Global Health Research Sites

Tanzania has 1 physician per 50,000 patients, one of the lowest ratios of physicians to patients in the world. Of the 49 million people living in Tanzania, approximately 34 million will never see a doctor in their lifetime. The mission of the Weill Cornell Medicine program in Tanzania is to improve healthcare by strengthening Weill Bugando School of Medicine and training the next generation of Tanzanian physicians and scientists. At present, Bugando Medical Centre is a 900-bed referral and teaching hospital employing approximately 950 people, serving one-third of the country's total population of about 40 million. Dr. Robert Peck and Dr. Jennifer Downs, Weill Cornell Medicine faculty- are based at Weill Bugando and lead Weill Cornell’s efforts in medical research. Examples of research projects include:

• Schistosomiasis: Dr. Jennifer Downs is developing new ways to diagnose and treat this water-borne tropical infection, which affects nearly half the population in Mwanza, causes liver and kidney failure, and can increase susceptibility to HIV infection.
• HIV Prevention and Treatment: Weill Cornell researchers, in collaboration with the Tanzanian Ministry of Health, and with support from the Bill & Melinda Gates Foundation, are studying how engaging and educating local religious leaders can increase the uptake of HIV prevention measures in the general population. With support from the National Institute of Health, we are studying a social worker intervention to improve survival of patients with HIV after hospitalization.
• Hypertension in People Living with HIV: Cardiovascular disease is a growing health problem in Tanzania and early onset hypertension is the single most important cause. Weill Cornell Medicine faculty and our Tanzanian colleagues are investigating the causes of hypertension in Tanzania and developing hypertension treatment programs to prevent cardiovascular disease deaths.

Publications

• Peck RN, Issarow B, Kisigo GA, Kabakama S, Okello E, Rutachunzibwa T, Willkens M, Deogratias D, Hashim R, Grosskurth H, Fitzgerald DW, Ayieko P, Lee MH, Murphy SM, Metsch LR, Kapiga S. Linkage Case Management and Posthospitalization Outcomes in People With HIV: The Daraja Randomized Clinical Trial. JAMA. 2024 Mar 26;331(12):1025-1034. doi: 10.1001/jama.2024.2177. https://pubmed.ncbi.nlm.nih.gov/38446792/

• Mertelsmann AM, Mukerebe C, Miyaye D, Shigella P, Mhango L, Lutonja P, Corstjens PLAM, de Dood C, van Dam GJ, Colombe S, Maganga JK, Aristide C, Kalluvya SE, Ward MM, Cordeiro AA, Lee MH, Changalucha JM, Downs JA. Clinical and Demographic Factors Associated With Kaposi Sarcoma-Associated Herpesvirus Shedding in Saliva or Cervical Secretions in a Cohort of Tanzanian Women. Open Forum Infect Dis. 2024 Mar 19;11(4):ofae161. doi: 10.1093/ofid/ofae161. https://pubmed.ncbi.nlm.nih.gov/38654970/

• de Jong D, Carrell C, Maganga JK, Mhango L, Shigella PS, Gill M, Shogren R, Mullins B, Warrick JW, Changalucha JM, van Dam GJ, Pham K, Downs JA, Corstjens PLAM. Flow-S: A Field-Deployable Device with Minimal Hands-On Effort to Concentrate and Quantify Schistosoma Circulating Anodic Antigen (CAA) from Large Urine Volumes. Diagnostics (Basel). 2024 Apr 16;14(8):820. https://pubmed.ncbi.nlm.nih.gov/38667466/

• Kisigo GA, Mcharo OC, Robert JL, Peck RN, Sundararajan R, Okello ES. Understanding barriers and facilitators to clinic attendance and medication adherence among adults with hypertensive urgency in Tanzania. PLOS Glob Public Health. 2022 Aug 23;2(8):e0000919. https://pubmed.ncbi.nlm.nih.gov/36962785/

• Nsanya MK, Ayieko P, Hashim R, Mgema E, Fitzgerald D, Kapiga S, Peck RN. Sustained high blood pressure and 24-h ambulatory blood pressure monitoring in Tanzanian adolescents. Sci Rep. 2021 Apr 16;11(1):8397. doi: 10.1038/s41598-021-87996-0. PMID: https://pubmed.ncbi.nlm.nih.gov/33864003/

• Reis KG, Desderius B, Kingery J, Kirabo A, Makubi A, Myalla C, Lee MH, Kapiga S, Peck RN. Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy. J Clin Hypertens (Greenwich). 2020 Sep;22(9):1554-1562. https://pubmed.ncbi.nlm.nih.gov/32815636/

Based in Port-au-Prince, Haiti, GHESKIO was founded in 1982 as the first institution in the developing world dedicated to the fight against HIV/AIDS. Under the leadership of Dr. Jean Pape, a professor at Weill Cornell Medicine, GHESKIO works with the Haitian Government to provide health care and humanitarian support to Haiti’s most vulnerable populations. As an international research center of excellence, it seeks to improve treatment and prevention strategies in resource-poor settings, and it is building Haiti’s public health system by training the next generation of healthcare workers. Drs. Daniel Fitzgerald, Molly McNairy, Kate Dupnik, Katey Walsh, Lily Yan, Lindsey Reif and Vanessa Rouzier – all Weill Cornell faculty – lead research efforts at GHESKIO on a variety of topics. Examples include:

• HIV: Weill Cornell in collaboration with GHESKIO has been conducting NIH-sponsored research on HIV/AIDS since 1983. Research studies include optimization of treatment of HIV/AIDS with a focus on children and adolescents and understanding resistance patterns of HIV.
• Tuberculosis: Weill Cornell and GHESKIO are part of the CDC TB Trials Consortium as well as a NIH-sponsored TB Research Unit. Research ranges from bench research in collaboration with Weill Cornell faculty in Belfer Research Building to phase 3 clinical trials. Research focuses on development of new drugs and novel regimens for drug-susceptible and drug-resistant tuberculosis, improving diagnostic assays and discovery of biomarkers of infection; and several prospective observational cohorts to better understand cavitary disease, pharmacokinetics of drugs and differentially-detectable tuberculosis.
• Cardiovascular disease: Cardiovascular disease is a major leading cause of death in developing countries. Weill Cornell faculty Dr. Molly McNairy and Dr. Lily Yan, in collaboration with GHESKIO researchers, have a large cardiovascular disease clinic with prospective community cohorts designed to better understand the pathophysiology of hypertension in this population, environmental factors affecting blood pressure, and why cardiovascular disease begins at an earlier age than in other populations. 
• Disease outbreaks: GHESKIO is at the forefront of detecting and managing disease outbreaks in Haiti, from cholera, Zika, Covid and emerging pathogens.

Publications

• Walsh KF, Lee MH, Zainabadi K, Vilbrun SC, Jean Juste MA, Joseph Y, Royal G, Saito K, McAulay K, Pape JW, Fitzgerald D. High variance in quantification of Mycobacterium tuberculosis at low bacterial loads and with differentially detectable mycobacteria. Antimicrob Agents Chemother. 2024 Jul 9;68(7):e0160123. doi: 10.1128/aac.01601-23. Epub 2024 Jun 3.  https://pubmed.ncbi.nlm.nih.gov/38829050/
• Bhattarai SK, Du M, Zeamer AL, M Morzfeld B, Kellogg TD, Firat K, Benjamin A, Bean JM, Zimmerman M, Mardi G, Vilbrun SC, Walsh KF, Fitzgerald DW, Glickman MS, Bucci V. Commensal antimicrobial resistance mediates microbiome resilience to antibiotic disruption. Sci Transl Med. 2024 Jan 17;16(730):eadi9711. https://pubmed.ncbi.nlm.nih.gov/38232140/ 
• Zainabadi K, Walsh KF, Vilbrun SC, Mathurin LD, Lee MH, Saito K, Mishra S, Ocheretina O, Pape JW, Nathan C, Fitzgerald DW. Characterization of Differentially Detectable Mycobacterium tuberculosis in the Sputum of Subjects with Drug-Sensitive or Drug-Resistant Tuberculosis before and after Two Months of Therapy. Antimicrob Agents Chemother. 2021 Jul 16;65(8):e0060821. https://pubmed.ncbi.nlm.nih.gov/34060896/
• Dorvil N, Rivera VR, Riviere C, Berman R, Severe P, Bang H, Lavoile K, Devieux JG, Faustin M, Saintyl G, Mendicuti MD, Pierre S, Apollon A, Dumond E, Forestal GPL, Rouzier V, Marcelin A, McNairy ML, Walsh KF, Dupnik K, Reif LK, Byrne AL, Bousleiman S, Orvis E, Joseph P, Cremieux PY, Pape JW, Koenig SP. Same-day testing with initiation of antiretroviral therapy or tuberculosis treatment versus standard care for persons presenting with tuberculosis symptoms at HIV diagnosis: A randomized open-label trial from Haiti. PLoS Med. 2023 Jun 9;20(6):e1004246. https://pubmed.ncbi.nlm.nih.gov/37294843/
• Zainabadi K, Lee MH, Walsh KF, Vilbrun SC, Mathurin LD, Ocheretina O, Pape JW, Fitzgerald DW. An optimized method for purifying, detecting and quantifying Mycobacterium tuberculosis RNA from sputum for monitoring treatment response in TB patients. Sci Rep. 2022 Oct 17;12(1):17382. https://pubmed.ncbi.nlm.nih.gov/36253384/
• Reif LK, Belizaire ME, Rouzier V, Seo G, Severe P, Bajo Joseph JM, Joseph B, Apollon S, Pape JW, McNairy ML, Elul B, Fitzgerald DW, Arpadi SM, Abrams EJ, Kuhn L. Point-of-care viral load testing among adolescents and young adults living with HIV in Haiti: a randomized control trial. AIDS Care. 2022 Apr;34(4):409-420. https://pubmed.ncbi.nlm.nih.gov/34612092/

Collaborative research and training programs between Cornell University and the Federal University of Bahia (UFBA) were first initiated in 1964. Since that time, they have received support from the Commonwealth Fund (1964-1975), the Rockefeller Foundation (1974-1979), and the National Institutes of Health (1979-2022). Research and training are currently based at UFBA and Fiocruz (Oswaldo Cruz Foundation) in Salvador, the capital of Brazil’s state of Bahia, with collaborators at the University of Iowa, Johns Hopkins, and the University of Pennsylvania. Research has focused on the major endemic tropical diseases in Brazil including schistosomiasis, leprosy, typhoid fever, Chagas disease, and leptospirosis. Examples include:

• Leishmaniasis: Leishmaniasis is caused by a parasite that is transmitted to humans from animal reservoirs by the bites of infected sand flies.  It most commonly manifests at the site of the sand fly bite as skin ulcers, which can be multiple and disfiguring. The research being conducted incorporates molecular epidemiology, immunology, and genetics with innovative approaches to determine the host and pathogen factors contributing to the development of disease.  Emerging knowledge of parasite proteomes and transcriptomes are being applied to studies of parasite biology and immunology. Collectively, the team of investigators and collaborators has authored over 500 papers on the epidemiology, biology, immunology, genetics, and therapy of leishmaniasis.
• Leprosy has afflicted humans for thousands of years. It is an infectious disease caused by a mycobacteria and predominantly affects the skin, nerves, eyes, and nose. The skin can become discolored, and in some cases, there is severe disfigurement. Antibiotics cure leprosy, however, nearly one third of people will develop a pathologic immune or allergic reaction after initiation of antibiotics. These immune reactions require steroids or other immune suppressing drugs and can be more debilitating than leprosy itself. Research focuses upon understanding the underlying immunologic basis of the leprosy immune reactions and finding ways to prevent this devastating complication. 

India is a middle-income country with significant disparities in health delivery to poorer regions and rural communities compared to wealthier communities. B.J Medical College’s mission is to provide excellent healthcare to all people for free. Since 2009, Dr. Jyoti Mathad (Weil Cornell faculty) has been conducting research in Pune, India, on the performance of immune-based latent TB diagnostics in pregnant women with and without HIV. Dr. Puja Chebrolu, also Weill Cornell faculty, works with Dr. Mathad on TB in pregnancy, with a focus on gestational diabetes in women living with and without HIV and on lean diabetes, a unique phenotype of diabetes frequently seen among South Asian communities. Research examples include:

• Tuberculosis in pregnancy: The immune system undergoes significant changes during pregnancy which make pregnant people uniquely at risk for tuberculosis. Research studies include immunological investigations, and prospective cohorts to better understand the spectrum of TB from infection through latency to reactivation in pregnant persons and how best to treat this population.
• Gestational Diabetes: Women who have gestational diabetes are at increased risk for developing hypertension later in life. Tuberculosis and diabetes are both diseases that impact immunity and can impact women’s immune systems in unique ways. Studies examine the epidemiology and pathophysiology of gestational diabetes in women with and without tuberculosis.
• Lean Diabetes: Lean diabetes is a unique phenotype seen in persons of South Asian descent. Since persons affected by this do not have the standard metabolic disorders seen with type 2 diabetes, the diagnosis is often missed. Epidemiologic studies to better understand the extent of lean diabetes and studies to understand the genetic factors contributing to this disease are underway.