NIH grant: TACTIC: Tuberculosis Active Case Tracking via Interpersonal Connections (1R01AI191221-01A1)

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NIH grant 1R01AI191221-01A1: TACTIC: Tuberculosis Active Case Tracking via Interpersonal Connections
Institute: {'code': 'AI', 'abbreviation': 'NIAID', 'name': 'National Institute of Allergy and Infectious Diseases', 'admin_org_id': '12500003', 'admin_funding_url': ''}. PI: Karen R Jacobson. Award: $487764.
Start: 2026-06-18T00:00:00.
PROJECT SUMMARY/ABSTRACT
Tuberculosis (TB) remains the leading infectious cause of death worldwide. Interruption of
transmission is the most effective strategy to reduce incident infections, yet current approaches
often fail to reach individuals for timely testing and treatment. This study addresses that gap by
leveraging social networks to identify individuals at highest risk of transmitting TB, specifically,
people who use drugs (PWUD). We will evaluate respondent-driven sampling (RDS), a peer7
based community recruitment strategy, to identify TB cases among PWUD and the household
contacts (HHCs) of those with TB disease (RDS-TB) in Kampala, Uganda. Conducting this work
in a high-prevalence setting such as Kampala where our team has established expertise allows
us to overcome recruitment challenges common in settings in the United States while
generating findings that are directly translatable. This is particularly relevant given that higher
TB prevalence and larger outbreaks in the United States have been associated with the use of
methamphetamine, heroin, and crack/cocaine, drugs that we will study. In Aim 1, we will
compare the effectiveness and reach of RDS-TB with a traditional clinic-based index case HHC
approach for TB case finding. We will screen 2,000 PWUD and their HHCs, estimate the
number needed to screen to identify one case of TB disease, and compare the demographic
and network characteristics of RDS-TB recruits with clinic-based HHCs. Whole genome
sequencing will be used to characterize transmission dynamics. In Aim 2, we will compare the
yield of individual and combined TB diagnostic strategies for community-based active case
finding. Participants will undergo chest radiography with computer-aided detection, tongue swab
testing for TB nucleic acid amplification tests (NAAT), and sputum testing for NAAT and
mycobacterial culture. We will identify the minimal combination of tests needed to meet World
Health Organization target product profile thresholds for screening. In Aim 3, we will define the
conditions under which RDS-based screening can effectively interrupt TB transmission. We will
develop an agent-based model informed by social network data from individuals with and
without TB, incorporating drug use patterns and demographic characteristics. This project will
generate a practical, scalable roadmap for social network–based TB active case finding in high28
risk communities. The approach will be readily adaptable to settings in the United States and
will inform strategies to interrupt transmission and advance progress toward TB elimination, in
alignment with the NIH Strategic Plan for TB Research.

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