The Communicable Diseases Policy Research Group (CDPRG) is a multidisciplinary team within the Department of Global Health & Development in the Faculty of Public Health and Policy at the London School of Hygiene & Tropical Medicine.The Group is based in Bangkok, Thailand, and conducts research across the SE Asia region, and beyond. It provides a focus of expertise on the diverse public health problems associated with communicable disease control internationally and carries out research that is in support of and for policy reform.

Prof Richard Coker with Prof Vonthanak Saphonn, Rector of UHS, Cambodia. He is accepting a Memorandum of Understanding between UHS and LSHTM on behalf of Prof Peter Piot, Director of LSHTM. May 2015. 

Congratulations to Richard Coker who has received a confirmed letter from the Faculty of Public Health, Mahidol University, for his Adjunct Professor position. 

Prof Richard Coker's talk session "Challenges to TB Control: Lessons from the field"at Faculty of Public Health, Mahidol University,  on 24 September 2014

Jointly organised by:

1. Communicable Diseases Policy Research Group (CDPRG), London School of Hygiene and Tropical Medicine (LSHTM)

2. Department of Epidemiology, Faculty of Public Health, Mahidol University 

Video on "Research in Cambodia and Indonesia protects the world from disease threats"

Interview with Dr. James Rudge about his team's research in Cambodia and Indonesia.


Video on "Influenza: Preparing for the next pandemic"

Tom Drake and Prof Richard Coker discuss pandemic influenza mitigation measures as they affect Southeast Asia, a region considered by many to be the front line of any future battle against the disease.

 

News

11 May 2016

Paper entitled "The effect of early versus late treatment initiation after diagnosis on the outcomes of patients treated for multidrug-resistant tuberculosis: a systematic review" has been published in BMC Infectious Diseases.

Rebecca C. Harris, Louis Grandjean, Laura J. Martin, Alexander J. P. Miller, Joseph-Egre N. Nkang, Victoria Allen, Mishal S. Khan, Katherine Fielding and David A. J. Moore authored the paper entitled "The effect of early versus late treatment initiation after diagnosis on the outcomes of patients treated for multidrug-resistant tuberculosis: a systematic review" which has been published in BMC Infectious Diseases BMC series – open, inclusive and trusted201616:193, DOI: 10.1186/s12879-016-1524-0.

Abstract

Background

Globally it is estimated that 480 000 people developed multidrug-resistant tuberculosis (MDR-TB) in 2014 and 190 000 people died from the disease. Successful treatment outcomes are achieved in only 50 % of patients with MDR-TB, compared to 86 % for drug susceptible disease. It is widely held that delay in time to initiation of treatment for MDR-TB is an important predictor of treatment outcome. The objective of this review was to assess the existing evidence on the outcomes of multidrug- and extensively drug-resistant tuberculosis patients treated early (≤4 weeks) versus late (>4 weeks) after diagnosis of drug resistance.

Methods

Eight sources providing access to 17 globally representative electronic health care databases, indexes, sources of evidence-based reviews and grey literature were searched using terms incorporating time to treatment and MDR-TB. Two-stage sifting in duplicate was employed to assess studies against pre-specified inclusion and exclusion criteria. Only those articles reporting WHO-defined treatment outcomes were considered for inclusion. Articles reporting on fewer than 10 patients, published before 1990, or without a comparison of outcomes in patient groups experiencing different delays to treatment initiation were excluded.

Results

The initial search yielded 1978 references, of which 1475 unique references remained after removal of duplicates and 28 articles published pre-1990. After title and abstract sifting, 64 papers underwent full text review. None of these articles fulfilled the criteria for inclusion in the review.

Conclusions

Whilst there is an inherent logic in the theory that treatment delay will lead to poorer treatment outcomes, no published evidence was identified in this systematic review to support this hypothesis. Reports of programmatic changes leading to reductions in treatment delay exist in the literature, but attribution of differences in outcomes specifically to treatment delay is confounded by other contemporaneous changes. Further primary research on this question is not considered a high priority use of limited resources, though where data are available, improved reporting of outcomes by time to treatment should be encouraged.

The paper is available online here.