# Sentinel populations and transmission hotspots of isoniazid-resistant tuberculosis

> **NIH NIH K23** · WEILL MEDICAL COLL OF CORNELL UNIV · 2024 · $195,480

## Abstract

PROJECT SUMMARY
Candidate: Dr. Kathleen Walsh is an Internal Medicine-trained physician scientist who has spent the past
seven years conducting research in Haiti. She has gained first-hand experience in treating drug-resistant TB,
learned Haitian Kreyol and trained a research team of Haitian physicians, nurses and lab technicians in the
conduct of research in tuberculosis. She has authored 22 publications including 9 first author papers. She has
preliminary data suggesting there is an emerging epidemic of isoniazid-resistant tuberculosis (INHr-TB), that
adolescents are a sentinel population for INHr-TB in Haiti and that INHr-TB is predominantly being transmitted
outside the household in community settings. She seeks to investigate the epidemiology of INHr-TB in Haiti.
Career Goals: Dr. Walsh's goals are:
 1. To gain skills in molecular epidemiology through utilization of whole genome sequencing to identify
 molecular disease clustering and INHr-TB transmission.
 2. To gain expertise in geographic information systems (GIS) mapping of INHr- and DS-TB in Haiti
 3. To acquire skills in biostatistics, specifically analysis of temporal trends and Poisson regression
Career Development Plan: Dr. Walsh will have mentorship from Dr. Daniel Fitzgerald (clinical TB
epidemiology), Dr. Jean W. Pape (TB disease mapping), Dr. Theodore Cohen (molecular epidemiology), Dr.
Denis Nash (spatial epidemiology) and Dr. Myung Hee Lee (biostatistics). She will engage in courses and field
work related to her proposed research. She will submit an R01 application based on this data.
Environment: The proposed research will occur at Weill Cornell Medicine (New York, USA) and GHESKIO
(Port-au-Prince, Haiti), which has 40 years of NIH-supported research and training in TB.
Research: INHr-TB is the most common form of drug-resistant TB worldwide. Strains of Mtb typically acquire
resistance to INH first and then sequentially to other drugs. Therefore, INH resistance is a precursor to
multidrug-resistant TB. Since INH resistance is rarely diagnosed, there are large gaps in our understanding of
this disease. Dr. Walsh hypothesizes that INHr-TB is an emerging epidemic in Haiti and adolescents are
sentinel populations for this emergence. She further postulates that INHr-TB is predominantly transmitted in
community settings and not in the household. She will test 5,183 diagnostic Mtb isolates from 2011 – 2021 to
characterize temporal trends in INHr-TB prevalence in Haiti and determine if INHr-TB trends in adolescents
precede INHr-TB trends in adults (Aim 1). She will prospectively investigate the conventional, molecular and
spatial epidemiology of 360 INHr-TB and 360 DS-TB patients in Haiti and identify congregate settings where
INHr-TB transmission is occurring (Aim 2). This project will provide critical insight into the epidemiology of
INHr-TB so that we can improve detection and prevention of INHr-TB in Haiti and worldwide.

## Key facts

- **NIH application ID:** 10887506
- **Project number:** 5K23AI175686-02
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Kathleen F Walsh
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $195,480
- **Award type:** 5
- **Project period:** 2023-07-13 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10887506

## Citation

> US National Institutes of Health, RePORTER application 10887506, Sentinel populations and transmission hotspots of isoniazid-resistant tuberculosis (5K23AI175686-02). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/10887506. Licensed CC0.

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