National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu

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The Tuberculosis Chemotherapy Centre (as the NIRT was then known) was set up in 1956 as a result of a collaboration between ICMR (Indian Council of Medical Research), BMRC (British Medical Research Council), USPHS (United States Public Health Service), and the government of Tamil Nadu. It became the Tuberculosis Research Centre (TRC) in the 1970s, and was renamed the National Institute for Research in Tuberculosis (NIRT) recently. NIRT’s vision is to undertake high quality research in Tuberculosis that is relevant to both national and global programmatic needs.

The first research activity undertaken in 1956 (‘The Madras Study’) was meant to compare the efficacy of drug treatment at home, for isolation in sanatoria during the treatment duration for TB patients. The study found that cure rates were the same in both settings, and there was no greater contact risk by leaving patients at home. The results of this trial prompted OPD treatment of TB patients.

Clinical trials have formed the backbone of NIRT activities throughout its history, with emphasis placed on shortening the duration of treatment regiments, children’s TB and HIV-TB coinfection. NIRT is currently working to shorten the TB regiment from 6 months to 4 months by working with a class of drugs called fluoroquinolones. All this is in addition to many basic science and laboratory-based research activitiesundertaken in NIRT.

On the epidemiology front, NIRT has worked with the Central Government in conducting TB surveys and prevalence estimates, as India has no rigorous nationwide system for generating data on TB mobidity, mortality, and heterogeneity.

A BCG trial (the largest vaccine trial anywhere in the world) was started in Chengelpet district (now Tiruvallur district) in the late 1960s. That trial required a baseline survey, and a population of 280 000 was followed consistently for years. NIRT has epidemiology data on that population stretching back 40 years.

NIRT’s field activity is now moving into urban areas (Chennai city) from the rural, semi-urban areas of Tiruvallur district. Urban areas comprise of a mix of affluent neighbourhoods on the one hand, and slum areas on the other where overcrowding and other major TB risk factors are prevalent. Its main ongoing field activity within Chennai city is a Pulmonary TB prevalence study.

There are two approaches to conducting TB surveys; 1) Detect Symptoms -> Sputum Collection, and 2) X ray -> Sputum Collection. NIRT does both in its ongoing Chennai Pulmonary TB Prevalence Study.

About 11 years ago, a Model DOTS (Directly Observed Treatment Shortcourse) Centre was launched in Tiruvallur with funding from USAID. While clinical trials dominated NIRT’s focus for decades, it now also emphasizes operational research on intervention programs. The design and implementation of intervention programs require a great deal of attention as successes in labs need to be translated to tangible public health benefits on the ground.

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