Dr Titus Divala
MBBS MPH MS
Research Degree Student
of Clinical Trials
I have been a practising physician in Malawi since 2009. Personal experience with challenges in managing infectious diseases prompted me to start a clinical research career in 2011. I joined the Blantyre Malaria Project (a centre of clinical research excellence established under the universities of Malawi, Maryland and Michigan State) as a clinical trial investigator. I have worked on trials assessing interventions for malaria, HIV and Tuberculosis. I started working with Professors Liz Corbett and Katherine Fielding of LSHTM in 2016 and enrolled for doctoral studies in September 2017.
In addition to my clinical training, I have distinction graded MPH (Epidemiology) from University of Malawi and MSc Epidemiology + Preventive Medicine (specialising in clinical research) from University of Maryland Baltimore. I have four best presentation awards and 11 other research/academic related recognitions. I have co-authored a good number of peer-reviewed publications and over 20 research conference abstracts.
I am a recipient of the Helse Nord Research Fellowship Award and Commonwealth Scholarship for doctoral studies registered in Infectious Disease Epidemiology Department at London School of Hygiene and Tropical Medicine (LSHTM) with research hosted by the University of Malawi. My other recent research award is the Global Forum for Bioethics in Research (GFBR) Fellowship, a Wellcome Trust and Bill and Melinda Gates Foundation award to review ethical implications of the presumption of exclusion of pregnant women in clinical trials.
I plan to be involved in teaching Clinical Trials and epidemiology in LSHTM and University of Malawi.
My research question is: should we continue using antibiotic treatment as a diagnostic for Tuberculosis?
Current point-of-care laboratory tests for detecting tuberculosis(TB) are suboptimal, they fail to detect TB in as many as 50% of tested individuals. Considering that TB is a life-threatening illness, there was need to still detect as many infected people as possible. To achieve this, standard TB diagnostic guidelines include giving patients antibiotic treatment that can treat most causes of respiratory symptoms except TB. Therefore if a patient improves after the treatment, the possibility of TB is very narrow but if they don’t improve, they are deemed more likely to have TB. In other words, we use antibiotic treatment as a diagnostic test for TB where current standard tests are likely to have missed the disease.
Although we have used this approach for over 20 years, there is no strong evidence confirming that using antibiotic treatment
- actually improves TB diagnosis
- has any other clinical benefits for patients
- how much it contributes to antimicrobial resistance, another major problem of this century
I am using systematic reviews and a Randomized controlled trial to investigate these three blind spots and improve our approach to TB diagnosis and management for antimicrobial resistance.
Expected impact of my PhD research
My PhD research is among global efforts towards identifying methods for averting impact of two major global problems:
1) Tuberculosis (TB): the leading cause of Infectious Disease deaths costing the world 1.7 million lives/year. Although treatment is readily available, for all the 30,000 TB cases that occur in Malawi per annum, only 17,000 are detected and the 13,000 that remain undetected are exposed to premature and unacceptable death; and
2) Antimicrobial resistance: currently over 700,000 people die of untreatable infections per year. This is steadily rising and is projected to reach 10 million per year by 2050 if unchecked, effectively becoming the world's leading cause of death.
Results from my work will provide definitive understanding on whether the current practice of using antibiotic treatments as a way of distinguishing other respiratory infections from Tuberculosis has more benefits than harms. This will improve efficiency in our approach for detecting TB and strengthen our fight against antimicrobial resistance.