Neglected Diseases: K-RITH Puts Cutting-Edge Research At The Heart Of HIV-TB Epidemic

The discovery of drugs for neglected diseases more often than not occurs in laboratories that are thousands of miles away from the very people who need help. That paradigm will change next month when the doors officially open at the KwaZulu-Natal Research Institute for Tuberculosis & HIV, known as K-RITH. The seven-story laboratory, a joint project between the Howard Hughes Medical Institute and the University of KwaZulu-Natal, is in Durban, South Africa—the heart of the HIV-TB epidemic.

The hope is that K-RITH’s proximity to patients will speed innovation in drugs and diagnostics for the diseases, as well as build scientific capacity in South Africa. “The mission is to try to enable South African scientists and partners from overseas to use first-world technology right where the disease is and to have ready access to clinical samples and clinical interventions right in their own backyard,” says K-RITH’s director, William R. Bishai.

Researchers would be hard-pressed to find an area more in need of better TB diagnostics and drugs than South Africa’s KwaZulu-Natal province. In sub-Saharan Africa, 70% of people with TB are coinfected with HIV, and in some areas of KwaZulu-Natal, the incidence rate of TB is as high as 1 in 1,000 people.

K-RITH’s new labs currently house six primary investigators, hired from around the world, and roughly 50 support staff. When everything is up and running, Bishai expects to be overseeing 10 investigators and roughly 100 other staffers, students, and employees. The labs will have expertise in microbiology, immunology, pharmacology, high-throughput biology, and clinical trial methods.

For Bishai, who has spent the bulk of his career at Johns Hopkins University School of Medicine, where he is still the codirector for the Center for Tuberculosis Research, the transition to Durban has been transformative. Bishai used to tell people that he was one of the best mouse doctors in the world. “I knew how to treat TB in mice better than anyone,” he says. “Now I have a chance to actually see patients. It’s been really sobering, and at the same time exhilarating, to see the disease that I’ve studied for so long right up close.”

Sitting in the center of the epidemic has changed his notion of how to prioritize research. “What I’ve learned here is that fast is better than perfect,” Bishai says. In addition to new and better drugs, the field is in need of instruments that can quickly diagnose the infection. Scientists have sensitive tests for diagnosing TB, “but they take forever,” he notes.

He recalls hearing from a health economist who studied the plight of patients at local clinics. One villager came to a clinic six times before his sputum was collected for testing. When the results came back, it turned out he had multi-drug-resistant TB. “It took 29 days for him to get his diagnosis, and each time it cost him a taxi ride,” Bishai says.

Similarly, treatment time must be significantly shortened to improve adherence and prevent resistance. Patients often feel better a month or so into treatment, and they stop taking the cocktail of antibiotics before the infection is fully shut down. “We need to be able to finish treatment in patients around the same time they’re starting to feel better,” Bishai says.