# Integrating genomic and spatial approaches for targeted control of HIV-associated tuberculosis epidemics

> **NIH NIH R01** · YALE UNIVERSITY · 2020 · $870,052

## Abstract

PROJECT SUMMARY
Tuberculosis (TB) remains the leading infectious cause of death due to a single pathogen and is a leading
cause of death among individuals living with HIV. Improved TB control in high HIV prevalence settings requires
new approaches for interrupting TB transmission. Recent studies have revealed substantial heterogeneity in
community risk factors for TB, as well as in TB transmission and prevalence, even within high-density urban
centers in Africa. Untargeted community-based interventions for active TB case finding in high HIV prevalence
settings demand substantial resources to implement yet have not reliably produced population-level benefits.
We hypothesize that more precisely targeted TB interventions, informed by whole genome sequencing of M.
tuberculosis isolates from all culture-positive TB patients, will result in more effective TB control, and may also
have efficiency benefits when compared with less focused community-based interventions in high HIV burden
settings. Based on previous studies and preliminary data from our study site in Blantyre, Malawi (where adult
HIV prevalence is around 20% and nearly 80% of notified TB cases are HIV seropositive), we believe that HIV
care settings and other locations will be identified as TB transmission hotspots where infectious TB cases are
in contact with highly susceptible individuals under poor infection control conditions.
In this project, we propose to use data and specimens that have been collected from notified TB patients from
all diagnostic centers in the city of Blantyre, Malawi between 2015 and the start of our study to accomplish
three specific aims: (Aim 1) To synthesize prospectively-collected demographic, spatial and genomic data to
illuminate patterns and critical drivers of local TB transmission dynamics in high HIV prevalence settings; (Aim
2) To develop and apply locally-calibrated mathematical models to investigate the potential impact and cost-
effectiveness of spatially-targeted TB interventions informed by high-resolution information on locations and
sources of infection in high HIV prevalence settings, and (Aim 3) To formally assess the value of information
afforded by whole genome sequencing and to estimate the costs and cost-effectiveness of building local
capacity for sequencing and analysis of pathogen genomic data.

## Key facts

- **NIH application ID:** 10057051
- **Project number:** 1R01AI147854-01A1
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** THEODORE H COHEN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $870,052
- **Award type:** 1
- **Project period:** 2020-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10057051

## Citation

> US National Institutes of Health, RePORTER application 10057051, Integrating genomic and spatial approaches for targeted control of HIV-associated tuberculosis epidemics (1R01AI147854-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10057051. Licensed CC0.

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