This series spotlights the amazing students in the YSPH Epidemiology of Microbial Diseases (EMD) program. This month focuses on students who are studying tuberculosis (TB). Here, 5th year MD/PhD candidate Ann Johnson tells us about the program and some of her exciting research in a Q&A format.
Please tell us a little about yourself and what inspired you to pursue a Ph.D. in the EMD Department at the Yale School of Public Health?
Ann: Hi, my name is Ann and I am a 5th year MD/PhD student in the EMD Department. I am passionate about using implementation science to make public health innovations accessible and effective for vulnerable populations. I also enjoy the creativity and innovation that arises from working on international and interdisciplinary teams. The EMD Department at the Yale School of Public Health is full of scientists (such as my PI Dr. Luke Davis!) who are passionate experts at leveraging implementation science for vulnerable communities, and I am lucky to study at YSPH to learn from and work with my peers and professors. Being at YSPH has also allowed me to collaborate with the Aurum Institute, a leading institute on TB and HIV research in South Africa, where I am currently based, and work with amazing scientists and policy-makers here.
What is the current focus of your research?
The current focus of my research is on examining tuberculosis preventive therapy (TPT) for people living with HIV (PLHIV) in South Africa. Most people with HIV die from TB, but TPT can greatly reduce the risk of death from TB. However, TPT is extremely underutilized. I am studying this underutilization from both a patient and clinic-level perspective. My patient-level project is a prospective cohort study looking at the prevalence of mental health and substance use comorbidities for PLHIV starting TPT in South Africa, and the impact of these comorbidities on TPT completion. My clinic-level project is examining how clinic-level factors, such as staff:patient ratio and types of adherence support provided, impact TPT initiation and completion proportions at clinics.
What are some of the most significant findings or innovations from your vaccine research?
So far, we are seeing that there is a high prevalence of depression, anxiety, alcohol use disorder, and tobacco use disorder among PLHIV starting TPT, and that depression is significantly associated with decreased TPT completion. Based on this, targeted interventions and support for comorbid depression should be tested because they might increase 3HP completion rates in South Africa.
Which emerging trends or technologies in vaccine research do you find most exciting?
I think that the emerging variations of TPT, such as the newer 3HP regimen that is 3 months of once-weekly isoniazid and rifapentine versus the daily treatments over longer periods (and potentially 1HP, just one month of treatment), are exciting because they potentially give patients the choice to choose a regimen that will fit their needs and lifestyle better, which could improve their likelihood of completing their TPT course. The more patients who complete their TPT course, the closer we are to TB elimination, which is exciting!
To eliminate TB we must make prevention and treatment available for everyone, and as we approach the goal of elimination I think people who tend to fall through the cracks will continue to be essential to attaining this goal.
Ann Johnson
Where do you see the field of vaccine research heading in the next few years, and what role do you hope your work will play in this future landscape?
I think it will continue to be important that we seek out people who are not able to access public health and clinical medicine in the ways it is offered now and design interventions based on their ideas about how we can bring TB prevention and treatment to them. To eliminate TB we must make prevention and treatment available for everyone, and as we approach the goal of elimination I think people who tend to fall through the cracks will continue to be essential to attaining this goal.
I love being part of a department that is full of people committed to improving and supporting their communities.
Ann Johnson
How has the EMD Department supported your research and academic goals?
The EMD Department has facilitated opportunities for me to work with leading policy-makers and experts both across the US and internationally through mentoring and funding support. I love being part of a department that is full of people committed to improving and supporting their communities.
What advice would you give to prospective students considering applying to the EMD training programs at Yale?
As long as you show passion, commitment, and enthusiasm for what you are doing and have done, it is okay to want to pivot your interests in the future and learn new things! That is what further training is for, and a past commitment to other areas of research does not disqualify you from being a great candidate for EMD training programs at YSPH.