CIDI Researchers Spurthi Kodali and Devanshu Gohil, recently presented their work at the RePORT International Annual Conference in Mumbai, India discussing important challenges facing tuberculosis (TB) survivors: long-term lung impairment and the risk of TB recurrence. In this Q&A, Kodali and Gohil discuss their research, key findings, and potential implications for TB care beyond treatment completion.

Could you tell us a little about yourself, your current role, and your research interests?

Spurthi Kodali: I am a physician with a Master of Public Health in Epidemiology and Biostatistics from Johns Hopkins University. I currently work with the Center for Infectious Diseases in India at Johns Hopkins, where I support collaborative TB research across India and the United States.

My research interests focus primarily on tuberculosis, particularly the role of modifiable risk factors in TB treatment outcomes and long-term health. I am especially interested in understanding how factors such as alcohol use influence TB outcomes and pulmonary recovery, and how epidemiologic research can help identify patients who may benefit from additional care.

Devanshu Gohil: I’m a statistician at the Johns Hopkins Center for Infectious Diseases in India in Pune. I’ve been working with Johns Hopkins for almost two and a half years.

My role involves statistical and data-related work, from CRF and EDC development to data analysis and reporting. Currently, I’m working on a few tuberculosis studies, with an interest in applying statistical methods to clinical and public health research.

What led you to investigate your particular research question?

Spurthi Kodali: Much of the existing research on tuberculosis focuses on whether patients successfully complete treatment and achieve microbiologic cure. However, successful TB treatment does not necessarily mean that patients regain normal lung function.

Many TB survivors continue to experience breathing difficulties, reduced exercise capacity, and impaired quality of life even after completing treatment.

At the same time, alcohol use is an established risk factor for TB disease and unfavorable treatment outcomes, including treatment failure, recurrence, and mortality.

This raised an important question for me: If alcohol affects TB disease and treatment outcomes, could it also influence how well the lungs recover after treatment?

That question became the motivation for our study.

Devanshu Gohil: TB recurrence is an important part of the TB burden in India. Since closely screening every TB survivor can be resource-intensive, we wanted to explore whether we could identify people who may be at higher risk and prioritize them for closer follow-up.

A prediction model had already been developed through the TB Aftermath study, so our aim was to see whether that model could also work in a larger and more diverse population.

For a general audience, can you explain the focus of your research and the health challenges you are investigating?

Spurthi Kodali: Post-tuberculosis lung disease, or PTLD, refers to persistent abnormalities in lung structure or function following pulmonary TB.

Even after the bacteria have been successfully treated, patients may experience airflow obstruction, reduced lung volumes, persistent respiratory symptoms, or difficulty performing everyday activities.

Alcohol may influence pulmonary health through several biological pathways. Chronic alcohol exposure can impair immune responses, increase oxidative stress, and interfere with the body's ability to repair damaged lung tissue.

However, while these mechanisms are biologically plausible, we still have limited evidence directly linking alcohol exposure to post-TB pulmonary recovery.

Our study was designed to investigate that relationship.

Devanshu Gohil: A prediction model uses information about a person to estimate their risk of developing TB again after completing treatment.

External validation simply means testing a model in a different population from the one in which it was originally developed to see whether it still works.

Why is it important to identify patients who may be at greater risk of health complications after completing TB treatment?

Spurthi Kodali: TB care has traditionally focused on achieving microbiologic cure. While that remains essential, we are increasingly recognizing that surviving TB and recovering fully from TB are not necessarily the same thing.

Persistent lung impairment can affect a person's ability to work, exercise, and carry out everyday activities, with consequences for long-term quality of life.

Identifying patients at higher risk could help TB programs prioritize post-treatment lung-function assessments, respiratory follow-up, and supportive interventions.

Alcohol use is particularly interesting because it is a potentially modifiable exposure. Understanding its association with long-term lung health could eventually help inform more comprehensive approaches to TB care.

Devanshu Gohil: Not everyone who completes TB treatment has the same risk of recurrence. If we can identify people who may be at higher risk, we could potentially focus closer follow-up on them.

This could help with earlier detection while making better use of the resources available in TB programs.

What data and patient populations did you use to investigate your research question?

Spurthi Kodali: We used data from the RePORT India Phase II Aim 3 Lung Health cohort, a multicenter study involving adults with drug-sensitive, culture-positive pulmonary tuberculosis in India.

At enrollment, alcohol exposure was assessed using the Alcohol Use Disorders Identification Test–Consumption, or AUDIT-C, a brief questionnaire that measures alcohol consumption.

We evaluated alcohol exposure in three ways: high-risk versus low-risk alcohol use, any alcohol use versus none, and as a continuous score to examine whether increasing alcohol exposure was associated with progressively worse outcomes.

We assessed lung health at baseline, at the end of TB treatment around Month 6, and again approximately six months after treatment completion at Month 12.

Our primary focus was ventilatory impairment measured using spirometry. We also evaluated respiratory health-related quality of life using the St. George's Respiratory Questionnaire and functional exercise capacity using the six-minute walk test.

Devanshu Gohil: We used data from the RePORT India cohort, involving TB survivors from multiple sites across Maharashtra and Tamil Nadu.

We wanted to see whether the prediction model developed in the TB Aftermath study continued to perform when applied to this larger and more diverse population.

What were the most important findings from your study? Were any results surprising?

Spurthi Kodali: One of the most interesting findings was that we did not observe a clear association between alcohol exposure and ventilatory impairment at TB diagnosis.

However, by the end of treatment, greater baseline alcohol exposure was associated with a higher likelihood of an obstructive or mixed ventilatory pattern.

This association remained even after accounting for the participants' baseline lung-function classification.

We also observed a graded relationship: each additional point on the AUDIT-C scale was associated with a higher relative risk of obstructive or mixed ventilatory impairment at Month 6.

At Month 12, higher alcohol exposure was associated with a lower FEV₁/FVC ratio, a measure used to identify airflow obstruction.

Another important finding was that participants with high-risk alcohol use reported worse respiratory health status at the end of treatment.

What surprised me most was that the association appeared to be specific to airflow obstruction, rather than a generalized reduction in all measures of lung function.

Devanshu Gohil: Overall, the model showed moderate performance in the RePORT India population.

The important finding was that the model continued to show a useful signal even when applied outside the population where it was originally developed.

BMI also appeared to be an important part of the prediction models.

How could your findings potentially influence future TB care or public health programs?

Spurthi Kodali: Our findings suggest that alcohol screening at TB diagnosis may have value beyond identifying patients at risk for unfavorable treatment outcomes.

It may also help identify individuals who could be at greater risk for persistent pulmonary impairment after completing treatment.

In the future, incorporating alcohol screening into a broader assessment of post-TB lung-health risk could help guide follow-up care.

For example, patients identified as higher risk might benefit from closer respiratory monitoring, lung-function testing, or evaluation for pulmonary rehabilitation.

However, our findings are observational, and additional research is needed before alcohol screening can be used specifically to guide PTLD care.

Ultimately, the broader goal is to move toward a model of TB care that focuses not only on treating the infection but also on preserving long-term respiratory health.

Devanshu Gohil: The idea would be to use it as a tool to help prioritize follow-up, rather than as a diagnostic tool.

People identified as being at higher risk could potentially receive closer monitoring, which may help detect recurrence earlier and make better use of available resources.

What are the next steps for your research?

Spurthi Kodali: An important next step is to validate these findings in larger and more diverse TB populations.

Our current study has some limitations, including self-reported alcohol exposure, smaller sample sizes during follow-up, and limited representation of women with high-risk alcohol use.

Future research should also examine changes in alcohol consumption during treatment and explore the biological mechanisms linking alcohol exposure to persistent airway impairment.

It would be valuable to understand whether reducing alcohol consumption during TB treatment is associated with improved long-term pulmonary outcomes.

Ultimately, we hope this research will contribute to identifying modifiable risk factors for PTLD and inform interventions that improve long-term health among TB survivors.

Devanshu Gohil: The next steps are to test the model in more populations and different settings and explore ways to improve its performance.

We also need to understand how practical it would be to use a simple prediction tool in routine TB programs.

Looking Beyond TB Treatment

Spurthi Kodali: I hope people recognize that successful TB treatment is not necessarily the end of the patient's health journey.

Many individuals continue to live with respiratory impairment long after the infection has been treated.

Our research highlights the importance of looking beyond microbiologic cure and understanding the factors that may influence long-term pulmonary health.

By identifying potentially modifiable risk factors such as alcohol use, we hope to contribute to more comprehensive, patient-centered TB care that focuses not only on survival but also on recovery and quality of life.