Research Areas

Researchers at the Division of Global Health Equity are engaged in a number of quantitative and qualitative studies that seek to advance the understanding and treatment of diseases worldwide. Particular emphasis is placed upon the study of HIV/AIDS, tuberculosis and cardiovascular disease in resource-poor settings, where disease burden is greatest.

In addition to furthering the boundaries of medical science, research shapes the provision of clinical services at the DGHE/Partners In Health’s international and domestic field sites. This collaboration brings the latest in academic medicine to underserved populations around the world. The growing body of knowledge obtained by DGHE researchers is shared and disseminated throughout the scientific community in an effort to improve the quality of and access to healthcare for all.

DGHE research faculty members have backgrounds in a variety of disciplines. Insights from medicine and the social sciences are utilized in order to approach problems and evaluate findings from a number of different perspectives. By taking a multidisciplinary approach to the complex scientific and social roots of disease, DGHE researchers consider multiple aspects of prevention and treatment models.

Tuberculosis

DGHE faculty are involved in a number of sponsored and unsponsored research studies on tuberculosis, including a series of studies on molecular epidemiology and transmission dynamics of drug resistant TB in Lima, Peru. The first of these, an NIH-funded study led by Dr. Mercedes Becerra, is designed to measure the transmissibility of MDR and isoniazid-resistant M. tuberculosis strains compared to drug-sensitive strains, to assess the impact of socio-demographic and clinical factors on transmission, and to measure associations among specific resistance mutations and resistance. This study is linked to an NIH-supported project led by Dr. Megan Murray that links three different studies focused on drug resistant tuberculosis and one on the epidemiology and transmission dynamics of MDR/XDR tuberculosis. To date, this project has recruited almost 4,000 TB patients and 12,000 household contacts. In related work, Dr. Ted Cohen is leading a study to investigate the prevalence and consequences of mixed TB strain infection in this context and in a setting in South Africa where HIV prevalence is high. He is also researching surveillance strategies for monitoring the prevalence of MDR TB in Moldova and South Africa.

Dr. Carole Mitnick was recently funded by the NIH to conduct a clinical trial of high dose rifampin for drug sensitive TB. This study will also take place in Lima.

In Russia, we are undertaking studies focused on treatment outcomes, risk factors for treatment failures, and community-based care delivery models. In an NIH-funded clinical trial led by Dr. Sonya Shin, we are assessing the effect of interventions in tuberculosis patients with alcohol disorders. Other research, funded through a grant from the Eli Lilly Foundation, focuses on care delivery models for TB, scale-up of the MDR program and toxicities associated with the treatment of MDRTB. Attention is also being directed to improving TB transmission control through training programs and consultations provided by our faculty and staff.  

In South Africa, we are conducting studies using an innovative approach to measure the transmissibility of M. tuberculosis. An experimental ward has been constructed that vents air from patient rooms to a chamber where guinea pigs are exposed to airborne bacteria. In an NIH-funded study, Dr. Edward Nardell is using this facility to study interventions to protect healthcare workers from airborne infections.

In Russia, we are undertaking studies focused on treatment outcomes, risk factors for treatment failures, and community-based care delivery models. In an NIH funded clinical trial led by Dr. Sonya Shin, we are assessing the effect of interventions in tuberculosis patients with alcohol disorders. Other research, funded through a grant from the Eli Lilly Foundation, focuses on care delivery models for TB, scale up of the MDR program and toxicities associated with the treatment of MDR TB. Attention is also being directed to improving TB transmission control through training programs and consultations provided by our faculty and staff.

In South Africa, we are conducting studies using an innovative approach to measure the transmissibility of M. tuberculosis. An experimental ward has been constructed which vents air from patient rooms to a chamber where guinea pigs are exposed to airborne bacteria. In an NIH funded study, Dr. Edward Nardell is using this facility to study interventions to protect healthcare workers from airborne infections.

Dr. Theodore Cohen is also conducting innovative research that explores the interaction between co-epidemics of TB and HIV with the overarching goal of developing tools that can be used by public health practitioners to design optimal disease control strategies.

HIV

DGHE’s HIV research agenda also spans multiple sites. In Haiti, Dr. Louise Ivers is leading a study investigating the impact of a pilot nutritional intervention on HIV-positive individuals.  In Peru, faculty members are studying the impact of social support on medication adherence among HIV/AIDS patients and conducting a pilot study on child development in household of HIV affected parents.  In Boston, the PACT project is conducting ongoing research, funded in part by the Rx Foundation, to document the impact of service delivery on health outcomes and life expectancy for underserved HIV and diabetes patients, and assessing the relative cost of community health worker interventions based on Medicaid data.  PACT is also documenting the impact on a range of outcomes of a major collaborative initiative using CHWs to help provide patient-centered medical homes to 2,500 chronically ill patients.

Cholera

In Haiti, Dr. Louise Ivers is conducting a study to measure the impact of a cholera vaccination program.

Primary Care

DGHE faculty are implementing and evaluating an integrated primary care program in the impoverished rural southeastern area of Rwanda. This project is supported by the Doris Duke Charitable Foundation and involves an analysis of changes in health indicators in intervention and non-intervention areas over the five years of the implementation project as well as a series of operational research projects that include economic analyses of health systems, ethnographic work on understanding barriers to accessing care, and the development of a rigorous monitoring and evaluation program capable of ongoing feedback and mid-course corrections.

School-Based Interventions for Child Health

DGHE faculty are leading the health component of a large randomized community trial of school-based interventions in impoverished urban neighborhoods in Santiago, Chile. Investigators are examining the impact of intensified case management within schools on outcomes including asthma frequency and school absenteeism.

Global Health Delivery

GHD is developing a series of case studies about how to develop and sustain large-scale HIV prevention programs and on the interaction between health systems and global health initiatives. In July 2011, GHD’s library of 21 case studies and associated teaching notes were published at no cost by Harvard Business Press.

DGHE faculty received an $8 million grant from the Doris Duke Charitable Foundation to strengthen and study community-based primary healthcare services in rural Rwanda in partnership with Harvard Medical School, the Harvard School of Public Health and Partners In Health. This consortium, lead by DGHE faculty member Peter Drobac, is working with the Rwandan Ministry of Health to implement and study an innovative model of comprehensive, community-based healthcare in two rural districts in Rwanda. The grant will help expand health services beyond HIV/AIDS and tuberculosis to cover all primary healthcare needs and chronic diseases and measure the impact of these services on people’s lives.