Many Americans would be surprised to learn that two billion people — one-third of the world's population — are infected with tuberculosis. There are nearly nine million new case of tuberculosis worldwide each year, and an estimated two million persons die of the disease annually.

The fact that this highly infectious illness is relatively rare in the U.S. is due in part to the work of UCSF Professor of Medicine Philip Hopewell, who will be receiving the prestigious 2007 World Lung Health Award at the American Thoracic Society (ATS) International Conference in San Francisco in May. Hopewell is one of two UCSF faculty receiving the society's highest honors.

Cited by the ATS as a "tireless worker to disseminate best practices worldwide in the fight against tuberculosis," Hopewell began his work with tuberculosis at the Centers for Disease Control in the 1960s before moving to the San Francisco General Hospital (SFGH), where he rose to become chief of the Division of Pulmonary and Critical Care Medicine and associate dean of the School of Medicine.

Through his close collaboration with the San Francisco Department of Public Health's (DPH) tuberculosis control program, SFGH and the Division of Tuberculosis Control have become recognized as leaders in tuberculosis care and research. Working with former DPH Directors of Tuberculosis Control Gary Slutkin and Gisela Schecter, and with the current Director, Masae Kawamura, Hopewell established a model collaboration in tuberculosis control between an academic institution and a public health department that has been widely emulated since.

The collaboration has enabled medical students, housestaff and fellows to gain experience in both the public health and clinical aspects of tuberculosis, and in some cases, pursue tuberculosis research.

"When Phil first came to San Francisco General, TB was controlled, but there were still cases in the community. He figured out how to manage it with good public health," says Talmadge E. King, Jr., MD, professor and interim chairman of the Department of Medicine, UCSF and chief of Medical Services at SFGH.

King, a pulmonary medicine specialist himself, is also being recognized in May by the the American Lung Association and the American Thoracic Society with the Trudeau Medal (see link below.)

"Phil has spent his career educating others how to treat tuberculosis and is committed to making a global impact," King says.

Hopewell on rounds at Persahabatan Hospital, Jakarta Indonesia

Hopewell has championed directly observed therapy, in which patients are closely monitored to ensure they follow the TB drug regimen exactly as prescribed. When patients use drug treatments inappropriately, it can lead to drug resistant TB bacteria. Controlling the spread of the disease means focusing on public health controls, not just treating individual patients. TB is most prevalent in developing countries where poverty, overcrowding, limited access to health care, and lack of public health controls are endemic.

To that end, Hopewell has worked closely with the World Health Organization (WHO) to establish and disseminate best practices and influence physicians worldwide. He and WHO colleagues recently developed a document, International Standards for Tuberculosis Care, which defines the core elements of TB care and has been endorsed globally. Hopewell is leading the efforts to implement these standards in the highest tuberculosis incidence countries in the world.

"If you look at most international standards documents about TB, you'll see Hopewell's name on them," says King.

UCSF actively supports faculty in their involvement in global health initiatives. The school sees its responsibility as going beyond San Francisco and California to a role in advancing health worldwide. "The school is making a much bigger effort in global health and Phil is an important part of it," says King.

Hopewell has worked to control tuberculosis with the Ministry of Health and the World Health Organization in Peru and with the government in Nigeria. He is also involved in a variety of international initiatives, including the Stop TB Initiative, the Tuberculosis Consortium for Technical Assistance and the Global Fund Against AIDS, Tuberculosis and Malaria.



Hopewell's work in San Francisco complements his international activities. He is the principal investigator for a CDC-funded national tuberculosis center, The Francis J. Curry National Tuberculosis Center, a collaboration between UCSF and the San Francisco tuberculosis control program. The center provides training in tuberculosis nationally and internationally and also develops and evaluates innovations in reducing the incidence of the disease.

Investigating the molecular basis of TB is also key to prevention and treatment. In an NIAID-funded research study, Hopewell and a number of collaborators, including Peter Small, Joel Ernst, Chuck Daley, Midori Kato-Maeda, Bob Jasmer, Payam Nahid, and Dennis Osmond, have examined the genetics of the TB bacillus to pinpoint genetic differences in bacilli from different patients and better trace the spread of the disease. Among their findings is the discovery that the disease may progress more rapidly than previously thought. This research may eventually shed light on the genetic factors underlying the development of drug resistance and lead to new ideas for TB drugs.

The same conditions that breed tuberculosis in developing countries also spur the spread of HIV; in many countries tuberculosis is the most common cause of death in patients with HIV infection. In the early years of the AIDS epidemic in the United States, patients developed an atypical form of tuberculosis which was a major problem. Hopewell was involved in studying the pulmonary complications of AIDS and identifying effective approaches to diagnosis.

Although tremendous strides in tuberculosis control have been made in the past 15 years, the rate of tuberculosis infection is still not decreasing globally. There are many factors — lack of health services, HIV infection and drug resistance — that need to be addressed before the disease can be controlled.

It will take further epidemiological research, operational and programmatic investigations, and development of new diagnostic tests, drugs and vaccines to stem outbreaks of this fatal disease in the high-incidence areas of the world.

Source: Elaine Gottlieb

Related Link: Chair of Medicine to Receive 2007 Trudeau Medal