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Ramnath Subbaraman, MD

Current position: Instructor in Medicine, Brigham and Women's Hospital

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GHES U.S. Fellow 2015-2016

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 had investigated the prevalence of this problem in major cities or shed light on barriers faced by patients that contribute to PTLFU. No studies described the development of interventions to address PTLFU in the Indian context. This GHES project proposed 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 were 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 aimed to develop a new, scalable intervention using implementation science research, which was a strategic priority of the Fogarty International Center. The research was 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 gaineed expertise in quantitative and qualitative research methods and behavioral science theories, which provided a foundation for a career as an independent investigator using implementation science to improve global healthcare delivery.