emory university medical research

Emory has continued its rapid growth in research funding with a total of over one billion in sponsored research funding for 2023.

Emory is a member of the Association of American Universities, an association of 64 leading research universities whose members are considered to be on the leading edge of innovation, scholarship and solutions that contribute to society's economy, security and well-being.

In 2024, Emory University School of Medicine was ranked in Tier 1 for research-oriented medical schools, a group that includes the top schools in the nation. U.S. News introduced group rankings for medical schools this year instead of assigning specific numbers for each institution. The publication ranked Emory 15th for most diverse medical schools.

Emory University continues to be ranked among the nation’s top universities, coming in 24th in U.S. News & World Report’s 2024 Best Colleges report.

Emory's faculty includes:

• 41 fellows of the American Association for the Advancement of Science
• 30 members of the American Academy of Arts and Sciences
• 26 members of the National Academy of Medicine
• 4 members of the National Academy of Sciences
• 2 Howard Hughes Medical Institute Professors

The Rollins School of Public Health was ranked 3rd in the nation by U.S. News and World Report (2024).

Molecular & Systems Pharmacology ranks 9th, Immunology & Molecular Pathogenesis and Microbiology & Molecular Pathogenesis both rank 10th, Population Biology, Ecology & Evolution ranks 11th, Genetics & Molecular Biology ranks 14th, and Biochemistry, Cell & Developmental Biology ranks 22nd. 

Emory University continues to be one of the largest recipients of research funding from the National Institutes of Health (NIH), as reported by the Blue Ridge Institute for Medical Research (BRIMR). In 2023, Emory received more than $485 million and is amongst the top 20 in the nation overall for institutional funding from the NIH.

Emory University was selected as one of America's 25 New Elite 'Ivies' by Newsweek.

Seven research areas in the Graduate Division were ranked in the Top Ten for Faculty Scholarly Productivity by the Chronicle of Higher Education. These research areas include ecology, evolutionary biology, immunology, microbiology, molecular pharmacology, nutrition sciences and pharmacology.

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Department of medicine.

The Department of Medicine, part of Emory University's School of Medicine, promotes excellence in education, patient care, and clinical and basic research.

Education Explore our Programs

The Department of Medicine is highly regarded nationally for its exceptional internal medicine residency, sub-specialty fellowships, and continuing medical education programs. Explore which program fits your needs.

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Diversity, Equity, and Inclusion

The Department of Medicine is committed to ensuring a climate of inclusion and organizational equity by leveraging the diversity within our community. The department’s commitment to diversity is guided by its values of integrity, respect, trust, compassion, innovation, collaboration, inclusion, quality, accountability, and excellence.

Faculty Recruitment

The Department of Medicine is home to more than 1,500 employees all working together to further our tripartite mission to enhance research, patient care, and education. Learn more about what our department has to offer potential faculty with all interests and at all career levels.

The Department of Medicine is proud of its robust research portfolio of cross-cutting, collaborative work by basic scientists, clinical researchers, and clinicians. The Office of Research provides many support programs and resources for investigators at all stages of their research careers

Health Advocacy and Equity in the IM Residency Program

The J. Willis Hurst Internal Medicine Residency Program is committed to providing residents with the knowledge and skills needed to address the downstream effects of the social determinants of health. Check out this video to hear our faculty and residents share their experiences at Emory.

Department of Medicine News

Emory researcher focused on pain measurement receives nih new innovator award aug. 30, 2024.

Emory researcher Daniel Harper, PhD, has received a $2.3 million, three-year grant to test a novel method of measuring pain in patients with fibromyalgia,

Emory Convocation speaker Christina Gavegnano gives undergraduates access to groundbreaking lab research Aug. 29, 2024

Researcher Christina Gavegnano is known for opening her lab to undergraduate students, giving them experience in human health research. She delivered the 2024 Convocation address, encouraging the Class of 2028 to start their own remarkable trajectories.

Train to save lives with Emory Healthcare and the Atlanta Falcons Aug. 28, 2024

On Saturday, Sept. 7, join the Atlanta Falcons and Emory Healthcare for “1 Trained at Every Game,” a free, hands-on CPR and AED training session that will equip community members to respond in medical emergencies.

Department of Medicine Events

Emory University Department of Surgery

Emory surgery has placed in the top 20 of all departments of surgery nationwide in annual nih funding since fy2008, enhancing the potential for our discoveries to translate into transformative changes in patient care., cardiothoracic research laboratory, cardiothoracic surgery center for clinical research, colorectal surgery research, critical care research, general and gi surgery research, oral and maxillofacial surgery research, pediatric surgery research, plastic and reconstructive surgery research, research at grady memorial hospital, surgical oncology research, surgical oncology nanomedicine research lab, transplant health services and outcomes research program, transplant immunology research program, vascular surgery & endovascular therapy research, clinical trials at emory.

Emory is currently accepting participants for clinical trials. Volunteers are needed for different research studies.

Learn More »

Clinical trials sponsored by the Winship Cancer Institute of Emory University

Student Research

Your impact awaits.

Even if you are unsure   of   where your future path leads, Emory sees that as an opportunity. Through education, leadership, and guidance, we help uncover and encourage your curiosities, so you can discover big things—well before you graduate.  

Digging Deeper

Seniors can apply for the opportunity to research and graduate with honors.

Emory Libraries

Experience specialized assignment research help in one of our multiple libraries across two campuses.

Spend a summer doing research on biomedical or biological projects at Oxford College.

From individual grants to workshops, resources, and events, we’re here to help you pursue your interests.

Students present research projects at the Summer Undergraduate Research Symposium

Over the summer, undergraduate students from Emory and other institutions dove into research ranging from infectious diseases to theatre. They displayed their research in late July through oral and poster presentations on Emory’s campus.

Graduate Opportunities

Nell hodgson woodruff school of nursing.

Research with faculty experts and take advantage of our status as No. 5 among nursing schools in National Institutes of Health research funding.

School of Medicine

From resources to faculty, to NIH funding, see why Emory has consistently been one of the fastest-growing research institutions.

Candler School of Theology

Make an impact on our communities and the world through scholarship and church service.

Goizueta Business School

Work collaboratively with industry leaders, conducting research that helps shape the business world.

Laney Graduate School

With broad expertise and interdisciplinary training, you can be present in nearly every area of research at Emory.

School of Law

Get opportunities to work closely with faculty and experts both inside and outside the classroom.

Rollins School of Public Health

Engage with other students, faculty, and staff in collaborative and interdisciplinary projects making an impact on global health.

Take Your Research Overseas

From specialized scientific opportunities for teams and individuals to programs designed to offer a change of scenery, see what it takes to qualify for these once-in-a-lifetime study abroad research opportunities. With financial aid and support from advis e rs, there ’ s a world of research out there, and we ’ re here to help you explore it.  

Graduate Research

Tracking ticks in georgia to help monitor emerging diseases.

Emory researchers have mapped the distribution of the lone star tick across Georgia to help build awareness for where people are most likely to encounter the most common biting tick in the state.

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White House awards Emory $24.8 million for mRNA research

U.S. President Joe Biden announced on Aug. 23 that Emory University will receive a $24.8 million cooperative agreement from the newly-established Advanced Research Projects Agency for Health (ARPA-H). Emory is the first-ever recipient of ARPA-H funding, according to Assistant Professor in the Department of Medicine Matthew Woodruff.

Philip Santangelo, who is a professor in the Wallace H. Coulter Department of Biomedical Engineering at Emory and the Georgia Institute of Technology, is leading the project, using mRNA technology to create new therapeutics to combat diseases, including cancer and facilitate organ transplants. 

The project will receive funding for three years. Santangelo has worked on developing mRNA technology and said it has become clear that mRNA technology can help fight “chronic or systemic dysregulation of the immune system.”

mRNA technology can control gene expression within cells, according to Santangelo. He believes mRNA is the best way to address issues of compromised immune systems because mRNA does not change DNA, making it a temporary fix.

Over the course of a month, Santangelo and his team put together a proposal with around 400 pages for ARPA-H to review.

“Both the cost proposal and the science are very detailed,” Santangelo said. “So for 30 days, pretty much you eat, sleep and breathe that.”

Professor of Surgery Christian Larsen, Emory Vaccine Center Director Rafi Ahmed and Mason I. Lowance Professor of Medicine and Pediatrics Ignacio Sanz will lead research under Santangelo as part of the project. The group will also collaborate with researchers from the University of Georgia and Yale University (Conn.).

“I'm not an expert in everything,” Santangelo said. “We needed the right group, but they also needed to be committed to doing this because you have to respond, you have to move, you have to move quickly.”

Larsen will focus on applying Santangelo’s mRNA technology to decrease organ transplant rejection. According to Larsen, organ recipients must take immunosuppressants indefinitely once they receive the new organ, but the drugs compromise the immune system and increase a recipient's chances of getting sick. Larsen hopes his lab will allow organ recipients to receive mRNA immunotherapy instead of taking immunosuppressants.

“The goal [is] that we're trying to use this mRNA technology is to silence the immune response specifically against the proteins from the donor,”  Larsen said. “The goal of that would be to prevent the development of antibodies against your donor, and antibodies against your donor organ can lead to accelerated failure and death.”

Ahmed’s research uses Santangelo’s mRNA technology to reverse “T-cell exhaustion.” T-cells become dysfunctional after long battles with chronic diseases and cancer, Ahmed explained, making them less effective in fighting against infected cells.

“These killer cells are the most important mechanism of eliminating either virally infected cells or tumor cells,” Ahmed said.

PD-1 blockades are used to “reawaken” T-cells and fight T-cell exhaustion but are only successful in 20% to 30% of cancer patients, creating a need for new T-cell-aiding therapies, according to Ahmed.

Sanz will work alongside Woodruff, performing autoimmune modeling with humans, while Woodruff will work with mice. Sanz’s lab has been working with B-cells, which are immune cells that destroy pathogens and other foreign substances that enter the body to fight infections, for the last 10 to 15 years.

Woodruff hopes Sanz’s research will create a more robust immune response by modifying B-cells with mRNA technology.

The feasibility of mRNA-based vaccines has expanded since the Pfizer-BioNTech and Moderna COVID-19 vaccines used mRNA technology, according to Woodruff. He added that while mRNA technology has been around for many years, it was not tested in humans until the pandemic created a pressing need and demonstrated that mRNA vaccines are feasible.

“We could develop the mRNA vaccines much, much faster than we would have been able to develop the protein vaccines,” Woodruff said.

Santangelo, Woodruff, Larsen and Ahmed agreed that the funding for this research is monumental. Larsen explained that the money ARPA-H is awarding Emory is unique because this project is “high-risk, high-reward,” as opposed to funding from the National Institutes of Health, which Woodruff said is typically based on “a really long-standing foundation of support [for] potential success.”

“Investigators are pretty excited to sort of be on the front end of where the federal government is trying to drive research in the United States,” Woodruff said. “We're looking forward to getting started on it. We'll see how it goes over the next three years.”

Emory codifies open expression guidelines prohibiting encampments, allegedly without consulting University Senate

CAIR designates Emory as institution ‘of particular concern,’ anti-Emory chalkings appear on campus

Emory professors discuss ‘historical’ 2024 presidential election

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Congestive Heart Failure Treatment

Expert care for all congestive heart failure stages.

Even though congestive heart failure isn’t curable, it’s still treatable.

This means you can take steps to slow its progression (keep it from getting worse). With the right treatments, you can improve your heart failure symptoms—and your overall heart health.

Fortunately, you’ll find all the treatments you might need at Emory Health & Vascular. We’re here to help you live well with your condition, no matter what stage of heart failure you’re in.

Congestive Heart Failure Treatment at Emory Heart & Vascular

The type of heart failure treatment you need depends on several factors. These include:

• Your congestive heart failure stage
• The frequency and severity of your symptoms
• Whether another medical condition caused your heart failure

At Emory Heart & Vascular, we offer the full range of nonsurgical and surgical heart failure treatments. We also research new treatments and offer clinical trials, working to improve the care available for every patient – now and in the future. We also offer device clinics throughout Georgia for convenient follow-up care.

Congestive Heart Failure

Standard heart failure treatments.

• Lifestyle changes: Certain lifestyle changes can improve your heart health and slow heart failure progression—or prevent it from occurring. These include quitting smoking, avoiding alcohol, eating a heart-healthy diet and exercising regularly.
• Cardiac rehabilitation: With cardiac rehab , licensed professionals help you strengthen your heart through personalized exercise and nutrition plans.
• Medications: Most people with heart failure take prescription medicines. Your doctor will pick the combination of drugs that is right for your individual needs and type of heart failure.
• Pacemakers and ICDs : When placed inside your chest, these small devices help your heartbeat normally or improve its pumping ability. For example, cardiac resynchronization therapy (CRT) uses a special pacemaker to help your heart’s bottom two chambers work together to pump blood more efficiently. And ICDs, also known as implantable cardioverter defibrillators, slow down heart rhythms that are dangerously fast.
• Heart surgery: If an underlying medical condition causes your heart failure, you might need  heart surgery . For example, if heart valve disease  weakens your heart’s pumping ability, we may be able to repair or replace your faulty valve. If a blocked coronary artery reduces blood flow to your heart, we can perform coronary artery bypass graft (CABG) surgery . We also offer a type of surgery called the modified DOR procedure. This removes scar tissue that can develop after a heart attack, interfering with blood flow.

Advanced Heart Failure Treatments

With Stage D heart failure, also known as advanced heart failure, standard treatments no longer work.

However, that doesn’t necessarily mean you’re out of options. Emory Heart & Vascular offers advanced treatments that can improve your quality of life—and even extend your life:

• Ventricular assist device: This device, also known as a VAD , is a type of mechanical pump. When implanted in one of your ventricles (the bottom chambers of your heart), it helps your heart pump blood to the rest of your body.
• Extracorporeal membrane oxygenation (ECMO). With ECMO , blood pumps from your body into a machine, where it’s mixed with oxygen and pumped back into your body. The machine takes over for your heart and lungs, allowing them to rest.
• Heart transplant: For some people with advanced heart failure, heart transplant surgery  is a lifesaving treatment option. During this procedure, a surgeon replaces your damaged heart with a healthy heart from a deceased donor.

Both VAD and ECMO can be “bridge-to-transplant” therapy. This means they help your heart function while you are on the heart transplant waiting list.

In some cases, VADs are “destination therapy.” This means the device will help your heart function for the rest of your life.

Georgia's Leader in Advanced Heart Failure

Treatment Emory Heart & Vascular has been at the forefront of advanced heart failure care for decades. For example:

• We performed Georgia’s first heart transplant  in the 1980s. Since then, more than 1,000 people from across the Southeastern United States have turned to us for heart transplant surgery. In 2006, we were the first in the state to implant a ventricular assist device. Also known as a VAD, this treatment is an option for people with advanced heart failure who aren’t eligible for a heart transplant.
• We’ve earned Ventricular Assist Device  certification from the Joint Commission. This distinction confirms we meet or exceed strict standards of care for VAD placement and management. Fewer than 100 hospitals and health systems in the U.S. have achieved (and maintained) this certification.
• We've implanted more than 500 durable, continuous flow Left Ventricular Assist Devices. In 2022, we implanted more HM 3 LVADs than any other program in the world.

Today, our heart failure experts continue to offer these life-changing and lifesaving treatments. They also conduct research that may lead to even more groundbreaking treatments.

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Aug. 27, 2024

The nine schools that make up Emory University have big plans for the 2024-25 academic year, from welcoming new faculty to introducing new programs and initiatives. Here’s a roundup of incoming class stats and other things to come, as listed by each school.

Candler School of Theology

Incoming class:  Candler welcomes 158 students from 27 states and seven countries.

New dean: Candler begins the new academic year with new leadership: Jonathan Strom , professor of church history, will be installed as Mary Lee Hardin Willard Dean of Candler during Fall Convocation on Thursday, Aug. 29 .

New faculty:  Joining the faculty are Geordan Hammond , acting associate professor of Methodist and Wesleyan studies; Soren Hessler , assistant professor in the practice of leadership and administration; Mark Jordan , Dean’s Professor of Christian Ethics; Jennifer Quigley , assistant professor of New Testament; and Dhruv Raj Nagar , Bhagawan Arnath Post-Doctoral Fellow in Jain Studies. Brian Blount, president emeritus of Union Presbyterian Seminary, will serve as the 2024-25 Alonzo L. McDonald Chair in the Life and Teachings of Jesus and Their Impact on Culture.

New endowed chair:  Anthony Briggman will be installed on Thursday, Aug. 29, as the inaugural Dr. Andrew J. and Georgia L. Ekonomou Distinguished Associate Professor of Patristic Theology, Candler’s newest named professorship.

Noteworthy event : Candler’s Pitts Theology Library will host its annual Morgan Forum on Thursday, Sept. 19 , centered around the English Bible’s history and ongoing significance to the church and world. The main event will be a screening of the documentary film “1946: The Mistranslation that Shifted Culture,” which traces the origins of the anti-LGBTQIA+ movement among Christians to a significant biblical translation choice made in 1946. A panel discussion featuring the film’s director will follow.

Learn more at the Candler School of Theology website .

Emory College of Arts and Sciences

Incoming class: Emory College welcomes a stellar, high-achieving first-year class of 1,448 students. Almost   20% of the class identifies as first-generation students.

New faculty:  Fifty new faculty members will join the Emory College ranks this fall. The diverse and highly accomplished cohort represents ambitious hiring across the sciences, humanities and arts.

Building community: The Emory College Communities Project, successfully piloted last spring, continues this fall. Spearheaded by Dean Barbara Krauthamer and Divisional Dean of Arts Kevin Karnes , the project supports grassroots efforts by students, faculty and staff to gather for conversations around complex issues facing our world today. Several small-group, moderated discussions around select campus events are also being planned.

New lecture series : As part of the College’s ongoing efforts to build an inclusive community, the inaugural Dean’s Distinguished Lecture will take place Thursday, Oct. 10, with Pearl Dowe , Vice Provost for Faculty Affairs and Asa Griggs Candler Professor of Political Science and African American Studies. She will discuss her most recent book, “The Radical Imagination of Black Women: Ambition, Politics, and Power.” This new lecture series aims to bring in prominent scholars to address timely topics and, in conjunction with the College Communities Project, give students the opportunity for in-depth interaction and discussion with speakers.

Building career pathways: Career and Professional Development in the Pathways Center will offer three career treks during spring and fall breaks for students to travel to cities around the country to network with alumni and learn more about opportunities in different industries. The treks will visit Miami, New York and San Francisco this year.

Learn more at the Emory College website .

Goizueta Business School

Incoming classes:  Goizueta welcomed more than 900 students for the new academic year. The new class included nearly 400 students and 70 exchange students in our BBA program and approximately 545 graduate students in our MBA programs and specialized master’s degrees . Across programs, Goizueta celebrated a record number of veterans and service members joining as students at our school. 

Launching inaugural programs: Goizueta launched the first incoming class for our Master in Management program , designed for recent graduates with a non-business major who are looking to level up their undergraduate degree with business knowledge and skills, and our Master in Business for Veterans program , which supports the transition of active-duty military members and veterans from service to a successful civilian career in business.

New faculty: Goizueta welcomes new faculty members Tucker Richard Balch , professor in the practice and research of finance; Jake Jo , assistant professor in the practice of organization and management; Brian Jonghwan Lee , assistant professor of finance; and Dionne Nickerson , assistant professor of marketing.

Elevating business and careers: Ranked #6 in the U.S. by Financial Times, Emory Executive Education continues to evolve its programs and courses to reflect the evolving needs of businesses and professionals. This fall, it is launching three new online certificates centered on Business and Digital Transformation, Analytics and AI. Existing and new short courses cover topics such as AI in business, change management, negotiations, design thinking and more. Connect to discuss significant discounts for Emory alumni and employees.

Learn more at the  Goizueta Business School website .

Laney Graduate School

New PhD program: The Laney Graduate School recently received approval for a new Environmental Studies and Society (ESS) PhD program. Through co-mentoring and experiential cross-training in applied natural and social sciences, students enrolled in the program will pursue actionable research to address environmental issues and their associated complex challenges through an integrated interdisciplinary applied perspective. Congratulations to the faculty who spearheaded this effort.

Laney joins national consortium: Laney-EDGE (Emory Diversifying Graduate Education) , with support from executive leadership at Emory, has become one of the newest members of the Leadership Alliance — a national consortium of leading research and teaching colleges, universities and private industry aimed to develop underrepresented students into outstanding leaders and role models in academia, business and the public sector.

ELSP revamped: The Laney Graduate School’s English Language Support Program (ELSP) was restructured to better support international students. The program removed the global assessment requirement, allowing newly admitted LGS students who indicated on their admissions application that English is not their first language to take oral and written Emory-specific language proficiency assessments, either through referral by their individual programs or through self-selection. We are delighted to take this more student-centered approach.

New administrative office: The administrative offices of the Laney Graduate School have moved from the Administrative Building to a new location. Located at 1784 North Decatur Road, Second Floor, the new space is designed to foster collaboration and community-building and is near the new graduate and professional student housing complex. Please come visit our new space!

Learn more at the Laney Graduate School website .

Nell Hodgson Woodruff School of Nursing

Incoming class:  The Nell Hodgson Woodruff School of Nursing is excited to welcome approximately 1,400 students this fall across pre- and post-licensure programs.

New faculty:  The School of Nursing is thrilled to welcome 14 diverse faculty members this fall.

New alumni:  The school celebrated 184 of its newest alumni during the August Graduation and Pinning Ceremony. These students graduated from the Certified Registered Nurse Anesthesia (CRNA) program, the Master of Nursing Pathway to Master of Science in Nursing (MN to MSN Pathway) program and the Distance Accelerated Bachelor of Science in Nursing (DABSN) program.

New programs:  The school recently launched a spring start for its Master of Nursing (MN) program to meet the needs of our population and prepare additional nurses. The MN spring start is a 15-month, full-time, campus-based program designed for second-degree students. It offers three career pathways designed to fit our student’s needs.

Faculty honors:  Ten members of the Emory Nursing community will be among the distinguished nurse leaders inducted into the  American Academy of Nursing 2024 Class of Fellows  this October. The honorees are Glenna Brewster , Renée Byfield, Ethan Cicero , Carrie McDermott , Adrianna Nava, Quyen Phan , Courtney Pitts , David Reinhart, David Jackson Smith and Irene Yang .

Learn more at the  Nell Hodgson Woodruff School of Nursing website .

• Oxford College

New leadership:  This year, Oxford welcomed several new leaders, including Darleny Cepin , the new senior associate dean of campus life and chief student affairs officer, who previously served as an assistant dean for student life at Princeton University’s Mathey College. Daisja Dukes also joins Oxford from the Morehouse School of Medicine as the new director of the College’s Center for Counseling and Wellbeing.

New and promoted faculty:  Oxford welcomed several new faculty members this fall. They are:  Joseph Cheatle , assistant professor of English and director of the Writing and Communication Center; Tulay Dixon , assistant teaching professor of QTM and linguistics; Mary Johnson , assistant professor of art; and Kelly Murray-Stoker , assistant professor of biology.

Oxford is also proud to announce several new faculty promotions. They are: Maria (Tanya) Davis ,  promotion to teaching professor of Spanish; Nicholas Fesette ,  promotion to associate professor of theater with tenure; Devon Goss , promotion to associate professor of sociology with tenure; Alix Olson , promotion to associate professor of women’s, gender and sexuality studies with tenure; Deric Shannon , promotion to professor of sociology; Salmon Shomade , promotion to professor of political science; Erin Tarver , promotion to professor of philosophy; and Daniel Walter , promotion to associate professor of German and linguistics with tenure.

New this fall:  Oxford College is launching a new office called Global Oxford, which will bring together all international student programs and expanded student international travel opportunities (faculty-led, summer programs and international internships). Global Oxford will be housed in the Center for Pathways and Purpose (CPP) and will be led by Daphne Orr , who will assume the role of senior director.

Oxford College will be the site of the Emory Center for Public Scholarship and Engagement’s inaugural  Ideas Festival  Emory Sept. 20-22. The weekend will feature some of the most impactful and interesting scientists, musicians, writers, filmmakers and creators of our time, including Jermaine Dupri , who will be the keynote speaker. Learn more or register here .

Learn more at the Oxford College website .

Rollins School of Public Health

Incoming class: Rollins welcomes 511 students (including Humphrey Fellows) representing 41 countries and 36 states. For the 2024-25 school year, 592 Rollins students have Rollins Earn and Learn awards (a work-study program unique to Rollins).

New programs: Starting this fall, Rollins is offering a fully online, part-time Master of Public Health in four subject areas. Prospective students can also apply for the Doctor of Public Health program, which will enroll its first cohort across two specializations for fall 2025. For students not seeking a degree, this summer marked the launch of the Rollins Health Education Institute, a new continuing education initiative offering short courses for public health professionals.

Scientific innovation: The Climate and Health Indicator Dashboard for Georgia launched this summer to track the impacts of extreme weather and climate change on human health throughout the state. This is part of a larger focus on climate and health across the school, including the expanding activities of the Climate and Health Actionable Research and Translation Center, established last fall. Rollins researchers are also innovating in outbreak analysis through the Center for Infectious Disease Modeling and Analytics and Training Hub, an innovation partner with CDC’s Center for Forecasting and Outbreak Analytics.

Expanding communications: In August, Rollins launched “ Health Wanted ,” a new podcast and radio show produced in partnership with WABE. Host Laurel Bristow — a research scientist and infectious diseases expert leading social media science communication at Rollins — talks to experts, delivers essential public health headlines and demystifies the science behind trending topics.

Learn more at the Rollins School of Public Health website .

• School of Law

Incoming class:  Emory Law welcomes new students from 35 states plus the District of Columbia and 15 countries to pursue JD, LLM, MCL and JM degrees. 

New faculty : Emory Law welcomes several faculty during the fall semester. Jessica Roberts is a professor of law in artificial intelligence, machine learning and data science at Emory University School of Law. She specializes in the legal and ethical issues related to genetics and other emerging health technologies, disability rights and antidiscrimination law. Dave Fagundes is a professor of law who writes and teaches about property, including copyright, real estate and wills and trusts. Matt Roessing is an assistant professor of practice who, prior to joining the Emory Law faculty, taught business, real estate and international trade law at business schools, first at Georgia College and State University, then University of Georgia.  Chelsea Harris serves as an assistant professor of practice teaching Introduction to Legal Analysis, Research, and Communication and Introduction to Legal Advocacy. 

Key upcoming events:  

• Faith in Law, Law in Faith: A Festschrift Celebration in Honor of John Witte Jr. : Wednesday, Aug. 28 
• Social Justice Workshop , Wednesday, Sept. 11 
• Innovator Diversity Pilots Conference : Friday, Sept. 13 
• What We've Been Up To with Professor Deepa Das Acevedo , Wednesday, Sept. 4 

Learn more at the School of Law website .

• School of Medicine

Incoming students:  On July 22, 150 students matriculated to the MD program . The incoming students are 61% women, with 86% non-traditional students (meaning they have been out of college for a year or more). Of these, 28 received other graduate degrees prior to medical school; 57 claim Georgia as home and 24 were born outside the U.S. Their average age is 24.

The Physician Assistant program Class of 2026 began July 29 with 57 students selected from a pool of nearly 1,300 applicants. They have an average of 4,200 hours of health care experience prior to Emory, 42% identify as racial or ethnic minority and 81% are women.

On June 3, the Doctor of Physical Therapy program welcomed 63 students in the class of 2027. The new class is 77% women, and students come from 22 U.S. states and four countries including China, Chile, Mexico and India. The DPT program was recently ranked no. 4 in the country according to U.S. News and World Report’s 2024 Best Graduate Schools.

Two students from the Anesthesiologist Assistant Program class of 2024 were selected as finalists to present posters on medically challenging cases at the Georgia Society of Anesthesiologists Summer Meeting in July. Students of the class of 2025 completed their skills labs in neuraxial blocks and central line placement. On Aug. 19, we welcomed 40 students to the Class of 2026.

The Genetic Counseling Training Program welcomes 12 incoming students and 12 returning students. The incoming class has the highest number of Georgia residents in the program history and represents three different countries.

The   Medical Imaging program   welcomes eight students in the Class of 2026. Additionally, applications open Sept. 1 for 2025 enrollment in the Bachelor of Medical Science “Bridge” Program (RT- BMSc). Contact Kimberly Cross at   [email protected]   for details.

Incoming residents and fellows: This summer, the SOM welcomed 468 new residents and fellows across 119 ACGME-accredited training programs. This outstanding group of residents and fellows will join their colleagues in providing essential services for our community while obtaining exemplary medical training.  

New centers: As part of a continued effort to transform education in the School of Medicine, we have launched a new Center for Humanizing Innovations in Medical Education (CHIME). The center will focus on meeting the evolving needs of faculty, staff, learners and patients through learning sciences, innovation and interdisciplinary collaboration. Experts in learning sciences, educational/faculty development, instructional technology and medical education will work together to prepare our people to become compassionate, competent and forward-thinking leaders who will be equipped to innovate in the rapidly changing health care and education landscape.

New leadership: After five years as department chair, Drew Patterson has stepped down and Anne Marie McKenzie-Brown , professor in the Department of Anesthesiology, will serve as interim department chair.  Ravi Rajani,   professor of surgery, stepped into the role of executive associate dean for Emory at Grady on June 1, 2024.  Carlos del Rio , will become the Department of Medicine chair beginning Sept. 1. Solomon F. Ofori-Acquah will arrive in Georgia in September and will have a joint faculty appointment at Emory University and Morehouse School of Medicine (MSM) as the Calvin Smyre GRA Eminent Scholar Chair. In this role he will lead the Georgia Solve Sickle Cell Initiative , coordinated by the Georgia Research Alliance in partnership with Emory, MSM and Children’s Healthcare of Atlanta.

Learn more at the School of Medicine website . 

Photos by Kay Hinton and Sarah Woods, Emory Photo/Video.

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Nursing Leadership Certificate

Get your brochure.

November 14, 2024

5 months, online 3-5 hours per week

PROGRAM FEE

US$6,150 US$5,227 and get US$615 off with a referral

To claim your US$615 program fee coupon for Nursing Leadership Certificate , please complete the information form.

Develop Future-Ready Skills Today

Emeritus is collaborating with Emory Executive Education to help you build future-ready skills. Enroll before and get up to 15% tuition assistance to set yourself up for professional success.​

Application Details

Program fee, us$6,150 us$5,227, elevate your nursing leadership.

As a nurse, you are more than just a caregiver, an educator, and a patient advocate. You are the eyes and ears of your healthcare organization, making a critical impact on enterprise-level decisions. Consequently, the need for nurse leadership has soared to an all-time high, driven by a host of complex challenges, including a shortage of nurses, a rise in chronic disease, and an aging baby boomer population.

The Nursing Leadership Certificate program from Emory Executive Education is designed and led by Emory’s foremost thought leaders in business and nursing leadership. Dane Peterson, former president and chief operating officer; Bob Dent, vice president of patient services and chief nursing officer; Trina Geyer, director of nursing leadership and development; and other Emory Healthcare leaders bring their vast experience and expertise in nursing leadership, healthcare and business management, patient care, and finance to the program. The five-month immersive curriculum is focused on providing the frameworks, skills, and experience you need to develop innovative healthcare delivery models and create a strategic vision to lead your team of nurses and your organization through any healthcare challenge.

ANCC Accreditation

The Nursing Leadership Certificate Program has been approved for 51.3 contact hours through the Emory Nursing Professional Development Center. Emory Nursing Professional Development Center (ENPDC) is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation.

Who Is This Program For?

The Nursing Leadership Certificate program is ideal for you if you are:

• A current or new nurse executive who is seeking to enhance your business acumen and nursing skill set
• An aspiring nurse executive who will soon take on leadership challenges in your healthcare organization
• A senior nursing leader looking to acquire new skills and expand your influence as you move toward an executive-level position

Participants are required to have:

• Minimum 10 years of combined experience in nursing and management roles
• Fluency in written and spoken English

Designed for Success

Structured with the needs of busy nursing leaders in mind, you will learn through online sessions, including guest lectures from top nursing executives in the healthcare industry. The flexible nature of the Nursing Leadership Certificate program allows you to customize your learning journey for maximum career and business impact.

Complete the program at your own pace, engaging in just three to five hours of learning time per week around your busy work schedule.

Grow your network by interacting with a global cohort of nursing leaders. Learn from world-renowned faculty and glean insights from industry experts with extensive experience in the nursing sector.

Gain in-depth knowledge and skills that are fundamental to advancing your career and enable you to thrive as a nursing leader. Inspire colleagues by building a shared vision that considers the unique needs of patient care delivery and the business needs of healthcare organizations.

"Complexity in healthcare is uncertain. Change is inevitable. Leading change in complex healthcare situations and settings, during rapidly successive crises, requires intentional leader development and organizational commitment to advance evidence, abilities, ethical care, resilience, and innovation. The Nursing Leadership Certificate program from Emory Executive Education offers current and aspiring nurse executives the space to learn, reimagine, and grow through volatile, uncertain, complex, and ambiguous healthcare times. Join us!" — Trina Geyer, PhD, MSN, RN, NPD-BC, NEA-BC, Co-Director, Nursing Leadership Certificate; Director of Nursing Leadership and Development, Emory Healthcare

What You Will Learn in the Program

• Understand the forces of change impacting today’s healthcare organizations, the specific needs of organizations, and the chief nursing executive’s role in driving transformation
• Sharpen your communication, conflict management, and influencing skills
• Strengthen your decision making and better manage people, teams, and conflicts in your role
• Develop strategies to guide yourself and your team of nurses and manage team performance
• Identify your organization's strategic placement of incentives to better motivate people and teams, manage key drivers of healthcare spending, and improve patient care
• Learn to manage clinical operations, liaising between the nursing, administration, and medical staff while ensuring that patients receive the highest standard of care
• Evaluate your organization’s current tools and methods for assessing well-being and create a well-being initiative to propose to your organization
• Acquire skills that are instrumental to navigating the complexities of healthcare and emerge as a leader who can mobilize teams to effect patient and organizational change
• Gain new perspectives, skills, and tools to play a more strategic role in decision making, change initiatives, and the future success of your organization

Program Highlights

The Nursing Leadership Certificate Program has been approved for 51.3 contact hours through the Emory Nursing Professional Development Center.

Cutting-Edge Content

Immerse yourself in an in-depth curriculum that is designed to equip nurses with the skills of the future, including leadership, personnel management, and finance.

Focused Learning Journey

Participate in a highly focused learning journey that examines leadership through the lens of nursing.

Real-World Applicability

Leverage evidence-based frameworks and the real-world expertise of Emory nursing and business leaders to create innovative solutions for the challenges you face at work.

Immediate Impact

Apply your learning in real time as you develop effective strategies to navigate the complex healthcare landscape in a capstone project.

Networking Opportunities

Join an active learning community of today’s nursing leaders and discover how your peers are making an impact on the health of their patients and the success of their organizations.

Certificate of Completion

Earn a cutting-edge certificate that provides a unique combination of practical experience in leadership, business, and finance, complementing advanced nursing degrees, such as the MSN or DNP.

A Practical Curriculum for Leaders in Nursing

The program’s curriculum is structured around four overarching areas of nursing leadership that are designed to elevate your success as a chief nursing executive: business; finance; building and leading teams; and diversity, equity, and inclusion. You will learn the skills needed to navigate the current complexities of healthcare and emerge as an effective leader who can drive positive change for patients and healthcare organization.

Being a successful nurse leader requires understanding the complexities of today’s healthcare landscape from both a patient and an organizational perspective. It also requires developing strategies that balance cost, access, and quality. Learn how to assess any healthcare climate and adjust your organization’s strategic plan to improve patient health and access to care.

• Competing Priorities in Healthcare
• Social Determinants of Health
• Organizational Design
• Health Economics    
• Watch the Money Flow
• Finance for the Non-Financial Manager
• Influence without Authority
• Strategic Thinking and Execution for Nurse Leaders
• Leading Your Organization's Culture
• Leading Your Organizational Change Well
• Talent Management
• Teams and Teamwork
• Diversity, Equity, and Inclusion
• Measuring Organizational Performance
• Measuring and Rewarding Individual Performance
• Resolving Conflict and Negotiation as a Nurse Leader
• Executive Presence/Professional Communication
• Population Health
• Wellness and Well-Being

Note: : Session topics and the order of the modules are subject to change.

Capstone Project

Meet the faculty.

This program is designed and taught by thought leaders who bring to the curriculum cutting-edge scholarship, extensive experience in the healthcare industry, and rich insights into the skills and frameworks needed to be a successful chief nursing executive. Industry experts and guest speakers also share their knowledge of best practices in nursing leadership and healthcare management.

Trina Geyer, PhD, MSN, RN, NPD-BC, NEA-BC

Co-Director, Nursing Leadership Certificate; Director of Nursing Leadership and Development, Emory Healthcare

Michael Sacks

Co-Director, Nursing Leadership Certificate; Professor in the Practice of Organization and Management, Emory Goizueta Business School; Faculty Director, Woodruff Leadership Academy, Emory Woodruff Health Sciences Center

Lynda Barrett

Associate Vice President, Strategic Planning, Woodruff Health Sciences Center; Vice President, Strategic Planning, Emory Healthcare

Tim Cunningham, RN, DrPH, MSN, FAAN

Co-Chief Well-Being Officer, Office of Well-Being; Vice President of Practice and Innovation, Emory Healthcare; Adjunct Associate Professor, Nell Hodgson Woodruff School of Nursing

Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE, FAAN, FAOL

Vice President, Patient Services and Chief Nursing Officer, Emory Decatur Hospital, Emory Long-Term Acute Care

Ildemaro J. González, MBA

Chief Diversity, Equity, and Inclusion Officer Emory Healthcare, Chief Diversity, Equity, and Inclusion Officer Winship Cancer Institute, Emory University

Sheryl Heron, MD, MPH, FACEP

Associate Dean for Community, Engagement, Equity, and Inclusion/Chief Diversity and Inclusion Officer; Professor and Vice-Chair of Faculty Equity, Engagement, and Empowerment, Department of Emergency Medicine; Associate Director for Education and Training, Injury Prevention Research Center at Emory (IPRCE), Emory University School of Medicine

Chief Financial Officer, Emory Healthcare

Rod McCowan, PhD

Associate Professor in the Practice of Organization and Management, Emory Goizueta Business School

Rebecca Martin, PhD

Vice President for Global Health; Director, Emory Global Health Institute

Rachel Patzer, PhD

President and Chief Executive Officer, Regenstrief Institute Inc.

Dane Peterson, MBA

Former President and Chief Operating Officer, Emory Healthcare

Molly Ryan Epstein, PhD

Professor in the Practice of Organization and Management, Emory Goizueta Business School

Chad Ritenour, MD

Co-Chief Well-Being Officer, Office of Well-Being; Professor of Urology, Emory University School of Medicine; Vice Chair of Education and Faculty Affairs, Department of Urology

Karen Sedatole, PhD

Asa Griggs Candler Professor of Accounting, Emory Goizueta Business School

Tom Smith, PhD

Professor in the Practice of Finance, Emory Goizueta Business School

Peter Topping

Krysia Wren, PhD

Organizational Psychologist

Trina Geyer, PhD, MSN, RN, NPD-BC, NEA-BC Co-Director, Nursing Leadership Certificate; Director of Nursing Leadership and Development, Emory Healthcare

Michael Sacks Co-Director, Nursing Leadership Certificate; Professor in the Practice of Organization and Management, Emory Goizueta Business School; Faculty Director, Woodruff Leadership Academy, Emory Woodruff Health Sciences Center

Lynda Barrett Associate Vice President, Strategic Planning, Woodruff Health Sciences Center; Vice President, Strategic Planning, Emory Healthcare

Tim Cunningham, RN, DrPH, MSN, FAAN Co-Chief Well-Being Officer, Office of Well-Being; Vice President of Practice and Innovation, Emory Healthcare; Adjunct Associate Professor, Nell Hodgson Woodruff School of Nursing

Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE, FAAN, FAOL Vice President, Patient Services and Chief Nursing Officer, Emory Decatur Hospital, Emory Long-Term Acute Care

Ildemaro J. González, MBA Chief Diversity, Equity, and Inclusion Officer Emory Healthcare, Chief Diversity, Equity, and Inclusion Officer Winship Cancer Institute, Emory University

Sheryl Heron, MD, MPH, FACEP Associate Dean for Community, Engagement, Equity, and Inclusion/Chief Diversity and Inclusion Officer; Professor and Vice-Chair of Faculty Equity, Engagement, and Empowerment, Department of Emergency Medicine; Associate Director for Education and Training, Injury Prevention Research Center at Emory (IPRCE), Emory University School of Medicine

Brad Haws Chief Financial Officer, Emory Healthcare

Rod McCowan, PhD Associate Professor in the Practice of Organization and Management, Emory Goizueta Business School

Rebecca Martin, PhD Vice President for Global Health; Director, Emory Global Health Institute

Rachel Patzer, PhD President and Chief Executive Officer, Regenstrief Institute Inc.

Dane Peterson, MBA Former President and Chief Operating Officer, Emory Healthcare

Molly Ryan Epstein, PhD Professor in the Practice of Organization and Management, Emory Goizueta Business School

Chad Ritenour, MD Co-Chief Well-Being Officer, Office of Well-Being; Professor of Urology, Emory University School of Medicine; Vice Chair of Education and Faculty Affairs, Department of Urology

Karen Sedatole, PhD Asa Griggs Candler Professor of Accounting, Emory Goizueta Business School

Tom Smith, PhD Professor in the Practice of Finance, Emory Goizueta Business School

Peter Topping Professor in the Practice of Organization and Management, Emory Goizueta Business School

Krysia Wren, PhD Organizational Psychologist

Certificate

Upon successful completion of the program, participants will be awarded a verified digital certificate by Emory Executive Education. The certificate will be a recognition of your achievement in the Nursing Leadership Certificate program. The program is also approved for 51.3 contact hours through the Emory Nursing Professional Development Center.

How do I know if this program is right for me? After reviewing the information on the program landing page, we recommend you submit the short form above to gain access to the program brochure, which includes more in-depth information. If you still have questions on whether this program is a good fit for you, please email  [email protected],  and a dedicated program advisor will follow-up with you very shortly.

Are there any prerequisites for this program? Some programs do have prerequisites, particularly the more technical ones. This information will be noted on the program landing page, as well as in the program brochure. If you are uncertain about program prerequisites and your capabilities, please email us at the ID mentioned above. Note that, unless otherwise stated on the program web page, all programs are taught in English and proficiency in English is required. What is the typical class profile? More than 50 percent of our participants are from outside the United States. Class profiles vary from one cohort to the next, but, generally, our online certificates draw a highly diverse audience in terms of professional experience, industry, and geography — leading to a very rich peer learning and networking experience.

What other dates will this program be offered in the future? Check back to this program web page or email us to inquire if future program dates or the timeline for future offerings have been confirmed yet.

How much time is required each week? Each program includes an estimated learner effort per week. This is referenced at the top of the program landing page under the  Duration  section, as well as in the program brochure, which you can obtain by submitting the short form at the top of this web page.

How will my time be spent? We have designed this program to fit into your current working life as efficiently as possible. Time will be spent among a variety of activities including:

• Engaging with recorded video lectures from faculty
• Attending webinars and office hours, as per the specific program schedule
• Reading or engaging with examples of core topics
• Completing knowledge checks/quizzes and required activities
• Engaging in moderated discussion groups with your peers
• Completing your final project, if required

The program is designed to be highly interactive while also allowing time for self-reflection and to demonstrate an understanding of the core topics through various active learning exercises. Please email us if you need further clarification on program activities.

What is it like to learn online with the learning collaborator, Emeritus? More than 300,000 learners across 200 countries have chosen to advance their skills with Emeritus and its educational learning partners. In fact, 90 percent of the respondents of a recent survey across all our programs said that their learning outcomes were met or exceeded. All the contents of the course would be made available to students at the commencement of the course. However, to ensure the program delivers the desired learning outcomes the students may appoint Emeritus to manage the delivery of the program in a cohort-based manner the cost of which is already included in the overall course fee of the course. A dedicated program support team is available 24/5 (Monday to Friday) to answer questions about the learning platform, technical issues, or anything else that may affect your learning experience.

How do I interact with other program participants? Peer learning adds substantially to the overall learning experience and is an important part of the program. You can connect and communicate with other participants through our learning platform.

What are the requirements to earn the certificate? Each program includes an estimated learner effort per week, so you can gauge what will be required before you enroll. This is referenced at the top of the program landing page under the  Duration  section, as well as in the program brochure, which you can obtain by submitting the short form at the top of this web page. All programs are designed to fit into your working life. This program is scored as a pass or no-pass; participants must complete the required activities to pass and obtain the certificate of completion. Some programs include a final project submission or other assignments to obtain passing status. This information will be noted in the program brochure. Please email us if you need further clarification on any specific program requirements. What type of certificate will I receive? Upon successful completion of the program, you will receive a smart digital certificate. The smart digital certificate can be shared with friends, family, schools, or potential employers. You can use it on your cover letter, resume, and/or display it on your LinkedIn profile. The digital certificate will be sent approximately two weeks after the program, once grading is complete. Can I get the hard copy of the certificate? No, only verified digital certificates will be issued upon successful completion. This allows you to share your credentials on social platforms such as LinkedIn, Facebook, and Twitter. Do I receive alumni status after completing this program? No, there is no alumni status granted for this program. In some cases, there are credits that count toward a higher level of certification. This information will be clearly noted in the program brochure. How long will I have access to the learning materials? You will have access to the online learning platform and all the videos and program materials for 12 months following the program  start date . Access to the learning platform is restricted to registered participants per the terms of agreement.

What equipment or technical requirements are there for this program? Participants will need the latest version of their preferred browser to access the learning platform. In addition, Microsoft Office and a PDF viewer are required to access documents, spreadsheets, presentations, PDF files, and transcripts. Do I need to be online to access the program content? Yes, the learning platform is accessed via the internet, and video content is not available for download. However, you can download files of video transcripts, assignment templates, readings, etc. For maximum flexibility, you can access program content from a desktop, laptop, tablet, or mobile device. Video lectures must be streamed via the internet, and any livestream webinars and office hours will require an internet connection. However, these sessions are always recorded, so you may view them later.

Can I still register if the registration deadline has passed? Yes, you can register up until seven days past the published start date of the program without missing any of the core program material or learnings. What is the program fee, and what forms of payment do you accept? The program fee is noted at the top of this program web page and usually referenced in the program brochure as well.

• Flexible payment options are available (see details below as well as at the top of this program web page next to  FEE ).
• Tuition assistance is available for participants who qualify. Please email  [email protected].

What if I don’t have a credit card? Is there another method of payment accepted? Yes, you can do the bank remittance in the program currency via wire transfer or debit card. Please contact your program advisor, or email us for details. I was not able to use the discount code provided. Can you help? Yes! Please email us with the details of the program you are interested in, and we will assist you. How can I obtain an invoice for payment? Please email us your invoicing requirements and the specific program you’re interested in enrolling in. Is there an option to make flexible payments for this program? Yes, the flexible payment option allows a participant to pay the program fee in installments. This option is made available on the payment page and should be selected  before  submitting the payment. How can I obtain a W9 form? Please connect with us via email for assistance. Who will be collecting the payment for the program? Emeritus collects all program payments, provides learner enrollment and program support, and manages learning platform services.

Are there any restrictions on the types of funding that can be used to pay for the program?

Program fees for Emeritus programs with Emory Executive Education may not be paid for with (a) funds from the GI Bill, the Post-9/11 Educational Assistance Act of 2008, or similar types of military education funding benefits or (b) Title IV financial aid funds.

What is the program refund and deferral policy? For the program refund and deferral policy, please click the link  here .

Didn’t find what you were looking for? Write to us at  [email protected]  or  Schedule a call  with one of our Program Advisors or call us at  +1 585 549 3600  (US) /  +44 11 7463 3354  (UK)

Early registrations are encouraged. Seats fill up quickly!

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• v.21(6); 2015 Jun

Risk Factors for Acquisition of Drug Resistance during Multidrug-Resistant Tuberculosis Treatment, Arkhangelsk Oblast, Russia, 2005–2010

Resistance should be determined quickly, and treatment should contain at least 3 effective drugs.

Acquired resistance to antituberculosis drugs decreases effective treatment options and the likelihood of treatment success. We identified risk factors for acquisition of drug resistance during treatment for multidrug-resistant tuberculosis (MDR TB) and evaluated the effect on treatment outcomes. Data were collected prospectively from adults from Arkhangelsk Oblast, Russia, who had pulmonary MDR TB during 2005–2008. Acquisition of resistance to capreomycin and of extensively drug-resistant TB were more likely among patients who received <3 effective drugs than among patients who received > 3 effective drugs (9.4% vs. 0% and 8.6% vs. 0.8%, respectively). Poor outcomes were more likely among patients with acquired capreomycin resistance (100% vs. 25.9%), acquired ofloxacin resistance (83.6% vs. 22.7%), or acquired extensive drug resistance (100% vs. 24.4%). To prevent acquired drug resistance and poor outcomes, baseline susceptibility to first- and second-line drugs should be determined quickly, and treatment should be adjusted to contain > 3 effective drugs.

Treatment of multidrug-resistant tuberculosis (MDR TB) is complicated by the length of treatment, toxicity, and expense involved in use of second-line drugs. The latest World Health Organization (WHO) recommendations for treatment of MDR TB include use of a second-line injectable agent for 8 months, a fluoroquinolone, pyrazinamide, and > 2 additional effective second-line drugs for almost 2 years ( 1 ). Fluoroquinolones and second-line injectable agents are essential for treatment of MDR TB because of their bactericidal activity relative to other second-line drugs ( 2 , 3 ). The second-line companion drugs are bacteriostatic and are used mainly to prevent amplification of resistance to the 2 key bactericidal drugs ( 4 – 6 ).

Mycobacterium tuberculosis drug resistance occurs by 2 mechanisms: initial infection with a resistant strain (primary resistance) or emergence of a resistant population of bacilli in a patient who initially had drug-susceptible TB (acquired resistance). Acquired drug resistance develops when inadequate treatment kills drug-susceptible M. tuberculosis bacilli while allowing bacilli with spontaneously occurring mutations that confer drug resistance to flourish until they predominate ( 7 ). Inadequate treatment can be a consequence of insufficient dosing, poor gastrointestinal absorption of oral medications, substandard quality of drugs, poor adherence to treatment, unsatisfactory duration of treatment, or treatment with a regimen containing > 1 drugs to which the organism is already resistant ( 7 , 8 ). Acquisition of additional drug resistance, especially to fluoroquinolones or second-line injectable agents, leaves few treatment options, complicating an already difficult treatment ( 9 ).

WHO estimates that almost half of all TB cases in countries of the former Soviet Union involve resistance to > 1 drug and that 1 in 5 TB patients has MDR TB ( 10 ). Furthermore, in this region, prevalence of extensively drug-resistant (XDR) TB, defined as MDR TB with additional resistance to any fluoroquinolone and > 1 of the 3 second-line injectable agents, is among the highest in the world ( 10 , 11 ). In Russia, the proportion of new cases that are MDR TB varies from 8.8% to 15% across regions ( 10 ). Reported proportions of MDR TB in new (13.5%–19%) and previously treated (45%–60%) case-patients have been among the highest in Arkhangelsk Oblast, which is in northwestern Russia ( 12 , 13 ). Although the overall rate of TB notification in this oblast is declining, especially among new cases, the relative proportion of MDR TB is increasing ( 14 ).

Before 2000, the Arkhangelsk TB Control Program had limited access to second-line drugs because of their high cost ( 15 ). In early 2002, this program applied to the Green Light Committee (GLC), which was created to evaluate, lend guidance, and approve TB control programs for access to reduced-price, quality-assured, second-line drugs ( 16 ). The GLC led the development of WHO guidelines for programmatic management of drug-resistant TB, at the time called DOTS–Plus. The GLC required programs to follow these guidelines, which were designed to minimize the risk for acquired drug resistance for MDR TB patients and to improve treatment outcomes ( 17 ). In May 2003, the GLC approved Arkhangelsk TB Control Program procurement of quality-assured second-line drugs.

Even programs that follow WHO guidelines for programmatic management of drug-resistant TB have reported detection of XDR TB in patients undergoing treatment for MDR TB, suggesting that M. tuberculosis is acquiring additional drug resistance over the course of treatment ( 18 ). Our goals with this study were to determine the frequency of acquired drug resistance, the risk factors for acquisition of additional drug resistance over the course of MDR TB treatment, and which treatment regimens for MDR TB will decrease the risk for acquired resistance and lead to better treatment outcomes.

Study Population and Data Collection

The study prospectively enrolled 2 cohorts of consecutively seen, consenting, nonimprisoned adult patients in Arkhangelsk Oblast, Russia, who had confirmed pulmonary MDR TB and were starting treatment with second-line drugs. MDR TB was confirmed by sputum culture and drug-susceptibility testing (DST) at the regional TB laboratory. Patients in cohort 1 were enrolled from January 1, 2005, through December 31, 2006; patients in cohort 2 were enrolled from January 1, 2007, through December 31, 2008. The 2 cohorts were approved in 2 separate applications to the GLC. Most patients in cohort 1 had been on a waiting list for MDR TB treatment for an extended amount of time at the time of treatment initiation, whereas most patients in cohort 2 had a recent diagnosis of MDR TB at the time of treatment initiation. Study inclusion criteria required having > 1 M. tuberculosis –positive culture result within 1 month (before or after) of starting second-line drugs for the treatment for MDR TB (baseline isolate) and > 1 month of treatment with second-line drugs.

Standardized forms were used to prospectively collect sociodemographic, clinical, and laboratory data from patients’ medical charts. Chest radiographs were read by experienced chest physicians and radiologists, and results were recorded in a standardized manner. Sputum specimens were collected from each patient at the start of second-line drug treatment (baseline isolate) and then monthly until treatment outcome was known.

The study protocol was approved by ethics committees at the US Centers for Disease Control and Prevention (CDC), Northern State Medical University in Arkhangelsk, and the State Research Center for Applied Microbiology and Biotechnology (SRCAMB) in Obolensk, Russia. All patients provided written informed consent.

Laboratory Methods

Baseline and follow-up sputum specimens were cultured on Lowenstein-Jensen solid media in the Arkhangelsk Regional TB Dispensary Laboratory. Frozen M. tuberculosis isolates were shipped to SRCAMB in Obolensk, Russia, for first- and second-line DST, genotyping, and DNA sequencing. The analysis reported in this article is based on the SRCAMB results. Testing at SRCAMB was conducted months to years after patients were enrolled, and results were not available in real time.

At SRCAMB, each isolate was cultured in 6 mL of Middlebrook 7H9 broth to an optical density of > 1.0 McFarland standard and on Lowenstein-Jensen medium. Susceptibility testing for the baseline and the last follow-up (final) isolates from each patient were determined for isoniazid, rifampin, ethambutol, streptomycin, kanamycin, amikacin, capreomycin, ofloxacin, ethionamide, and para-aminosalicylic acid. Drug susceptibility was determined by the proportion method according to CDC protocol ( 19 ). When drug susceptibility of a patient’s baseline and final isolates differed, isolates were genotyped by mycobacterial interspersed repetitive units–variable number of tandem repeats analysis and by restriction fragment-length polymorphism–IS6110 analysis to determine whether the isolates were the same strain.

Definitions

Definitions of pulmonary TB, MDR TB, and treatment outcomes were based on WHO guidelines ( 20 ). Third-line drugs refer to drugs classified by WHO as group 5 drugs ( 1 ). “Effective treatment” was defined as treatment with a drug or combination of drugs to which baseline DST reported susceptibility. “Ineffective treatment” was considered use of said drug(s) despite reported resistance. Effectiveness of treatment was considered unknown and the patient was not included in the analysis when the patient never received said drugs or baseline DST results were not available. “Acquired resistance” was defined as occurring when baseline DST result showed susceptibility in vitro, the final DST result showed resistance in vitro, and genotypes matched for the initial and final isolates. Acquired resistance was considered absent in each of the following 3 scenarios: 1) baseline and final isolates were susceptible to a drug; 2) DST result changed from susceptible to resistant, but genotyping indicated different strains; or 3) no follow-up positive culture results were available because the patient’s sputum culture results sustainably converted to negative after the baseline DST, the patient died, or the patient was lost to follow-up. In each instance, the denominator for each group refers to the number of isolates with baseline DST results indicating susceptibility to the given drug. Patients whose baseline isolate was resistant to a given drug were excluded from the acquired resistance analysis for that drug. Successful treatment outcome was defined as cure and treatment completion ( 20 ). Poor treatment outcome was defined as treatment failure or death. The second-line companion drugs were para-aminosalicylic acid or ethionamide. Being underweight was defined as having a body mass index <18.5 kg/m 2 .

Data Management and Statistical Analyses

The data from standardized forms were double-entered into an Epi Info (CDC, Atlanta, GA, USA) database in Arkhangelsk and sent to CDC for checking and analysis. Laboratory data were sent directly from the SRCAMB laboratory to CDC.

Statistical analyses were performed by using SAS version 9.3 (SAS Institute Inc., Cary, NC, USA). The main outcome of interest was acquired resistance to specific second-line drugs. The secondary outcome of interest was end-of-treatment outcome. Bivariate associations between the potential risk factors and the outcome variable for each respective analysis were examined by using the Fisher exact test with a significance level of 0.05. Multivariate logistic regression was used to assess associations of acquired resistance and treatment with treatment outcomes while controlling for the potential confounding effects of extent of drug resistance at baseline, disease severity, and previous treatment for MDR TB.

Patient Population

A total of 202 MDR TB patients were enrolled in the study: 81 in cohort 1 and 121 in cohort 2. Median patient age was 42 years, 171 (84.7%) patients were male, and none were HIV infected (HIV test results were available for all patients). Most patients had previously received treatment for TB: 69 (34.7%) had received first-line drugs and 73 (36.7%) had received additional second-line drugs. Almost all patients (189 [93.6%]) had pulmonary cavities, 162 (80.2%) had bilateral lung involvement, 161 (80.9%) had sputum smears with acid-fast bacilli seen with microscopy, and 45 (22.3%) had a body mass index <18.5 kg/m 2 at the start of MDR TB treatment.

A total of 740 M. tuberculosis isolates from 202 patients were shipped to SRCAMB. Of these 202 patients, baseline DST results from SRCAMB were available for 171 (84.7%) and were included in analysis of baseline drug resistance ( Figure ). Of the 171 patients for whom baseline DST results were available, follow-up DST results at SRCAMB were available for 117. Among the other 54 patients (without a final DST result), cultures converted after the initial isolate for 45, follow-up cultures were contaminated or did not grow for 5, and a reason was not documented for 4.

Patient enrollment and reference laboratory drug susceptibility and genotype testing results. DST, drug-susceptibility testing; MDR TB, multidrug-resistant tuberculosis; SRCAMB, State Research Center for Applied Microbiology and Biotechnology.

Baseline Drug Resistance

Among 171 patients for whom baseline isolate DST results were available ( Table 1 ), MDR TB was not confirmed by DST for 4 (2.3%) isolates, and 130 (76.0%) baseline isolates were resistant to 4 first-line drugs tested (rifampin, isoniazid, ethambutol, and streptomycin). In addition, 74 isolates were resistant to > 1 of the 3 second-line injectable agents: 72 (42.1%) to kanamycin, 30 (17.5%) to amikacin, 13 (7.6%) to capreomycin, and 10 (5.8%) to all 3. A total of 10 (5.8%) isolates were resistant to ofloxacin, and 7 (4.1%) were XDR. Of the second-line companion drugs tested, resistance to ethionamide was found for 46 (26.9%) isolates and to para-aminosalicylic acid for 54 (31.6%) isolates.

*AMK, amikacin; CAP, capreomycin; EMB, ethambutol; ETA, ethionamide; FQ, fluoroquinolone; INH, isoniazid; KAN, kanamycin; OFX, ofloxacin; MDR TB, multidrug-resistant tuberculosis; RIF, rifampin; STR, streptomycin; PAS, para-aminosalicylic acid; XDR, extensively drug-resistant tuberculosis. †RIF and INH. ‡RIF, INH, EMB, and STR. §KAN,AMK, and CAP. ¶RIF, INH, a second-line injectable drug, and an FQ.

Acquired Drug Resistance

Among 117 patients for whom final DST results from SRCAMB were available, results for the baseline and final isolates differed for 32 (27.3%) and the isolates were successfully genotyped. Of these, genotype results for isolate pairs matched for 17 (53.1%) patients and were eligible for inclusion in numerators for respective analyses of acquired drug resistance ( Figure ). Of 41 paired isolates with baseline susceptibility to > 1 first-line drug, resistance to a first-line drug was acquired in 3 (7.3%) ( Table 1 ). Of 161 paired isolates with baseline susceptibility to > 1 second-line injectable agents, resistance to > 1 second-line injectable agents was acquired in 7 (4.4%): resistance to kanamycin by 4 (4.0%) of 99, to amikacin by 1 (0.7%) of 141, and to capreomycin by 3 (1.9%) of 158. Resistance to ofloxacin was acquired by 6 (3.7%) of 161, and XDR TB was acquired by 4 (2.4%) of 164 over the course of treatment for MDR TB.

Risk Factors for Acquisition of Drug Resistance

Acquired resistance to capreomycin was significantly associated with receiving the following drugs or drug groups: <3 effective drugs (p = 0.008), an ineffective fluoroquinolone (p = 0.009), or ineffective para-aminosalicylic acid (p = 0.02). Furthermore, acquired resistance to capreomycin was associated with not having received ofloxacin (regardless of baseline DST results) (p = 0.003), baseline resistance to ofloxacin (p = 0.008), and baseline resistance to para-aminosalicylic acid (p = 0.03) ( Table 2 ). In addition, patients whose isolates acquired resistance to capreomycin were more likely to have received moxifloxacin (instead of ofloxacin) in the treatment regimen.

*CAP, capreomycin; DST, drug-susceptibility test; FQ, fluoroquinolone; MDR TB, multidrug-resistant tuberculosis; MOX, moxifloxacin; OFX, ofloxacin; PAS, para-aminosalicylic acid. †Certain variables were tested for association but omitted from table because results were not statistically significant at α = 0.1. ‡Fisher exact test. §Patient(s) who did not receive treatment with the respective drug during the current episode of MDR TB were not included in the analysis. ¶For 23 patients, history of treatment with PAS was unknown.

Acquired resistance to ofloxacin was significantly more common among patients who were underweight (p = 0.02) ( Table 3 ). Patients with acquired ofloxacin resistance were more likely to have received moxifloxacin (p = 0.006), to have had fluoroquinolones switched during treatment (p = 0.05), and to be receiving a third-line drug during the current episode (p = 0.01).

*FQ, fluoroquinolone; OFX, ofloxacin; MDR TB, multidrug-resistant tuberculosis; MOX, moxifloxicin. †Certain variables were tested for association but omitted from table because results were not statistically significant at α = 0.1. ‡Fisher exact test.

Acquired XDR TB was more frequent among those receiving <3 effective drugs than among those receiving > 3 effective drugs (p = 0.03) and among those who were underweight (p = 0.03) ( Table 4 ). Those who acquired XDR TB were more likely to be receiving moxifloxacin during the current episode (p = 0.02). Patients in whom isolates acquired resistance to any second-line companion drug (ethionamide or para-aminosalicylic acid) were less likely to have received ofloxacin (p = 0.003) and more likely to be receiving moxifloxacin (p<0.001) during the current episode ( Table 5 ).

*FQ, fluoroquinolone; OFX, ofloxacin; MDR TB, multidrug-resistant tuberculosis; MOX, moxifloxicin †Certain variables were tested for association but omitted from table because results were not statistically significant at α = 0.1. ‡Fisher exact test. §Patients who did not receive treatment with the respective drug during the current episode of MDR TB were not included in the analysis.

*OFX, ofloxacin; MDR TB, multidrug-resistant tuberculosis; MOX, moxifloxacin. †Certain variables were tested for association but omitted from table because results were not statistically significant at α = 0.1. ‡Fisher exact test.

Treatment Outcomes

Of 171 patients for whom baseline DST results were available, treatment was successfully completed for 94 (55.0%), treatment failed for 18 (10.5%), 20 (11.7%) died, and 39 (22.8%) defaulted from treatment. Poor treatment outcomes (treatment failure or death) were more likely among patients whose MDR TB acquired resistance to capreomycin (100% vs. 25.9%; p = 0.02) or ofloxacin (83.3% vs. 22.7%; p = 0.004) or became XDR TB (100% vs. 24.4%; p = 0.004) than among those in whom the respective resistance was not acquired ( Table 6 ). Patients who received an effective fluoroquinolone were statistically less likely to have poor treatment outcomes than were those who received an ineffective fluoroquinolone (25.6% vs. 85.7%; p = 0.002). Patients who received any third-line drug were more likely to have previously received treatment for MDR TB (21.6% vs. 8.4%; p = 0.02), have resistance to >4 drugs at baseline (72.7% vs. 47.0%; p<0.001), and experience treatment failure or die (42.0% vs. 20.6%; p = 0.01) than those who did not receive any third-line drug. According to multivariable analysis, compared with no acquired resistance, acquired resistance to ofloxacin was associated with 10.2-fold (95% CI 1.1–95.1) increased odds of poor outcome when confounding was controlled for ( Table 6 ). Compared with not receiving a third-line drug, treatment with a third-line drug was associated with 2.7-fold (95% CI 1.2–5.7) increased odds of poor treatment outcome when confounding was controlled for. Compared with not receiving effective fluoroquinolone treatment, effective treatment with a fluoroquinolone was associated with 16.7-fold (95% CI 1.9–100.0) increased the odds of successful treatment outcome when confounding was controlled for.

*aOR, adjusted odds ratio; CAP, capreomycin; FQ, fluoroquinolone; MDR TB, multidrug-resistant tuberculosis; MOX, moxifloxacin; NR, no result; OFX, ofloxacin; XDR, extensively drug-resistant tuberculosis. †Certain variables were tested for association but omitted from table because results were not statistically significant at α = 0.1. ‡Cure or treatment completion. §Death or treatment failure. ¶aOR for poor treatment outcome versus successful treatment outcome controlling for extent of drug resistance at baseline, severity of disease, and previous treatment for MDR TB. #Patient(s) with baseline TB resistance to the respective drug (or drug groups) were not included in the analysis. **Patient(s) who did not receive treatment with the respective drug during the current episode of MDR TB were not included in the analysis ††16.67 (95% CI 1.89–100.0) aOR of successful treatment outcome vs. poor treatment outcome.

This study measured the frequency with which drug resistance was acquired during MDR TB treatment and identified statistically significant associations for acquiring resistance to a specific drug or group of drugs in a population of MDR TB patients being managed in a high-quality TB program. The rates of acquired resistance to the 2 essential groups of drugs for MDR TB treatment were 4.3% for second-line injectable agents and 3.7% for fluoroquinolones, the middle of the range recently reported for GLC-approved programs ( 21 ). In this study, odds of treatment failure or death were 10.2-fold higher among those with acquired resistance to ofloxacin than among those without, further supporting the value of this class of drugs in successful MDR TB treatment. Although this study focused on 1 region of Russia, it reflects the broader global context of increasing use of second-line drugs and rapidly emerging resistance as exemplified by the global phenomenon of XDR TB reported in 2006 ( 22 , 23 ).

We found that the highest proportion of acquired second-line drug resistance was to any second-line injectable agent (4.3%), most frequently kanamycin (4.0%). Given the high baseline level of kanamycin resistance, the cross-resistance between second-line injectable agents, and the rate of acquired resistance to second-line injectable agents illustrated in this study, treating MDR TB with second-line injectable agents is becoming less of an effective option ( 24 ). Furthermore, because of the common baseline resistance to kanamycin, most of the acquired XDR TB was the result of acquired ofloxacin resistance. Historically in Arkhangelsk Oblast, kanamycin was widely used for TB treatment along with 2–3 other drugs, including first- and second-line drugs, whereas fluoroquinolones were rarely used for TB treatment before GLC approval in 2003 ( 12 , 25 ). Acquired resistance to fluoroquinolones during MDR TB treatment was reported for 11.2% of cases in 9 countries, including Russia, possibly because of the high mutation frequency of the gyrA and gyrB genes ( 21 , 26 – 28 ). Of any single second-line drug tested in this study, acquired resistance to ofloxacin occurred second most often. Most patients whose isolates acquired resistance to either of the second-line companion drugs tested also experienced acquired resistance to a second-line injectable agent, ofloxacin, or both (i.e., acquired extensive drug resistance), making TB in these patients virtually untreatable with available drugs ( 28 ).

As seen elsewhere and in this population of MDR TB patients for whom prevalence of baseline resistance to kanamycin, ethionamide, and para-aminosalicylic acid was high, baseline susceptibility to and use of fluoroquinolones were essential for preventing further resistance to second-line injectable agents, preventing acquired XDR TB, and increasing treatment success ( 29 , 30 ). With fewer effective treatment options, the risk for acquired resistance to additional drugs increases ( 28 ). This study illustrates the value of effective use of bactericidal drugs such as fluoroquinolones and companion drugs (especially para-aminosalicylic acid) in preventing acquired resistance to second-line injectable agents during treatment for MDR TB. Other studies reported a significant association between use of thioamides and treatment success but not with para-aminosalicylic acid ( 31 ).

WHO recommends that MDR TB be treated with > 4 second-line drugs to which M. tuberculosis is likely to be susceptible plus pyrazinamide, creating a regimen of > 5 drugs during the intensive phase of treatment ( 1 ). Many factors make creating such a regimen challenging, including availability of timely DST results for second-line drugs and availability of multiple drugs within a class of second-line drugs. In this setting, in which baseline DST results for multiple second-line drugs were available, M. tuberculosis treated with > 3 effective drugs were less likely to acquire resistance to each of the drugs or drug groups tested than were M. tuberculosis treated with <3 effective drugs. However, this association was only statistically significant for acquired resistance to capreomycin and for acquired extensive drug resistance. Treatment with > 4 effective drugs had a similar, but not statistically significant, inverse association with acquired drug resistance.

Acquired resistance to ofloxacin was not associated with any of the effective treatment variables. The treatment and patient management characteristics that were associated with acquired ofloxacin resistance may be an artifact of clinical management practices when treatment regimens fail and probably reflect confounding. The treatment for severe disease or a failing regimen will often be switched to a newer generation fluoroquinolone because these are thought to be more effective and because cross-resistance within the class is not complete ( 32 , 33 ). Therefore, the only significant risk factor for acquired ofloxacin resistance in this population was being underweight, which is a risk factor for incident TB and an indicator of disease severity, regardless of drug susceptibility ( 34 ).

Other studies have found that the main risk factors for acquired drug resistance included empiric re-treatment (i.e., without reference to DST) and unsupervised treatment ( 35 , 36 ). In this study population, drug resistance was acquired among patients with MDR TB even though the patients had received individualized treatment, and directly observed therapy was mandatory for all patients in the program.

The MDR TB treatment outcomes for this population are consistent with previously reported outcomes. Treatment success for this population (55%) was greater than the WHO-reported worldwide average (48%) but less than published results of individualized MDR TB treatment programs ( 31 , 37 ). This study indicates that treatment failure and death are significantly more common among patients who experienced acquired resistance to capreomycin or ofloxacin or who acquired XDR TB than among patients who did not, providing even more evidence that these drugs are essential for successful treatment of MDR TB ( 38 ).

This study had several limitations. First, the relatively small sample size limited statistical power of our analyses. Second, testing of M. tuberculosis for susceptibility to second-line drugs is difficult and not well standardized ( 39 ), which could have caused patient misclassification for both the effective treatment and acquired resistance variables because both sets of variables involve DST results. Third, the effective treatment variables did not consider dosage or length of time the drug was given—all key components of effective treatment. Last, the prevalence of cavitary disease in this population was unusually high, and because cavitation is associated with acquired resistance, the results might not be directly applicable to patient populations with less chronic or destructive disease ( 21 ).

Knowing the drug resistance pattern in the community and risk factors for acquired resistance to second-line drugs can help TB programs initiate effective treatment regimens, prevent additional acquired resistance, and improve treatment outcomes for patients for whom MDR TB is suspected before DST results are available. The likelihood of treatment success can be further improved by adjusting treatment after receipt of DST results for second-line drugs. The need for rapid diagnosis of drug resistance and effective treatment is crucial.

Acknowledgments

We thank the patients, doctors, nurses, and microbiologists in Arkhangelsk Oblast, Russia, for their contributions to this work.

This study was supported by the US Agency for International Development Mission in Russia and the US CDC.

Ms. Smith is a health scientist with the International Research and Programs Branch of the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia. Her research interests include drug-resistant TB diagnosis and treatment in low- and middle-income settings.

Suggested citation for this article : Smith SE, Ershova J, Vlasova N, Nikishova E, Tarasova I, Eliseev P, et al. Risk factors for acquisition of drug resistance during multidrug-resistant tuberculosis treatment, Arkhangelsk Oblast, Russia, 2005–2010. Emerg Infect Dis. 2015 Jun [ date cited ]. http://dx.doi.org/10.3201/eid2106.141907

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• Drug Resistance

Risk Factors for Acquisition of Drug Resistance during Multidrug-Resistant Tuberculosis Treatment, Arkhangelsk Oblast, Russia, 2005–2010

• Emerging Infectious Diseases 21(6)
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