Ramnath Subbaraman, MD

GHES U.S. Fellow 2015-2016

E-mail: ramnath.sub@gmail.com
Fellowship Site: National Institute for Research in Tuberculosis, Chennai, India
U.S. Institution: UC Berkeley

Project Title: Investigating pretreatment loss to follow-up of smear-positive tuberculosis patients in Chennai, India

Pretreatment loss to follow-up (PTLFU) of tuberculosis (TB) suspects is a major problem for TB control in India, leading to ongoing transmission of infection, increased mortality, and overestimation of cure rates in government TB programs.

Prior studies of PTLFU in India have not investigated the prevalence of this problem in major cities or shed light on barriers faced by patients that contribute to PTLFU. No studies describe the development of interventions to address PTLFU in the Indian context. This GHES project proposes investigating PTLFU of TB suspects in Chennai, India, using a mixed methods approach, to inform the development of a multi-component health system strengthening intervention.

The following Specific Aims are proposed:

1) To determine the prevalence of, and risk factors for, PTLFU in retrospective cohorts of smear- positive and smear-negative TB suspects in Chennai;

2) To create an explanatory model for PTLFU by using qualitative methods to identify patient- and health system-related reasons for PTLFU.

This work will develop a new, scalable intervention using implementation science research, which is a strategic priority of the Fogarty International Center. The research will be conducted in collaboration with investigators at the National Institute for Research in TB in Chennai, which is a NIH International Center for Excellence in Research. I will gain expertise in quantitative and qualitative research methods and behavioral science theories, which will provide a foundation for a career as an independent investigator using implementation science to improve global healthcare delivery.

These are selected publications associated with the fellowship:

Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study.

Psycho-Socio-Economic Issues Challenging Multidrug Resistant Tuberculosis Patients: A Systematic Review.

The right to water in the slums of Mumbai, India.

A killer combination that must be stopped.