Menzies senior clinical fellow, Associate Professor Anna Ralph was recently awarded a Career Development Fellowship as part of the National Health and Medical Research Council’s (NHMRC) yearly multi-million dollar funding round.

Anna’s fellowship provides support for her salary for the next four years. She shares her thoughts on the fellowship.

What is the title of your fellowship?

Towards the elimination of tuberculosis (TB) and rheumatic heart disease (RHD) in Northern Australia and our region.  

What major health issue does your research hope to address and how?

The goal of this program of research is to address knowledge-practice gaps in the diagnosis and management of TB and RHD, to prevent new cases and improve the quality of care. Both TB and RHD are important regional causes of mortality and morbidity. Both can be prevented by early intervention, and controlled using disease elimination frameworks.

Building on my work to date, including the establishment of international collaborations, I will translate TB elimination goals into practice in northern neighbouring countries (especially Indonesia’s Papua province) using health system strengthening strategies. An important focus of this work is prevention of TB in household contracts, especially children who are most vulnerable. The work has a strong local capacity building component, supporting local clinical and research expertise. In parallel, I will apply lessons from TB control to development and implementation of the Australian strategy for RHD elimination. I will work with the ‘END RHD’ Centre of Research Excellence to target knowledge-practice gaps, and test and scale up new models of care for people living with rheumatic fever and RHD. 

What is the most exciting aspect of your funding win?

Having the opportunity to work with world-class researchers to make a genuine difference for people affected by diseases of disadvantage.  

What are the proposed details of your research methodology?

For the TB component in Papua (Indonesia) and Sabah (Malaysia), I will support local higher degree research scholars to embed continuous quality improvement and education within their TB programs to strengthen the quality of healthcare delivery. Novel approaches will include symptom-based screening for contacts - a method that reduces logistic roadblocks in access to preventive treatment - and strategic use of the GeneXpert MTB/RIFTM (‘Xpert’) diagnostic. Xpert is recognised by the World Health Organisation as a gold standard diagnostic for TB, and provides a major advance over traditional methods in settings lacking accredited laboratory services, as is the case at both our field research sites in Indonesia and Malaysia. 

For the rheumatic fever component, a key goal is to improve the diagnosis of this condition, which progresses to permanent RHD. The study will aim to discover and validate new candidate biomarkers in ARF, for development as a clinically-translatable diagnostic tool. The lack of a diagnostic test is a major reason that ARF is under-diagnosed, causing missed opportunities for secondary prevention to stop progression to RHD. Alongside this study, I am developing and implementing new models of care for RHD, informed by community priorities.

What are the broader health implications of your fellowship?

There are approximately 10.4 million TB annual cases, most being in the Asia-Pacific region. The knowledge on how to prevent and treat cases is already available, but implementation is lacking, especially in low-resource settings, so health systems need to be strengthened to deliver these evidence-based practices more effectively.

Meanwhile, RHD is widely acknowledged to be a leading priority in Indigenous health. Steps which successfully reduce RHD rates would directly reduce suffering and healthcare costs, and would also have wider ramifications, since RHD shares its origins with many other transmissible diseases of disadvantage.