# Tuberculosis Transmission and Preventive Therapy in Tibetan Children and Young Adults in India

> **NIH NIH K01** · JOHNS HOPKINS UNIVERSITY · 2021 · $137,353

## Abstract

Summary
Annually, one million children die of TB and 25% of the global TB cases occur in children, adolescents and
young adults. Tibetan refugees in India have extraordinarily high TB rates. In 2017-18, we observed a TB case
and infection prevalence of 916/100,000 and ~20%, respectively, for schoolchildren residing in Tibetan
boarding schools in India. More than 60% of the total Tibetan TB cases occur in the schools and monasteries.
Despite this burden, understanding is limited of the epidemiology of TB in the Tibetan population and strategies
for its prevention.
 Zero TB in Tibetan Kids (ZTBK) is a fully funded and established public health program of the Johns
Hopkins University, Tibetan Delek Hospital, and the Department of Health of the Central Tibetan Administration
that aims to eliminate TB for Tibetan children and adolescents through a multipronged approach of screening,
treatment and preventive therapy. With ongoing support, the ZTBK is now scaled up to cover ~40,000 people
in schools and monasteries across 3 states through 2022. In this mobile program, the entire institution is
screened for TB using symptom, tuberculin skin test, chest X-ray, and Xpert. All Xpert positive and suspected
specimens are sent to the Hinduja Lab, Mumbai, for culture and drug susceptibility testing. Culture positive
isolates are stored at the Hinduja for whole genome sequencing (WGS). I will use data from this ZTBK initiative
to study TB epidemiology, transmission, and preventive therapy outcomes for children, adolescents, and young
adults in the Tibetan schools, monasteries, and nunneries in Himachal Pradesh state of India.
 For Aim 1, I will characterize TB infection and disease and study the epidemiologic risk factors.
For Aim 2, I postulate that most TB transmission in the congregate settings happen through recent
transmission. I will study TB transmission by analyzing single nucleotide polymorphisms in the WGS data and
relate the genomic clusters with epidemiological links. Using geospatial analysis, I will relate the transmission
data with spatial coordinates for a complete understanding of the transmission dynamics. For Aim 3, I will test
the postulate that receiving preventive therapy in the congregate settings will lead to a sustained lower risk of
disease over five-years of follow-up period. Through the aims, I will study the characteristics of subclinical TB
disease and its transmissibility. The results will inform TB preventive therapy strategies and targeted
interventions to interrupt transmission at the facility/community levels and have broad applicability to children
and young adults in schools and other settings, globally.
 The training goals I have identified that include spatial analysis and analysis of WGS data will enable
me to accomplish the aims of the study. The opportunity for mentorship, training, and research through this
award will give me the knowledge, experience, and expertise to develop an R01 proposal for a multicenter
study on ...

## Key facts

- **NIH application ID:** 10187516
- **Project number:** 5K01AI148583-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Kunchok Dorjee
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $137,353
- **Award type:** 5
- **Project period:** 2020-06-09 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10187516

## Citation

> US National Institutes of Health, RePORTER application 10187516, Tuberculosis Transmission and Preventive Therapy in Tibetan Children and Young Adults in India (5K01AI148583-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10187516. Licensed CC0.

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