Windhoek

Researchers are investigating the spread and control of drug-resistant tuberculosis DR-TB in Namibia, a country with a high burden of TB including multidrug-resistant and extensively drug-resistant cases. The study aims to understand the epidemic by examining clinical, epidemiological, geospatial, social network, and laboratory data to identify transmission hotspots. It also evaluates targeted case finding interventions in high-transmission areas and develops a transmission model to predict the impact of these interventions on DR-TB incidence. The study is observational and includes all DR-TB cases identified in three regions of Namibia. It collects various data including GeneXpert MTBRIF results, cultures, drug sensitivity tests, and whole genome sequencing WGS of Mycobacterium tuberculosis samples. WGS is performed locally with validation abroad. After identifying hotspots, feasibility studies of case finding strategies are conducted in households, hospitals, and communities. These data also support a health economics component to inform resource allocation. Participants provide clinical and social data and undergo laboratory testing. The study includes questionnaires to assess intervention feasibility and collects comprehensive information to inform policy and strengthen diagnosis, surveillance, and control of DR-TB. The research spans several years with outcome measures including hotspot identification over 18 months, intervention feasibility over 24 months, and transmission modeling over 12 months. Participation involves collaboration with national health institutes to capture all possible cases for effective monitoring and intervention planning.

This trial investigates transfusion strategies for younger patients aged 18 to 65 undergoing cardiac surgery with the use of cardiopulmonary bypass. It compares two common approaches to red blood cell transfusion thresholds to determine which is better for patients at moderate to high risk, focusing on important health outcomes after surgery. Participants are randomly assigned to one of two groups. One group receives a restrictive transfusion strategy, where transfusions are given only if hemoglobin levels drop below 75 gL during or after surgery. The other group follows a liberal transfusion strategy, with transfusions given at higher hemoglobin thresholds during surgery, in the intensive care unit, or on the ward. The study is open-label and conducted at multiple international centers. During the trial, researchers monitor participants for events such as death, heart attacks, kidney failure requiring dialysis, and neurological problems up to six months after surgery. They also track hospital stay length, infections, mechanical ventilation time, and other complications. Participants are followed closely through hospital discharge and for several months afterward to collect this important information.