Meet our graduate researchers - Dr Rendi Moke
Research title: Prospective study of treatment outcomes on the shorter treatment regimen among drug resistant tuberculosis with various mutations.
Started PhD studies in 2023
Please tell us about your PhD research
Papua New Guinea (PNG) has a high burden of tuberculosis (TB) and drug-resistant TB (DRTB) within the Western Pacific Region (WHO, 2022). There is heterogeneous prevalence of DRTB with the highest numbers seen in Daru of Western Province, followed by National Capital District, and lesser in other provinces in PNG (Aia, 2016).
There is limited access to culture and drug susceptibility testing facilities in the country. It is costly to perform DST outside of the country, as well as maintaining the only PC3 Lab at the Central Public Health Laboratory (CPHL) of the National Department of Health, within Port Moresby General Hospital (PMGH).
Whole genome sequencing (WGS) studies have been done previously in PNG using sequencing methods other than nanopore sequencing (Illumina Technology) (Bainomugisa, 2019, 2022). Since 2013 novel drugs like bedaquiline have been introduced under compassionate use, and were fully adapted into treatment protocols by 2018 to be used country-wide. There is now evidence of resistance to these novel drugs, with primary transmission.
The aim of this research is to determine the extent of resistance to these novel and re-purposed anti-TB drugs using nanopore sequencing, and its transmission dynamics within the country. Secondarily, to establish nanopore sequencing as the rapid WGS diagnostic tool in the country. Furthermore, monitoring of the resistance acquisition during the shorter treatment regimen (BPaL/M) is necessary, as the country prepares to adapt the new WHO-recommended shorter treatment regimen (BPaL, Bedaquiline, Pretomanid, Linezolid).
What and where did you study/work/undertake placement/training before your PhD?
I did most of my medical training at the School of Medicine & Health Sciences, University of Papua New Guinea where I completed Bachelors of Medicine, Bachelors of Surgery and Masters in Medicine - Internal Medicine. From 2004 after my Bachelors, I worked as a Medical Officer (since 2004) in PNG, and following the completion of my Masters in 2011 I worked as a Physician. I'm now the Clinical Coordinator of the Internal Medicine Department of Port Moresby General Hospital, where I'm resonsible for the clinical care and management of TB patients (as well as other medical patients). During the COVID-19 pandemic, I was the Chairman of the COVID-19 Committee at Port Moresby General Hospital and I am also a member of the Technical Advisory Group (TAG) of the National TB Program, National Department of Health, PNG.
What made you decide to first undertake a PhD and choose the Doherty Institute?
My interest has been in tuberculosis - clinical as well as other aspects of TB program since 2004, given the fact that TB was and is rife in PNG. My aim has been to improve TB diagnosis and treatment in PNG; that is to contribute in developing rapid, affordable and accessible diagnostic tools as well as improving treatment modalities and measures that could help reduce the burden of TB, such as vaccine development or preventative therapies. The purpose of undertaking PhD was to fulfill my dream of improving TB services, through research into tools that can enable our aim of TB control.
I believe obtaining my PhD will help me build my skills in research and in turn, help my hospital and the country in tuberculosis control through research, public health and clinical interventions, as well as improving diagnostic capacity. Potentially developing a Tuberculosis Research Institute or an Infectious Disease Centre (IDC) within the next 10-years in Port Moresby, PNG.
The Doherty Institute was preferred over other institutes because of the research network we already had with Professor Lachlan Coin through existing TB research, and through late Professor Evelyn Lavu from CPHL. I was also accepted by the University of Melbourne to undertake PhD studies and was given a fee-offset scholarship.
How do you combine your PhD research with your role as an clinician/how do you see your research complementing your clinical work?
As mentioned earlier, I came with the aim of building an Infectious Disease Centre (IDC) after my PhD. I have proposed a building plan already to accommodate research, teaching, clinical wards to accommodate TB/HIV/COVID-19/ Malaria, etc and public health. This is because of the high TB burden in my country, which is the leading cause of morbidity and mortality in my hospital (one third of all medical admissions, n 3,200). I believe this will require collaboration from a reputable organisation, and I would preferably choose the Doherty Institute to collaborate with.
When do you hope to complete and what are your plans post-PhD?
I hope to complete my PhD by the end of 2025, and get to work on my aims following this.
What advice do you have for a clinician who is considering a PhD?
I just started my PhD and this is my second month working on my project proposal. I believe as a clinician, we need a set of research skills that will help guide our practice, in developing and providing evidence-based practice in providing care for our patients which is expected to improve patient outcomes.
I believe getting research skills to go with our clinical duties will make a big difference.