBA1c and Fasting Blood Glucose (FBG) done. Results will be used to classify patients into normal, impaired plasma glucose and diabetes as per the American Diabetes Association guidelines. All cases will be followed during treatment after consent has been sought. Detailed clinical and demographic data including lesion location by x-ray, previous treatment will be collected. We will re-test the HbA1c levels among all DM cases at 2, 5 months of treatment and 3 months after treatment to determine glycemic control. In addition, the treatment outcome and other complications during treatment will be documented. Laboratory analyses will include pharmacokinetics of anti-TB and diabetic drugs, culturing and genotyping of Mycobacterium tuberculosis complex isolates, drug susceptibility testing of all mycobacterial isolates. Association between any of the measured variables, clinical and demographic variables and DM will be calculated using standard statistics such as logistic regression analysis. At the end of the study, findings will contribute to a better understanding of DM on TB incidence and treatment outcome as well as management of the two co-morbidities.

 

Host Department: Bacteriology, Noguchi Memorial Institute for Medical Research – University of Ghana (NMIMR-UG)

Funding: European and Developing Countries Clinical Trials Partnership (EDCTP)/ GlaxoSmithKline (GSK) Senior Fellowship. This project (TMA2017GSF-1942) is part of the EDCTP2 programme supported by the European Union.

 



Project Approval:
NMIMR-STC/IRB and KBTH-STC/IRB

 

Principal Investigator: Prof. Dorothy Yeboah-Manu (PhD, Microbiology)

Dyeboah-manu@noguchi.ug.edu.gh

Collaborators:                       

Prof. Kwadwo Ansah Koram (MD, PhD)

Dr. Adwoa Asante-Poku (PhD, Microbiology)          

Dr. Audrey Forson (Consultant Pulmonologist)

Dr. Akosua Baddo (MD, Chest Physician)

Dr. Jane Afriyie-Mensah (MD, Head Chest Dept)

Dr. Yacoba Atias (MD, Head Diabetic Clinic)

Prof. Regina Appiah-Opong (PhD)

 

Two PhD students and a masters student who proved to be highly motivated and hardworking prospective students were selected upon an extensive screening and interview process to respectively lead 3 major aims of the project.

  Emelia Konadu Danso is a first year PhD student in Microbiology at Kwame Nkrumah University of Science and Technology. Her doctoral project, sponsored by EDCTP, focuses on the effect of diabetes mellitus on the evolution of Mycobacterium tuberculosis complex lineages and drug resistance in southern Ghana. She holds an MPhil in Molecular Cell Biology of Infectious Diseases from the University of Ghana and works as a senior research assistant at the Department of Bacteriology, NMIMR-UG. Her publications are primarily on Mycobacterium ulcerans, Mycobacterium tuberculosis and Vibrio c holerae.

 

 

Augustine Asare Boadu is a first year PhD candidate at University of Cape Coast - Ghana, reading drug discovery and toxicology. He holds an MPhil in Pharmacology from the University of Ghana. Augustine currently works under the supervision of Professor Dorothy Yeboah-Manu with his thesis titled “Effect of diabetes mellitus on the pharmacokinetics (PK) of anti-tuberculosis drugs in comorbid patients in southern Ghana” funded by EDCTP. His doctoral work is to help investigate the serum pharmacokinetics of the first line anti-TB drugs in the presence or absence of anti-diabetic agents in patients with tuberculosis only as well as comorbid with diabetes.

 

Portia Abena Morgan is a Ghanaian and a final year MPhil student at the university of Ghana, studying Molecular Cell Biology of infectious Pathogens. The title of her research work is “analysis of lung and gut microbiome of pulmonary tuberculosis patients with diabetes comorbidities”. This work aims to understand the interplay between microorganisms of the lungs and gut and how they influence TB disease progression and treatment outcomes. Specifically, to profile the non-mycobacterial species from sputum and stool of the different study groups using both culture and non-culture methods. Also, to determine the antibiogram of isolated culturable organisms before and after TB treatment.

 

The Noguchi Memorial Institute for Medical Research (NMIMR), set up in 1979 as a semi autonomous institute of the University, is the leading biomedical research facility in Ghana.

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