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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa Appendix C Participant Biographies Salim S. Abdool Karim, MBchB, Ph.D., is pro vice-chancellor for research at the University of KwaZulu-Natal in Durban, South Africa. He is also director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), a professor at Columbia University, and an adjunct professor at Cornell University. A clinical infectious disease epidemiologist, Dr. Abdool Karim performed research on TB and HIV treatment that shaped the current therapeutic approach to treating coinfected patients. He is coinventor of part of South Africa’s first HIV subtype C vaccine and subsequently led the first HIV vaccine trial in South Africa. His recent research on microbicides showed that an antimicrobial gel may prevent HIV infection in women. Dr. Abdool Karim is chair of the World Health Organization (WHO) Scientific Advisory Group for Reproductive Health and is a member of the WHO Expert Advisory Panel on Sexually Transmitted Infections and HIV. Clifton E. Barry, III, Ph.D., received his Ph.D. in organic and bioorganic chemistry in 1989 from Cornell University, designing and synthesizing inhibitors to study the mechanism of a complex enzyme involved in actinomycin D biosynthesis. He then spent 2 years doing postdoctoral research at The Johns Hopkins University in one of the leading laboratories involved in beta-lactam synthesis before joining the Intramural Research Laboratories of the National Institute of Allergy and Infectious Diseases in Hamilton, Montana, to study bacterial pathogens. After studying the pathogenesis of Chlamydia trachomatis, the leading cause of blindness in the developing world, he was given the opportunity in 1993 to start his own laboratory on
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa the pathogen of his choice—Mycobacterium tuberculosis (M.tb.). TB was a natural choice given the reemerging epidemic that was gaining public attention in the early 1990s and Dr. Barry’s increasing interest in global health. Over the next 5 years, his laboratory focused on understanding some of the basic biochemistry of the cell wall of TB, a rich source of potential drug targets. In 1998, Dr. Barry was tenured as chief of the Tuberculosis Research Section (TBRS) and relocated his laboratory to the main campus of the National Institutes of Health (NIH) in Maryland. In addition to his research group at NIH, with more than 30 members focusing on drug and diagnostic development, he has developed an active clinical research program in South Korea, where he has five ongoing trials with more than 700 participants. Dr. Barry’s group contributed to the development of PA-824, a new drug for TB now in Phase II clinical trials, and developed SQ109, another new TB drug now in Phase Ib trials. Dr. Barry is a member of several editorial boards and has authored more than 130 research publications on TB since entering the field. In 2009 he was named by ScienceWatch as the most highly cited researcher working in the field of TB. Enriqueta C. Bond, Ph.D., retired in August 2008 as President of the Burroughs Wellcome Fund (BWF), a private foundation whose mission is to advance the medical sciences through the support of research and education. Dr. Bond is a founding partner of QE Philanthropic Advisors and now consults with philanthropic and nonprofit organizations on program development and governance. Previously Dr. Bond served for nearly 20 years as staff officer and division director at the Institute of Medicine, National Academy of Sciences, serving as executive officer from 1989–1994. She serves on numerous board and advisory groups such as the Scientific Advisory Committee on Stewardship for Research on Infectious Diseases of Poverty at WHO’s Program for Research and Training in Tropical Diseases, the NIH Council of Councils, the board and executive committee of the Hamner Institute for Health Sciences, the board of the Health Effects Institute and the James B. Hunt Jr. Institute for Educational Leadership. She currently chairs a National Academies Board on Developing the Capacity of African Academies of Science, is a member of the National Research Council (NRC) Committee on Research Universities, a member of a Task Force on the Organization of the National Academies, and serves as a frequent reviewer of Academy Reports. Dr. Bond previously chaired the Institute of Medicine Clinical Research Roundtable and was a member of the Council of the Eunice Shriver National Institute of Child Health and Human Development. Dr. Bond is a member of the Institute of Medicine and is a fellow of the Association for the Advancement of Science. She was educated at Wellesley College (A.B.), the University of Virginia (M.A.), and Georgetown University (Ph.D.) in genetics and molecular biology.
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa Gail Cassell, Ph.D., is a Visiting Professor in the Department of Social Medicine, Harvard Medical School, and Vice President of TB Drug Discovery of the not-for-profit Infectious Disease Research Institute in Seattle. Dr. Cassell has recently retired as Vice President, Scientific Affairs and Distinguished Lilly Research Scholar for Infectious Diseases, Eli Lilly and Company in Indianapolis, Indiana. In this capacity among other things, she was responsible for initiating and leading the not-for-profit Lilly TB Drug Discovery Initiative launched in 2007. In 2003, she was one of two individuals at Lilly who initiated and developed the Lilly Multidrug Resistant Tuberculosis (MDRTB) Partnership. The partnership has resulted in company support to date of $135 million dollars and is the largest philanthropic effort in Lilly’s 125-year history. The partnership now involves over 20 partners, including WHO and CDC. She is the former Vice President of Infectious Diseases Drug Discovery and Clinical Development of Eli Lilly where she led the program of a hepatitis C protease inhibitor from the discovery phase to clinical candidate. The compound is now in phase III clinical trials under the direction of Vertex. Prior to moving to Lilly in 1997, Dr. Cassell was the former Charles H. McCauley Professor and Chair of the Department of Microbiology at the University of Alabama Schools of Medicine and Dentistry at Birmingham, a department which ranked first in research funding from the National Institutes of Health during the decade of her leadership. She obtained her B.S. from the University of Alabama in Tuscaloosa and in 1993 was selected by that institution as one of the top 31 female graduates of the 20th century. She obtained her Ph.D. in Microbiology from the University of Alabama at Birmingham and was selected as its 2003 Distinguished Alumnus. She is a past President of the American Society for Microbiology (the oldest and single largest life sciences organization with a membership of over 42,000). She was named to the original Board of Scientific Counselors of the Center for Infectious Diseases, Centers for Disease Control and served as Chair of the Board. She has served on the Advisory Board of the Director of National Institutes of Health, the Director of the Centers for Disease Control, and the Secretary of Health and Human Services Advisory Council of Public Health Preparedness, the FDA Science Board: Advisory to the Commissioner. Currently she is a member of the NIH Science Management Board, the newly appointed “NIH Board of Trustees” and the Advisory Council of the Fogarty International Center of NIH. Since 1996 she has been a member of the U.S.–Japan Cooperative Medical Science Program responsible for advising the respective governments on joint research agendas, (U.S. State Department/Japan Ministry of Foreign Affairs). She has served on several editorial boards of scientific journals and has authored over 350 articles and book chapters. Dr. Cassell has received national and international awards and two honorary degrees for her research in infectious diseases, including the CDC Honor Award in
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa Public Health for exceptional leadership and contributions in the development and implementation of CDC’s Emerging Infectious Disease Plan 1997 and a Citation from the FDA Commissioner for her role as chair of the review of science and technology at the FDA and the Report FDA: Science and Mission at Risk 2008 and the Emmy Klineberger-Nobel Award in 2008 by the International Organization for Mycoplasmology for outstanding and sustained research contributions to the field of mycoplasmology. She is a member of the Institute of Medicine (IOM) of the National Academies and has recently completed a second 3-year term on the IOM Council, the governing board. Dr. Cassell has been intimately involved in establishment of science policy and legislation related to biomedical research and public health. For nine years she was chairman of the Public and Scientific Affairs Board of the American Society for Microbiology; has served as an advisor on infectious diseases and indirect costs of research to the White House Office of Science and Technology Policy, and has been an invited participant in numerous congressional hearings and briefings related to infectious diseases, antimicrobial resistance, and biomedical research. She has served two terms on the LCME, the accrediting body for U.S. medical schools as well as other national committees involved in establishing policies in training in the biomedical sciences. She is an Emeritus Member of the Board of Research!America and a former member and Chair of the Board of Directors of the Burroughs Wellcome Fund. She has completed a term on the Leadership Council of the School of Public Health of Harvard University. Currently she is a member of the Morehouse School of Medicine Board of Trustees, Executive Committee of the Board of Visitors of Columbia University School of Medicine, the Advisory Council of the School of Nursing of Johns Hopkins, and the Advisory Council of the University of North Carolina Gillings School of Global Public Health. Richard E. Chaisson, M.D., is professor of medicine, epidemiology, and international health and director of the Center for Tuberculosis Research at The Johns Hopkins University in Baltimore. His research focuses on TB and HIV infection, including global epidemiology, prevention, treatment, and public health interventions. He is principal investigator of the Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE), an international research consortium funded by the Bill and Melinda Gates Foundation to assess the impact of novel strategies for controlling HIV-related TB. Dr. Chaisson has published more than 350 scientific papers and book chapters. He was awarded the 2006 American Thoracic Society World Lung Health Award for his contributions to global control of pulmonary infections. Gerrit Coetzee is a pathologist currently living in Johannesburg, South Africa. He is the head of the National Tuberculosis Laboratory (NTBRL)
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa at the National Institute for Communicable Diseases (NICD), a division within the National Health Laboratory Service of South Africa (NHLS). His main interests include anti-TB resistance within national program settings—particularly MDR and XDR TB, the epidemiology of TB in high-burden settings, molecular epidemiology and outbreak investigations, and surveillance of TB (especially MDR/XDR TB). He is currently managing a large 2-year line probe assay (LPA) roll-out project in South Africa, aimed at the very early detection of MDR TB and early initiation of optimal treatment. Roseanne Diab, Ph.D., is executive officer of the Academy of Science of South Africa (ASSAf) and a senior professor at the University of KwaZulu-Natal in Durban. Her research interests are broadly based in the atmospheric sciences, with a particular focus on air pollution and air quality management and climate change. Dr. Diab serves on the editorial board of the South African Journal of Science, the Clean Air Journal, the South African Geographic Journal, and Atmospheric Environment. She has served on a number of international commissions, including the Commission on Atmospheric Chemistry and Global Pollution and the International Ozone Commission. Dr. Diab is a fellow of the South African Geographical Society and of the University of Natal. She holds a Ph.D. in environmental sciences from the University of Virginia. Jason E. Farley, Ph.D., M.P.H., CRNP, is an assistant professor at The Johns Hopkins University School of Nursing and a nurse practitioner in the Division of Infectious Diseases within The Johns Hopkins AIDS Service. He also holds an adjunct faculty appointment at Stellenbosch University in Cape Town, South Africa. Dr. Farley has been working in the arena of infection control for the past 10 years and is member of the Association of Professionals in Infection Control, as well as the Infectious Disease Society of America. He is presently on the editorial board of the American Journal of Infection Control. Dr. Farley’s current research is assessing the epidemiologic interactions of patients with HIV and drug-resistant infections in both domestic (U.S.) and international settings. His research projects include an evaluation of treatment outcomes in patients with multidrug-resistant (MDR) TB in the context of a high HIV/AIDS prevalence in South Africa in collaboration with the South African Medical Research Council (MRC). Further, his team recently completed a countrywide assessment of knowledge, attitudes, and practices related to infection control in MDR/extensively drug-resistant (XDR) TB hospitals in South Africa. This project successfully enrolled 24 of these hospitals, 100 percent of such hospitals across all nine provinces of the country. In addition, his team enrolled 499 health care workers across these sites. In the United States, Dr. Farley is working to assess methicillin-resistant Staphylococcus aureas (MRSA) colo-
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa nization and infection among patients with HIV/AIDS in Maryland. He is also the principal investigator on a grant addressing adherence to guidelines for cardiovascular disease among providers of HIV care within The Johns Hopkins AIDS Service. Gerald Friedland, M.D., is professor of medicine and epidemiology and public health at Yale School of Medicine and adjunct professor at the Mailman School of Public Health, Columbia University. He is a former member of the Governing Council of the International AIDS Society, National Advisory Council, Office of AIDS Research, and currently serves on the WHO HIV/TB Working Group, the NIH/NIAID–Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents, and the NIH International HIV Research Planning Group. He also serves as chairman of the board of directors of the Aaron Diamond AIDS Research Center in New York City. Dr. Friedland is actively involved in international research on HIV/AIDS and TB, with a major focus on the integration of care and treatment in coinfected patients and the aim of improving diagnosis, treatment, and outcomes for both diseases. This work has led to the uncovering of XDR TB as a major cause of death among HIV/TB coinfected patients in South Africa. With U.S. and South African colleagues, Dr. Friedland formed Tugela Ferry Care and Research (TF CARES), a clinical and research collaboration in rural KwaZulu-Natal. The work of TF CARES currently focuses on defining the epidemiology, reducing the transmission, and decreasing the morbidity and mortality from MDR and XDR TB. Elaine K. Gallin, Ph.D., is currently a senior advisor at the Doris Duke Charitable Foundation (DDCF). From 1999 through February 2010, she served as DDCF’s first program director for medical research, leading the creation and management of a portfolio of grant programs that has committed approximately $185 million to supporting clinical research. Dr. Gallin also designed and led the foundation’s $60 million African Health Initiative. Launched in September 2007, this initiative is supporting large-scale health service delivery projects in sub-Saharan Africa that are linked to rigorous operations and implementation research. Before joining the foundation, Dr. Gallin spent two decades, first as a research physiologist and then as a research administrator, with the U.S. government, last serving as deputy director of the Office of International Health Programs in the U.S. Department of Energy. She has participated on numerous professional committees and review panels. Currently, she is member of the board of directors of the Health Research Alliance (an alliance of non governmental research funders); the IOM’s Forum on Drug Discovery, Development and Translation; and the Sickle Cell Disease Advisory Committee at the
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa National Heart, Lung and Blood Institute. Dr. Gallin received her Ph.D. from the City University of New York and completed postdoctoral fellowships at The Johns Hopkins University Medical School and Columbia University Medical School. Neel Gandhi, M.D., is an assistant professor of medicine and epidemiology at Albert Einstein College of Medicine and Montefiore Medical Center and a principal investigator in TF CARES. He has been engaged in clinical research on TB/HIV coinfection since 1998. In November 2006, he was the lead author for a study describing high rates of mortality in patients with XDR TB and HIV coinfection. This study has been credited for uncovering a rapidly expanding MDR and XDR TB epidemic in South Africa. Dr. Gandhi continues to focus on the converging epidemics of drug-resistant TB and HIV in South Africa. A particular emphasis of his work is on elucidating the role of primary transmission in the expansion of this epidemic and on developing optimal treatment strategies for MDR TB/HIV coinfected patients. Dr. Gandhi is currently funded through a Clinical Scientist Development award and an Operations Research on AIDS Care and Treatment in Africa award from DDCF. These grants provide support to elucidate risk factors for developing MDR and XDR TB, to test the microscopic-observation drug-susceptibility (MODS) assay (a rapid TB drug resistance assay) in a high HIV prevalence setting, to create a community-based treatment program for MDR TB in HIV coinfected patients, and to develop a comprehensive airborne infection control program in a rural district hospital. Additionally, Dr. Gandhi is a coinvestigator on grants to expand TB/HIV integration efforts in rural South Africa (President’s Emergency Plan for AIDS Relief [PEPFAR], U.S. CDC), to examine the risk of household transmission of MDR and XDR TB in rural South Africa (NIH Fogarty Institute), and to elucidate the molecular epidemiology of drug-resistant TB in rural South Africa (Einstein Center for AIDS Research). Anne Goldfeld, M.D., attended Brown University and the University of California, Berkeley, where she earned a bachelor’s degree in zoology. After receiving her M.D. from Albert Einstein College of Medicine, she completed a residency in internal medicine and a clinical fellowship in infectious disease at the Massachusetts General Hospital, followed by postdoctoral research training at Harvard University and the Dana-Farber Cancer Institute. Dr. Goldfeld has been a devoted advocate for health and human rights, particularly as related to refugees working in many postconflict settings around the world. In 1994 she cofounded the Cambodian Health Committee with Sok Thim. She has pioneered community-based TB treatment and more recently AIDS treatment strategies in southeastern Cambodia that integrate basic scientific discovery with operational models. Dr. Goldfeld is
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa a senior investigator at Uganda’s Infectious Diseases Institute (IDI), a professor of medicine at Harvard Medical School, and a physician in medicine in the Division of Infectious Disease at Brigham and Women’s Hospital. William R. Jacobs, Ph.D., is a professor of microbiology and immunology and a professor of molecular genetics at the Albert Einstein College of Medicine, and a Howard Hughes Medical Institute (HHMI) investigator. He is an expert in TB and other diseases in the mycobacteria family. His research uses bacterial viruses—called phage—to introduce foreign DNA into the bacteria that cause TB, (M.tb.). That work has revolutionized scientists’ understanding of TB bacteria. Prior to Jacobs’ development of gene transfer mechanisms, little was known about the genetics behind M.tb., including which genes were related to virulence and drug resistance. Jacobs and former Einstein colleague and HHMI investigator Barry Bloom collaborated on a series of experiments that led to the first genetic manipulation of M.tb. Dr. Jacobs, who wrote his doctoral dissertation on leprosy, is currently developing a multipurpose vaccine that could attack malaria, HIV, and TB. Charlotte Kvasnovsky, M.D., M.P.H., is a guest researcher with the Division of TB Elimination at CDC, where she has served since 2007 on the Global Preserving Effective TB Treatment with Second-line drugs (PETTS) Coordinating Team and as coordinator for South Africa. She conducts research with the MRC on XDR TB. Dr. Kvasnovsky received her medical degree from Emory University in May 2010, as well as an M.P.H. in epidemiology from the Rollins School of Public Health. She is a resident in general surgery at the University of Maryland. Barbara Laughon, Ph.D., is senior scientist for TB Drug Development Partnerships at NIAID. She is the primary NIH liaison with the Lilly TB Drug Discovery Initiative. She also serves as chair of the Scientific Advisory Committee of the TB Alliance and was one of the original founding stakeholders of this public–private partnership. Dr. Laughon is an active participant in the Stop TB Partnership, serving on working groups on new drugs and TB/HIV coinfection; she will be serving as executive secretary of the board of advisors. Stephen Lawn, M.D., is an associate professor of infectious diseases at the University of Cape Town, South Africa, and a reader in infectious diseases and tropical medicine at the London School of Hygiene and Tropical Medicine. He trained in infectious diseases in London and has also worked in Ghana, west Africa, and at CDC in the United States. Dr. Lawn has been based in Cape Town since 2005, funded by the Wellcome Trust. His princi-
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa pal research focus has been on HIV-associated TB in the context of scale-up of antiretroviral therapy (ART). Lerole David Mametja, M.P.H., is currently the Chief Director for TB Control and Management in the National Department of Health. He has more than 15 years of experience in the social sector, in particular, public health. As Executive Director of the Health Systems Trust (HST) he gained experience in setting up processes needed to facilitate implementation of organizational policies and decisions and managing an annual budget of between R60 and R200 million. He has managed senior employees, and has interacted with both governmental (including ministerial levels), and non- governmental institutions. He was also Regional Health Sector Manager for RTI International, overseeing its health program operating in the Southern African Development Community (SADC). In this capacity, he was responsible for the identification of opportunities for research and development projects, negotiating partnerships, project proposal design, management and monitoring of projects, particularly in Mozambique, Lesotho, Swaziland and Namibia. He was also the Chief Executive Officer of the Health and Welfare Sector Education Training Authority (HWSETA), an entity that focuses on providing training and skills development opportunities for South Africans. He holds a master’s degree in public health (M.P.H.) in Health Policy and Management from Columbia University, New York. While working on his M.P.H. he served as an Assistant to the Deputy Chief Medical Officer and Vice President, Health and Hospital Corporation, City Health Department, New York City, where he was responsible for reviewing and evaluating hospital quality care systems. Claudio Marra, M.D., graduated from the Università La Sapienza in Rome in 1978, and specialized in internal medicine in 1983. For the past 15 years he has been working in public health in both development and emergency settings in Kenya, Somalia, Mozambique, Malawi, and South Africa with international nongovernmental organizations (NGOs), the Italian Development Cooperation, the Italian National Institute of Health, and United Nations agencies. In all these countries he has worked in close partnership with the respective local health authorities and other stakeholders. His focus has been on health system development, in particular on development of district health systems; prevention and control of communicable diseases, including coinfection with TB and HIV/AIDS; prevention, care, and treatment of HIV/AIDS and malaria; maternal health; and emergency preparedness and response in the area of health. Since 2005 Dr. Marra has been providing technical assistance to the KwaZulu-Natal (KZN) provincial Department of Health in understanding and addressing the complexity of MDR and XDR TB, as well as the challenges posed by coinfection with
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa TB and HIV/AIDS. In the Umzinyathi district of KZN, the district with the largest number of cases of MDR and XDR TB in South Africa, he developed an innovative household surveillance and community-based tracing system using GPS mapping software. The report documenting the experience in Umzinyathi district is available online on the KZN Department of Health website at www.kznhealth.gov.za. Valerie Mizrahi, Ph.D., was born and raised in Zimbabwe. She obtained her Ph.D. in chemistry from the University of Cape Town in 1983. She completed a postdoctoral fellowship at the Pennsylvania State University, and worked at SmithKline and French Research and Development in King of Prussia, Pennsylvania, before returning to South Africa in 1989 to establish a research unit at the South African Institute for Medical Research in Johannesburg. Currently, she is director of the MRC/National Health Laboratory Service (NHLS)/University of Witwatersrand (WITS) Molecular Mycobacteriology Research Unit at NHLS and research professor at the University of the Witwatersrand. She is also codirector of the Department of Science and Technology (DST)/National Research Foundation (NRF) of South Africa Centre of Excellence for Biomedical TB Research, which she leads together with Professor Paul van Helden from the University of Stellenbosch. Dr. Mizrahi is the two-time recipient of an International Research Scholar’s grant from the Howard Hughes Medical Institute in the United States (2000 and 2005). She has received numerous awards and honors in South Africa, and in 2009 was elected a fellow of the American Academy of Microbiology. Dr. Mizrahi has published 80 articles and book chapters in the fields of organic chemistry, enzymology, and mycobacteriology. In 2002, she shifted the focus of her research to the field of TB. Her research team played an instrumental role in developing genetic tools for validating new drug targets and vaccine candidates for TB and is internationally recognized for its work on molecular mechanisms of DNA metabolism, stress responses, resuscitation, and drug action in mycobacteria. Dr. Mizrahi is an active member of the TB research community. She chaired the Gordon Research Conference on Tuberculosis Drug Development in Oxford in August 2007 and organized the Keystone Symposium on Pathogenesis and Control of Emerging Infections and Drug Resistant Organisms in Bangkok in 2008. She chairs the International Scientific Advisory Committee of the Institute of Infectious Disease and Molecular Medicine (University of Cape Town) and serves on the scientific advisory boards of numerous local and international research programs and institutes. She has served on the editorial advisory boards of four international journals and on the Department of Science and Technology’s South Africa Reference Group for Women in Science.
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa Matsie Mphahlele, M.Phil., is a senior scientist at the MRC’s TB Epidemiology and Intervention Research Unit, which she joined in 1997. She has worked as a laboratory manager in the unit, responsible for overseeing Supranational Reference Laboratory (SRL) activities including rapid surveys, laboratory support, and capacity strengthening for South African Development Community (SADC) countries. She is responsible for the clinical, laboratory, and experimental work undertaken at the MRC Airborne Research Facility in Witbank, which is currently investigating the transmission dynamics of MDR TB and the efficacy of various environmental infection control interventions in reducing the transmission of TB. Ms. Mphahlele holds an M.Phil. degree in international health from the University of Bergen in Norway and an M.Sc. degree in microbiology from the University of Pretoria. Norbert Ndjeka, M.D., is a specialist family physician with an interest in TB and HIV. He is employed as director, drug-resistant TB, TB and HIV under the TB Cluster, Department of Health, Republic of South Africa. He has extensive clinical and programmatic experience in the management of TB and HIV. Dr. Ndjeka also serves as WHO temporary MDR TB advisor and is a member of the TB TEAM Experts Roster, serving as an experienced expert in M/XDR-TB under the Stop TB Department of WHO. Previously, he worked as medical officer at Kgapane Hospital and Botlokwa Hospital in Limpopo, South Africa. He was also senior medical superintendent at St. Rita’s Hospital and Warmbaths Hospital in Limpopo and clinical head of Limpopo’s MDR TB unit. Previously, he was a senior specialist and senior lecturer in family medicine at the University of Limpopo. Dr. Ndejka was also an MDR TB and infection control advisor with the University Research Corporation, LLC. He holds a medical degree from the University of Kinshasa, Democratic Republic of the Congo; a postgraduate diploma in health services management from Witwatersrand University, Johannesburg, South Africa; a diploma in HIV medicine from the College of Medicine of South Africa; and a master’s degree in family medicine from the University of Limpopo, Medunsa. Dale Nordenberg, M.D., is a principal with Novasano Health and Science. He is a physician executive who leverages his experience as a pediatrician, medical epidemiologist, and informatician to deliver strategic, operational, and scientific services to domestic and international clients in the health care and health information technology arenas. Recent projects include the development of a public–private partnership to build laboratory capacity for MDR TB across diverse international settings, which he is currently leading; development of governance structures for the National Bio surveillance System for Human Health; development of a multi-institutional collaboration
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa to revise U.S. Food and Drug Administration (FDA) regulatory processes to establish standards for national laboratory data exchange; and the evaluation of emerging diagnostics related to the gut microbiome from both the scientific and clinical perspectives. For the past few years, Dr. Nordenberg has been working as a health care consultant, first with PricewaterhouseCoopers and then with Novasano. From 2002 through 2007, he held various positions at CDC, including associate director and chief information officer and senior advisor for strategic planning. Dr. Nordenberg has led and participated in many disease surveillance, outbreak response, and bioterrorism preparedness and response activities and associated informatics initiatives. He has worked extensively in the arena of pandemic influenza preparedness and response. He was detailed part time to the Office of the National Coordinator for Health Information Technology in 2004–2005 to catalyze a national strategy for children’s health information technology. In 2007 and 2009, Dr. Nordenberg was a member of the Science and Technology Subcommittee of the FDA’s Science Advisory Board, which was tasked with the evaluation of science and technology at the FDA. Prior to serving with CDC, Dr. Nordenberg was a founding executive of a company that launched VeriSign affiliates in Latin America and Asia and was a member of the faculty of the Emory School of Medicine, where founded and directed the Office of Medical Informatics for the Emory University Children’s Center. He has served on the boards of numerous companies. Dr. Nordenberg is a board-certified pediatrician. He received a B.S. in microbiology from the University of Michigan and his medical degree from Northwestern University, and completed his training in pediatrics at McGill University, Montreal Children’s Hospital. He completed his fellowship in epidemiology and public health in the Epidemic Intelligence Service program at CDC. Nesri Padayatchi, M.D., is the CDC Durban site manager for the Starting Tuberculosis and Anti-Retroviral Therapy (START) project of Centre for the AIDS Programme of Research in South Africa (CAPRISA). She has 18 years of clinical and research experience in the management of TB and related problems. She was manager of the Provincial Tuberculosis Referral Hospital for 14 years. She was also acting director of the MRC’s Tuberculosis Lead Program from 1999 to 2003. Dr. Padayatchi has received the Columbia University–South Africa Fogarty AIDS International Training and Research Program (AIRTP) fellowship and completed her M.S. in epidemiology from Columbia University. The focus of her M.S. was on temporal trends in drug-resistant TB (1998–2001). She has extensive experience participating in multicenter clinical trials from 1996 to the present. Shreemanta K. Parida, M.D., Ph.D., is a physician scientist from India working in the field of infectious diseases, with a particular focus on
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa mycobacterial diseases over the last 23 years. His expertise encompasses clinical, field, and laboratory settings; clinical trials of vaccines; immunopathology; molecular pathogenesis; molecular immunology; epidemiology; and vaccinology. Dr. Parida obtained his Ph.D. from the National Institute of Immunology (NII) in India. Since 1990, he has worked in several institutions in Europe, including the WHO Immunology Research and Training Center (IRTC) in Geneva, the University of Giessen in Germany, the Pasteur Institute of Brussels, and Oxford University. From 2003 to early 2006, he worked in Africa at Armauer Hansen Research Institute in Addis Ababa, Ethiopia, and thereafter at the Max-Planck-Institute für Infektionsbiologie (MPIIB) in Berlin. He also received an advanced diploma in vaccinology from Foundation Merieux, France, in 2003. Dr. Parida started his research career with Phase II and III clinical trials of a leprosy vaccine based on an atypical mycobacterium—M.w (M. indicus pranii)—at NII. The vaccine has been licensed as an immunotherapeutic agent for leprosy. Dr. Parida was an early proponent of postexposure T cell boosting vaccine for nonreplicating persistent TB and received a vaccine innovation grant from Sequella and WHO/Special Programme for Research and Training in Tropical Disease (TDR) in 2000–2002. In his current position, he has been instrumental in building a cohesive and functional team focused on the quest for TB biomarkers; the team includes 15 partners from Africa, Europe, and the United States. Dr. Parida is committed to translating research from the bench to the clinic to combat the TB emergency in the developing world. He is passionate about science and translational research in the pursuit of solutions to public health problems, and has particular skills in networking, initiating collaborations, and coordinating multicenter studies. Sidney Parsons, Ph.D.,1 is an international expert in energy management of buildings. His expertise and research also include indoor air quality and environmental control for building-related illnesses, in particular the spread of hazardous biological agents such M.tb., as well as commissioning processes for buildings, particularly within the health care sector. Dr. Parsons is a professional engineer registered with the Engineering Council of South Africa and with the International Society for Professional Engineers. His research interests are in the fields of indoor air quality, building-related illnesses, and infection control. Dr. Parsons has worked as a consulting engineer for more than 28 years. While in private practice, he undertook a broad spectrum of work for the public and private sectors in the areas of university campus utility planning; health care, research, and pharmaceutical facilities (clean room applications); commercial developments; and mechanical installations for industrial applications. During 2002 and 1 Deceased.
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa 2003, he took a sabbatical from his practice and was contracted to Arup Consulting Engineers to provide support in developing its health care portfolio. He also conducted a course in air-conditioning and refrigeration at the University of KwaZulu-Natal. Dr. Parsons has coauthored a number of publications and presented peer-reviewed papers and presentations at international conferences and seminars. He has also been an invited copresenter in professional development programs, focusing on indoor air quality and occupational safety influences, including energy management and efficiency strategies. Over the past 8 years, he has worked with the MRC, CDC, and the Harvard School of Public Health on investigations into the efficacy of electro/mechanical building service systems for the protection of health care workers against airborne infectious diseases such as TB. Simon Schaaf, MBChB, DCM(SA), MMed(PAED), is a pediatrician with a subspeciality in infectious diseases in the Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, and Tygerberg Children’s Hospital. He has focused most of his clinical and research efforts on TB, especially drug-resistant TB in childhood. His doctoral studies were on drug-resistant TB in children and included a pharmacokinetic study on isoniazid and its possible role in low-level isoniazid-resistant TB cases. Currently he is involved in ongoing drug resistance surveillance in children in the Western Cape of South Africa, as well as in several studies on children as contacts of MDR TB cases and children with drug-resistant TB. His other area of interest is the pharmacokinetics of anti-TB drugs in children. Professor Schaaf completed both pre- and postgraduate studies at Stellenbosch University. He has authored or coauthored many articles, most on childhood TB, and is, together with Ali Zumla, coeditor of the book Tuberculosis: A Comprehensive Clinical Reference, published by Saunders Elsevier in 2009. Karen Shean, PN, is a professional nurse and has been a member of the Lung Infection and Immunity Unit (LIIU) at the University of Cape Town (UCT) for the past 2 years. Enrolled at UCT, she is presently completing her MscMed and operates as MDR TB study coordinator. She has a vast wealth of experience in TB, specifically drug-resistant TB. Prior to joining the LIIU, Ms. Shean had worked in the provincial TB program since 1990, eventually attaining the position of TB advisor and provincial TB hospital MDR/XDR TB coordinator. She has presented at many conferences internationally, nationally, and locally on MDR TB, XDR TB, infection control, and health care worker issues. In 2007 she was the provincial nominee for the International Council of Nurses (ICN)/Lilly Award for Nursing Excellence in TB Care. In 2009 she received the Investigator Award on Multidrug-Resistant Tuberculosis for the best abstract submitted to the European Respiratory Society in that category.
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa Adriaan Willem Sturm, M.D., Ph.D., is dean of the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal in Durban, South Africa. He is also interim director of the new KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH). During his career as a medical microbiologist, Dr. Sturm has studied TB, HIV, and sexually trans mitted diseases. He was a leading scientist investigating the first outbreak of XDR TB in KwaZulu-Natal Province and a principal investigator on the project that sequenced the genetic code of that pathogen. Dr. Sturm began his research career in the Netherlands and became chair of the microbiology department at Aga Khan University in Pakistan in 1990. He came to the University of KwaZulu-Natal in 1993 and has served as a professor, head of the medical microbiology department, and dean. He is also director of the MRC’s genital ulcer disease research unit at the university. Maketekete Alfred Thotolo has worked for the Adventist Development and Relief Agency (ADRA) in Lesotho as a treatment literacy and advocacy coordinator since April 2008. Previously he served as director of that same organization from July 2007 to March 2008. From January 2006 to June 2007, Mr. Thotolo worked as national HIV/AIDS coordinator for the Seventh-Day Adventist Church in Lesotho. He holds a diploma in science education from the National University of Lesotho. He taught mathematics and science in a number of high schools in Lesotho from 1986 to 2005, when he started working full time in the field of HIV/AIDS. From July 1997 to March 2001, Mr. Thotolo worked in South Africa for the Professional Assignment Group (PAG) as a payroll officer; he also worked as a payroll helpdesk officer and an HIV/AIDS coordinator. Mr. Thotolo took an active part in the formation of the Lesotho Teachers’ Trade Union in 1990, where he served for a number of years as Leribe District chairperson. He also served as chairperson for the Leribe District Math Teachers coalition, and was instrumental in the formation of community support groups in various districts of Lesotho. Janet Tobias is a media/technology executive and an Emmy award–winning director/producer with 20 years of experience working for three American networks—PBS, Discovery, and MSNBC. Ms. Tobias started her career with 60 Minutes as Diane Sawyer’s associate producer, where she distinguished herself working on a wide range of domestic and international stories. Ms. Tobias then moved with Ms. Sawyer to ABC News to launch Prime Time Live, where she produced/directed both domestic and international stories. Subsequently, she served as a national producer for Dateline NBC and also continued to produce and direct her own stories. Moving to VNI (which became New York Times Television) as an executive producer, she supervised the production of a foreign news show and reporting on a
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa variety of foreign stories. Ms. Tobias then returned to ABC News to head editorial activities at its newly created Law and Justice Unit. In 1998, she began working as an executive with PBS, where she developed and produced programming not only for PBS but also for joint projects with ABC and Discovery. She continued her directing and writing career, winning two American Bar Association silver gavels. In 2001, she launched LIFE 360, a weekly PBS series. In 2002, Ms. Tobias joined Sawyer Media Systems, a creator of video technology for the web, where she served as vice president of production and a member of the executive committee. She also continued to be involved in documentary production through her own company, Sierra/Tango Productions. In 2004, she was a founding partner of Ikana Media, a digital strategy and production company whose primary focus is on health care information. Over the last 5 years she has worked with a variety of clients in the health care arena on subjects ranging from broad-based delivery of health care information to communications efforts around obesity and HIV/AIDS. Ms. Tobias has received a number of additional awards, including two Cine Golden Eagles, two Casey medals for meritorious journalism, a National Headliner award, a Sigma Delta Chi award, and honorable mention Robert F. Kennedy Journalism and Overseas Press awards. She is a member of the Writers Guild of America and a graduate of Yale University. She serves on the boards of Healthright International, Mindset Media Society, Rwanda Works, and SochiReporter. She served from January to September 2009 as a senior fellow at the University of British Columbia, Sauder School of Business Centre for Sustainability and Social Innovation. Maletela Tuoane-Nkhasi, Ph.D., holds her Ph.D. in social statistics from the University of Southampton, a master’s degree in population studies from the University of Ghana, and a bachelor’s degree in statistics and demography from the National University of Lesotho. She has worked as a lecturer and senior lecturer in demography at the National University of Lesotho and as research project manager at the Department of Social Development in South Africa. Dr. Tuoane-Nkhasi is currently a manager in the Births and Deaths component of the Health and Vital Statistics Division at Statistics South Africa. She is responsible for management of data processing for information on mortality and causes of death from civil registration systems, and for the production of statistical reports on mortality and causes of death and recorded live births. Martie van der Walt, MScAgric, M.B.A., Ph.D., is interim director for the TB Epidemiology and Intervention Research Unit and joined TB research at the MRC in 1998. She has more than 9 years of experience in research on drug-resistant TB, operations research, diagnostics evaluation, and TB
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa infection control. She has worked in close collaboration with the Ministry of Health in research translation, policy development, and policy implementation, especially for drug-resistant TB and the uptake of new diagnostics. Dr. van der Walt has been responsible for the large-scale rapid MDR TB diagnosis project, which is providing evidence to WHO for evaluating rapid assays for routine use in developing countries. She has also been overseeing the 5-year cooperative agreement between CDC and the Unit, which has included managing subpartners (for example, the THAT’S IT program). She is also responsible for the Unit’s operational research program and for projects covering such areas as program implementation, Directly Observed Treatment Short course (DOTS) evaluation, and drug-resistant TB and epidemiology. Through the Unit’s operations research activities, Dr. van der Walt has a network encompassing TB control programs on both the national and provincial levels. She is a member of the Stop TB New Diagnostics Working Group, the Drug Resistance Working Group, and the WHO Global XDR TB Task Force, and served on the Green Light Committee from 2005 to 2007 as the MRC alternate. She received her basic training in microbiology (MScAgric) from the University of Pretoria, a master’s degree in business administration from the University of Pretoria, and a Ph.D. in biotechnology from the University of Pretoria. Paul van Helden, Ph.D., obtained his doctorate in biochemistry in 1978 and has served on the Faculty of Health Sciences at Stellenbosch University, Cape Town, since January 1979. He is professor and head of the Division of Molecular Biology and Human Genetics and also director of the MRC Centre for Molecular and Cellular Biology, as well as codirector of the Department of Science and Technology/National Research Foundation (DST/NRF) Centre of Excellence for Biomedical TB Research. He has been associated with the MRC since 1979 and employed by the Council since 1990. He has been awarded the Vice-Chancellors’ Award for Excellence in Research (University of Stellenbosch, 2000); the Gold Medal Award, South African Society for Biochemistry and Molecular Biology (2001); the MRC Silver Medal for Research (2004); and the National Science and Technology Forum (NSTF) Award for Outstanding Contribution to Science and Technology in the Republic of South Africa (RSA) over 5 years (2005). Dr. van Helden’s interest in TB began in 1989. This interest has grown and is now a major focus of the Division and faculty. The Division operates across diverse areas of TB research, from diagnostics, to immunology and genetics, to clinical trials and veterinary TB. Dr. van Helden has published more than 220 research publications, and his team has extensive global networks. He describes their efforts as attempting to develop a continuum of activities to span the divide between basic research and clinical practice in hospitals, clinics, and community settings. A disease such as TB not only
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa has scientific components, but also is intimately linked to culture, society, poverty, and local and international norms and activities, which cannot be ignored. Sabine Verkuijl, M.D., has worked in South Africa since 1998. She holds a DTM&H from the Royal Tropical Institute in Amsterdam (The Netherlands) and an MMed (FamMed) degree from UNITRA (South Africa). From 1998 to 2002, Dr. Verkuijl was employed as a senior/principal medical officer in Bambisana Hospital, a rural district hospital in the former Transkei (O.R. Tambo District, Eastern Cape). With funding from the Netherlands, she initiated and supervised a community-based DOTS project in primary health care facilities under Bambisana. Between 2002 and 2006, Dr. Verkuijl worked with the Health Systems Trust, first as a facilitator for the Initiative for Sub-District Support (ISDS) around district health systems development in the OR Tambo District, and later as Eastern Cape provincial coordinator for the Technical Assistance Service Contract for Tuberculosis (TASC-TB) program, in collaboration with University Research Corporation (URC) and Management Sciences for Health (MSH). From 2006 to 2007, she was a part-time HIV and TB/HIV clinician in primary health care facilities and a TB Hospital in East London. Since 2006 she has been employed by the International Center for AIDS Care and Treatment Programs (ICAP), under Columbia University, as a technical advisor for TB/HIV integration, supporting selected districts in the Eastern Cape, KwaZulu-Natal, Free State, and Northern Cape Provinces to improve TB/HIV collaborative activities. Kristina Wallengren, Ph.D., technical advisor to the Provincial TB Control Programme, Department of Health, KwaZulu-Natal (KZN), since 2007, is presently evaluating piloting of decentralized MDR TB treatment in KZN with support from IZUMI Foundation. Supported by WHO, Dr. Wallengren conducted a situational analysis of MDR and XDR TB in KZN following the XDR TB outbreak reported by Church of Scotland Hospital (CoSH). Dr. Wallengren has worked as TB and HIV research investigator with Harvard University in KZN since 2005, and has also undertaken an HIV seroprevalance and knowledge, attitudes, and practice (KAP) survey in the apparel industry in Lesotho. Currently, Dr. Wallengren is the Acting Clinical Core Manager at KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH). She holds an MPH in international health from Harvard School of Public Health and a PhD in molecular biology and virology from Karolinska Institute in Sweden. Rob Warren, Ph.D., obtained his doctorate in biochemistry from the University of Cape Town in 1995 and subsequently joined the Department of
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa Medical Biochemistry, Stellenbosch University. He was appointed associate professor in the department in 2004. Under his guidance, the study of the molecular epidemiology of M.tb. in a high-incidence setting (Cape Town, South Africa) has been brought to the forefront of international TB research. This study now represents the largest molecular epidemiological data set in the developing world and has been referred to as a national heritage. Much of this work has provided new understanding that has allowed long-standing dogmas to be challenged. Dr. Warren has published more than 110 papers in international peer-reviewed journals in the fields of molecular epidemiology, drug resistance, and bacterial evolution since 1996. From this work, five patents have been registered, which hold promise for the development of novel vaccines, new diagnostics, and genetic manipulation of M.tb. Dr. Warren’s current research focuses on (1) the disease dynamics of drug-sensitive and MDR/XDR TB in the Western Cape, (2) the development of novel diagnostics that are applicable to the developing world, (3) discovery of the mechanisms whereby drug resistance develops, (4) speciation of mycobacteria causing disease in humans and animals, (5) application of novel methods to improve the speed of diagnosing smear-positive disease, (6) host–pathogen compatibility, (7) identification of highly pathogenic strains of M.tb., (8) pathogen evolution, and (9) mycobacterial epigenetics. Robin Wood, M.D., is director of the Desmond Tutu HIV Research Centre and Professor of Medicine at the University of Cape Town, visiting scientist at Harvard University Medical School, and a member of the governing council of the International AIDS Society. He received his undergraduate training at London University and his medical degree from Oxford University. His internist specialization was at the University of Cape Town, and he completed an Infectious Disease Fellowship at Stanford University. Dr. Wood’s research interests include treatment of HIV infection and interactions between HIV and TB; he has published more than 200 scientific articles. He has acted as a consultant on HIV and TB issues to international pharmaceutical industries, the South African mining industry, and WHO. Tomás Zimba, M.D., MMed, is director of the Clinical Laboratories at Hospital Central de Maputo in Maputo, Mozambique, and a lecturer in virology at at Instituto Superior de Ciências e Tecnologia de Moçambique. From 2007 to 2009, Dr. Zimba served as director of the laboratory course in Instituto Superior de Ciências de Saúde. From 1999 to 2000, he served as a general practitioner at Provincial Hospital of Tete, clinical director of the Department of Medicine and Provincial Laboratory, clinical counselor at the provincial level of the National Program against Tuberculosis, and
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The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions - Summary of a Joint Workshop by the Institute of Medicine and the Academy of Science of South Africa clinical counselor at the provincial level of the Essential Drugs Program at Provincial Hospital of Tete. Dr. Zimba received his M.D. from the First Medical University of St. Petersburg, Russia, and holds an MMed in medical microbiology from the Nelson Mandela School of Medicine of the University of KwaZulu-Natal in South Africa.