Tanzania
The University of Virginia's collaboration with Kilimanjaro Christian Medical Centre in Moshi, Tanzania, has been growing since 2002, when Dr. Eric Houpt lived there and began research on the burden of parasitic infection on AIDS patients.
Many patients were suffering from Cryptosporidium diarrhea, but surprisingly others were only carriers. This illustrated a fundamental question in infectious diseases, which is why some infections lead to disease while others do not. We were able to attribute part of the variation in clinical symptoms to parasite sub-species, and have found the same paradigm to be true for Giardia infection in Bangladesh. Detecting intestinal infections to the sub-species level is not trivial and we have had to develop new molecular diagnostic tests to perform this work. These tools are developed in the lab at UVa and then transported to Tanzania for evaluation. Fortuitous side effects of this work are that technical capacity is improved there and enrolled patients receive a much better diagnosis than they would otherwise, which translates to better treatment.
Projects have proliferated in Moshi and as of 2006-2007, 10 UVa students or residents have performed clinical or research rotations there. Presently we are examining whether screening for subspecies infection in advanced Tanzanian AIDS patients can lead to a preemptive strategies that minimizes diarrhea, which would otherwise become a death sentence there. We have recently completed a characterization of the burden of cryptococcal meningitis (which is huge) and are now scaling up a tuberculosis early-diagnosis project via Tb DNA capture and real-time PCR of sputum.