This PhD opportunity is being offered as part of the LSTM and Lancaster University Doctoral Training Partnership. Find out more about the studentships and how to apply.
| Abstract | There are over 10 million new diagnoses of tuberculosis (TB) annually and approximately 155 million TB survivors worldwide. TB treatment varies but normally consists of 6 months of antimicrobial treatment, at the end of which the patient is normally “cured” and discharged from the service. However, there is a growing body of evidence, that suggests a significant number of survivors have morbidity that extends for years beyond TB treatment completion despite a “successful” treatment outcome. Approximately, half of patients treated for pulmonary TB have some form of persistent pulmonary morbidity, with approximately 20% having significantly abnormal lung function. Neurological, cardiac, psychological and socioeconomic sequelae are also well recognised. Following the 1st international symposium of Post-TB in Stellenbosch, South Africa, in 2019, survivors called for researchers and clinicians to develop guidance and pathways for follow-up after TB treatment completion. In April 2023, a consortium of international experts, led by myself, published the first clinical statement on post-TB Health and wellbeing. In addition, the minimum clinical standards for post-TB lung disease were published by the International Journal of Tuberculosis and Lung disease, highlighting the need for ongoing follow-up for survivors of tuberculous. However despite this little is known about the natural history of Post-TB lung disease in lower TB burden settings such as UK. Whilst the overall numbers of patients diagnosed with TB in UK each year (over 4000) are lower than in high burden countries, patients diagnosed with TB in UK are often from population that struggle to access healthcare, such as refugees and those with specific social and economic vulnerabilities. The optimal post-TB treatment pathways for these patients are unknown, with NICE still recommending no full up after completion of standard antimicrobial TB treatment, despite the risk of ongoing TB-related disease. Thanks to a newly obtained grant from Asthma and Lung UK, held by myself and Dr Naomi Walker there is unique chance to follow up Post-TB patients in Liverpool. Depending on the candidate's interests this could involve laboratory analysis of sputum and blood samplesto quantify potential immune mediators and identify host biomarkers, co-supervised by Doctor Naomi Walker and longitudinal clinical follow up including spirometry, X-ray, and quality of life data to identify clinical risk factors and quantify morbidity. There is the potential for this project to span the whole spectrum of translational research, including the opportunity to work with guidelines and policy makers. This project is part of the Centre for Tuberculosis research and the PhD student will have the opportunity to draw on the knowledge of skills of this hugely successful multiple disciplinary team. |
| Where does this project lie in the translational pathway? | T1 - Basic Research,T2 - Human /Clinical Research,T3 - Evidence into Practice ,T4 - Practice to Policy/Population |
| Expected Outputs | We would expect 4 publications minimum from this PhD. These will include a systematic review and clinical papers that will have direct impact on this relatively new area of research. I am currently co-chair of the Post-TB symposium and authored the first clinical statement on Post-TB. It is highly likely this research will contribute to guidelines in the future. Dr Walker is senior author on a recent AJRCCM State of the Art review, highlighting the need for further mechanistic understanding in this area. Samples collected in this project will potentially support future hypothesis-driven mechanistic research. |
| Training Opportunities | Clinical training opportunities: Training in clinical research methods, spirometry and chronic lung health management, including TB. Lab: Sample processing, molecular biology and immunology techniques. Quantitative data analysis: The PhD will allow the student to learn and actively use a statistical package and learn longitudinal data analysis skills. |
| Skills Required | This project would be particularly suitable for a registered healthcare professional (ideal UK registered or the ability to become UK registered) as clinical data collection is central to the project. Some prior knowledge of chronic respiratory disease or TB or Post-TB lung disease would be advantageous although not essential, however enthusiasm for learning is in this area is key. Some prior laboratory experience may be beneficial although not required as training will be provided. |
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Key Publications associated with this project |
https://www.ingentaconnect.com/content/iuatld/ijtld/2023/00000027/000000... |
| https://thorax.bmj.com/content/77/11/1131.abstract | |
| https://gh.bmj.com/content/7/5/e007643.abstract | |
| https://www.atsjournals.org/doi/10.1164/rccm.202402-0374SO | |
| https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30564-X/fulltext |