1020, Pine Avenue West
Office Phone: (514) 398-5422
%20madhukar [dot] pai [at] mcgill [dot] ca (madhukar [dot] pai [at] mcgill [dot] ca)
Link to Pubmed
My general interests include infectious diseases epidemiology, global health research, evidence based medicine, diagnostic research methodology, and systematic reviews and meta-analyses. My international tuberculosis research program covers four key areas:
- Evaluation of novel, T-cell based diagnostic tools for TB infection
- Synthesis of evidence on TB diagnostics
- Development of evidence-based standards for TB care and control
- Nosocomial TB and TB infection control in developing countries
1) Evaluation of novel, T-cell based diagnostic tools for TB infection
Detection and treatment of latent TB infection (LTBI) is an important component of TB control. Currently, diagnosis of LTBI relies on the tuberculin skin test (TST), a century-old test with several limitations. A breakthrough in recent years has been the development of interferon-g release assays (IGRAs) for LTBI. From a clinical and public health perspective, it is important to determine if IGRAs should replace the TST, and to assess their role and relevance in high burden countries. By conducting field evaluations of IGRAs in India, we have generated interesting and useful information on how these tests perform in a high burden country, especially in high-risk populations such as healthcare workers, children, and TB patients with HIV co-infection. For example, our study in India compared the TST with an IGRA in over 700 healthcare workers – the largest study of its kind (JAMA 2005;293:2746-55). Our data has informed evidence-based guidelines on how IGRAs should be used in clinical practice. They have also been used by FIND, TDR & WHO to develop a research agenda for the evaluation of these tests in resource-limited settings (Lancet Infect Dis 2007;7:428-38).
2) Synthesis of evidence on TB diagnostics
High quality diagnostic studies are critical to evaluate new tools, to develop evidence-based policies on TB diagnostics, and, ultimately, for effective control of the global TB epidemic. Systematic reviews and meta-analyses provide the best synthesis of current evidence and have the potential to impact policy. I have conducted and supervised several meta-analyses on various TB diagnostics. In addition to informing the field of evidence-based TB diagnosis, these reviews have been helpful in making policy decisions and in identifying key knowledge gaps and unresolved questions. For example, our review on yield of serial sputum smear examination (IJTLD 2007;11(5):484-95) was discussed in the 7th meeting of the Strategic and Technical Advisory Group for TB (STAG-TB), which concluded with a series of recommendations to WHO, including endorsement of a revised TB case definition. Similarly, on the basis of our series of reviews on smear microscopy (Lancet Infect Dis 2006), TDR/WHO recently launched a research program on optimization of sputum smear microscopy for TB.
3) Development of evidence-based standards for TB care and control
In order to control the TB epidemic, we need to ensure that our standards of TB care are based on rigorous scientific evidence, are clear and well understood, and are accessible to and applied by all types of health care providers -- public, private, certified, and non-traditional -- in all corners of the world. I participated in the development of the “International Standards for Tuberculosis Care (ISTC),” an initiative to develop evidence-based standard of care guidelines for TB, aimed primarily at the private healthcare sector. My role was to compile evidence-based guidelines on TB care, and co-write the standards. The ISTC report was published in 2006 (Lancet Infect Dis 2006;6:710-25). The ISTC is now an integral part of the new Global Stop TB Strategy.
4) Nosocomial TB and TB infection control
TB is a significant but neglected occupational problem among healthcare workers (HCWs) in poor countries. With the emergence of XDR-TB, there is growing concern about a real need to protect HCWs and HIV infected patients from TB. To inform policies and guidelines on TB infection control in developing countries, it is important to conduct research on dynamics of nosocomial transmission in high burden settings, and to determine the effectiveness and feasibility of simple and low-cost interventions that may work in resource limited settings. Our research in India has shown that TB is an important problem among HCWs, and the annual risk of TB infection is high, even among young medical and nursing trainees. Our work in India, for the first time, showed that interpretation of serial testing with novel T-cell based assays is complicated because of non-specific variations, conversions and reversions (Am J Respir Crit Care Med 2006; 174 349-355).
Epidemiology, Biostatistics & Occupational Health; Medicine (Divisions of Respirology & Infectious Diseases)
Accepting students from
Epidemiology; Medicine; Infectious Diseases