Mentoring the Next Generation of Researchers: The McGill Tuberculosis Research Centre

One third of the world’s population is currently suffering from tuberculosis, and the work of a team of doctors from the EU and Canada aims to change that. Dr. Madhukar Pai of McGill University in Montreal has been collaborating with researchers from the United Kingdom, India, South Africa, Germany and Italy on a Seventh Framework Programme project to mentor new researchers in the development of diagnostic and treatment tools for TB.

The project’s main goal is sustain research momentum in TB by nurturing and supporting doctoral and postdoctoral students globally. These young researchers are assisting in the development and evaluation of new diagnostic tools.

Tuberculosis is most prevalent in the developing world, and therefore diagnostic tools must be inexpensive and rapid to be most effective. The tests that are currently most widely used to diagnose TB include the tuberculin skin test, the chest x-ray, and sputum smear microscopy. These tests are over a century old, take weeks to obtain results, and produce a large number of false positives. Without being able to trust the diagnostic tools, doctors are unable to stop the epidemic.

In March 2011, Dr. Pai told Indian newspapers that a 100 per cent detection rate must be achieved. “Unless we are able to do that, we will not be able to cut off the epidemic’s legs. Tuberculosis has suffered from a century of neglect, in terms of primary tools for diagnosis. The sputum smear microscopy test has remained unchanged for years,” says Dr. Pai.

In recent years, the development of a test called interferon-g release essays has been an important breakthrough in the diagnosis of latent tuberculosis infection, or LTBI. Dr. Pai’s team has been conducting field research in India to determine if this test could replace the others. With a higher early detection rate, doctors would be able to diagnose and begin treatment of TB before an infected patient spread the disease to more individuals. The study is the largest one of its kind in focusing on high-risk populations – particularly children, healthcare workers, and TB patients with HIV co-infection. Dr. Pai’s research in high-burden areas is now being used by leading health organizations.

The team has also produced a website – BCG World Atlas – which is a database of vaccination methods in different countries, as overexposure to the BCG vaccine can interfere with the results of the tuberculin skin test.

“We were always frustrated with the fact that we could not interpret the skin test because the policy for BCG varies across countries, so we had the idea that it might be nice to collect the data from as many countries as possible and put it in one place,” Dr. Pai told Postmedia News. “Let’s say I’m looking at somebody who has come from the Philippines, Ukraine or Japan, and they don’t remember how many shots of BCG they got, or when they got the BCG. I can easily look up the country policy and say, ‘Ok, in all likelihood this person got the vaccine too many times.’ Therefore I probably shouldn’t rely too much on the skin test and I could ask for a blood test, which is unaffected by BCG.”

Another advance made by Dr. Pai’s team has been in the development of evidence-based standards for TB care and control. Dr. Pai assisted in the development of the International Standards for Tuberculosis Care. This document, aimed primarily at the private health care sector, aims to standardise the care practices so that they are consistent and based on rigorous scientific evidence. These international standards are now an integral component of the new Global Stop TB Strategy.

This extensive research program is helping young medical researchers to hone their skills to ensure a sustainable movement in the coming decades towards stopping the tuberculosis epidemic.