Professor David Moore
MBChB MD DTM&H MSc (Epi) FRCP
of Infectious Diseases and Tropical Medicine
In my current position I have four roles - I lead a TB research group in Lima, Peru; I am Course Director for the DTM&H; I am a member of the LSHTM TB Centre Steering Committee; and I am Consultant in Infectious Diseases and Tropical Medicine at the Hospital for Tropical Diseases in London.
Four years after graduating from Birmingham Medical School in 1989 I found myself working at Hlabisa Hospital in rural Kwazulu-Natal in South Africa. It was here that my eyes were opened to tropical medicine and public health. On returning to the UK I was fortunate to get onto the North Thames ID training rotation culminating in a year at the Hospital for Tropical Diseases.
After a 2001/2002 Masters in Epidemiology at the school we moved to Lima, Peru with a Wellcome Trust Research Training Fellowship in Clinical Tropical Medicine to evaluate the rapid TB and MDRTB diagnostic test MODS (www.modsperu,org) in the laboratory of JHU Professor Bob Gilman (http://faculty.jhsph.edu/default.cfm?faculty_id=261) at Universidad Peruana Caytano Heredia (http://www.upch.edu.pe/).
With a few minor tweaks MODS has been transformed from an interesting research observation into a formally recognised rapid diagnostic test endorsed by WHO in 2010 and with further Wellcome support through a Career Development Fellowship we were able to evaluate the process of implementation of MODS into the Peruvian National TB Control Programme (NTP) and Regional Reference Laboratory Network. At $4.50 for an TB detection and MDR test available within 7 days MODS represents good value for money in this MDR high-burden setting.
The success of this work generated several additional questions, amongst them -
can MODS be used to diagnose XDRTB? (it can)
can MODS be developed into an off-the-shelf kit that performs just as well? (it can)
what should be/can be done for household contacts of MDRTB patients? (as yet unanswered)
what should be/can be done for patients with isoniazid-resistant non-MDR disease? (as yet unanswered)
The success of our research effort in Peru is largely a result of excellent collaborative links with the Peruvian NTP and with ID and chest physicians in the major Lima hospitals. Thus our work is integrated from the outset and only follows an agenda that is acceptable and prioritised in-country, maximising the likelihood of policy adoption at the end of the process.
My main teaching responsibility at LSHTM is as Course Director for the DTM&H (http://www.lshtm.ac.uk/prospectus/short/stmh.html); I am also a tutor for the MSc in Tropical Medicine and International Health.
During my 7 years in Lima I was privileged to supervise and mentor a large number of extremely talented and dynamic science and medical undergraduates and postgraduates from the UK, Peru and the US who passed through our research unit. Their names are too numerous to mention but most of them feature on at least one and often two of the publications on our publication list.
My research group in Lima remains active and postgraduate students from LSHTM and elsewhere are welcomed, though a good command of Spanish is a prerequisite.
My primary research interest is in control of tuberculosis and drug-resistant tuberculosis through innovative strategies for diagnosis of adult and paediatric TB, management of latent TB infection and active TB disease (drug-susceptible and drug-resistant), and institutional and domestic TB infection control.
MODS delivers rapid, low-cost diagnosis of MDR-TB but important by-products of this enhanced diagnostic testing include identification of a large number of MDR-exposed household contacts and individuals with isoniazid resistant (non-MDR) TB. My group is exploring transcriptomic responses to preventive therapy for contacts exposed to drug-susceptible TB with an eye to future evaluations of preventive therapy for MDR-exposed contacts. We are also working on development of a MDR contact registry to enhance capacity of programmes to identify and track MDR contacts and to create a ready-to-go line list of individuals eligible for MDR preventive therapy in the event that current ongonig trials identify an efficacious regimen.
We also have a growing interest in development of laboratory capacity through innovative laboratory design and application of portable containerized laboratories.
An expanding area of interest is control of bartonellosis (Oroya fever, Verruga Peruana) due to Bartonella bacilliformis; knowledge gaps in diagnosis, natural history, epidemiology, vector biology and therapeutics are amongst the major challenges for this neglected disease affecting impoverished Andean communities. We have started to grow a research collaboration with Peruvian academic and Ministry of Health partners in order to undertake a major programme of research with a view to development of an agenda for disease control and ultimately elimination.
In London, aligned with my clinical tropical medicine practice at the Hospital for Tropical Diseases (UCLH), we are leading operational research into implementation of screening for Chagas disease in Latin American migrants now living in the UK.