Jeffrey Klausner, MD, Awarded Funding from Open Philanthropy Towards Improving Sexual and Reproductive Health in Low-Resource Settings

Over the last 2 years, Jeffrey Klausner, MD, MPH, has received four gifts from Open Philanthropy towards his research on the prevention and control of infectious diseases centering on sexual and reproductive health in low- and middle- income countries. Open Philanthropy is a grantmaking organization which aims to use its resources to help others address gaps in global public health. Klausner, a physician and epidemiologist, has worked in public health for over 25 years with entities such as the Centers for Disease Control and Prevention (CDC) and the San Francisco Department of Public Health. With the ongoing global syphilis crisis, Klausner has dedicated his research towards interventions that have a practical and direct application to communities with the greatest need.

Improving birthing outcomes

Pregnant women with chlamydia, gonorrhea, and trichomoniasis are more likely to have a preterm delivery compared to those without sexually transmitted infections (STIs). Preterm birth is one of the leading causes of mortality in children under five. Klausner’s first gift from Open Philanthropy was devoted towards gaining a better understanding of why these infections lead to poor birthing outcomes. The study, which was published in the Journal of Infectious Diseases, a leading journal in the country, examined the immune system of pregnant women with STIs. This type of research is crucial to advancing knowledge to inform better diagnostic tests to prevent preterm birth delivery. Globally, there are millions of children who die every year, especially in low- and middle-income countries where limited resources lead to a higher risk of mortality. “The death of a baby is a tragedy which affects the mental health of a mother, the family, and often causes disruption in family structure. It leads to women having more pregnancies and lowers economic productivity—there are various downstream effects from pre-term birth that are not only personal, but also social and economic at the country level,” explains Klausner.

Shortages in syphilis treatment

The second gift was dedicated towards the control and prevention of syphilis in low resource settings. The study, based in South Africa, Botswana, and Malawi, aims to understand of the genetics of Treponema pallidum the bacteria that causes syphilis. “As we work to develop a syphilis vaccine, we want to ensure the vaccine is effective all around the world against different variants,” explains Klausner. Historically, research around syphilis vaccines has been centered on the United States and South America. By conducting research in underrepresented regions of the world, Klausner is promoting health equity by ensuring global representation in research. These findings can in turn inform widespread effective prevention efforts guided by evidence-based research.

This study comes at a critical time when the US is experiencing the highest number of cases of congenital syphilis in the last 40 years. “In 2022, over 3,700 babies were born with syphilis, this is a crisis—and the best tool to prevent syphilis would be a vaccine,” stresses Klausner. “The prevalence of syphilis is also high in Southern Africa where one out of 25 pregnant women in some settings have syphilis—this has been a long-standing problem,” he reveals. His research helps to accelerate vaccine development through an increased understanding of the health needs of populations being served.

Expanding treatment options

In November 2023, Klausner received another gift to explore new drugs for syphilis treatment to help address drug shortages fueled by the continued lack of penicillin. Currently, injectable penicillin is the treatment of choice for syphilis, but it has become increasingly hard to come by globally. In the U.S., there is only one penicillin manufacturer. Penicillin is not a profitable drug which has led to dwindling production. Klausner is investigating an alternative treatment. Linezolid is a widely available FDA approved drug which is commonly used to treat staph, urinary tract, and gastrointestinal infections. The drug is inexpensive and available globally but has not been studied for syphilis treatment. Klausner’s study will be the first in the U.S. to study the repurposing of Linezolid for syphilis treatment. The study will investigate treatment in non-pregnant adults first and once deemed safe, will be researched among pregnant women. The benefits of repurposing a drug include faster development which is crucial in this case due to the high and increasing prevalence of syphilis.

Innovative treatment approaches

In April 2023, through a collaboration with researchers from The University of Edinburgh, Klausner received funding for a pilot study to investigate the efficacy of a new polypill to address preterm birth. A polypill is single pill combined with several medications. Polypills have already been developed for heart disease and Klausner is exploring the possibility of applying them towards improving birthing outcomes. Open Philanthropy shared a commitment of $4.6 million upon successful pilot completion.

“This study on polypills aims to create interventions that are easy to implement, affordable, and are effective, especially in low-resource settings,” Klausner indicates. “There have been strong studies showing that low dose aspirin can reduce inflammation, and multivitamins beyond iron and folate can prevent preterm birth.” Klausner’s own previous research has suggested that azithromycin, an antibiotic, can also prevent pre-term birth. Through a randomized controlled trial, he will investigate the efficacy of these drugs and supplements with and without the addition of the antibiotic. The study will include 4,000 pregnant women in Botswana across eight clinics in rural and urban settings and follow them throughout their pregnancy.

Advancing national policy

Klausner’s goal is for his research to inform antenatal guidelines at the national level. Since he is also an advisor to the World Health Organization (WHO), his work also helps to build the evidence base to update global guidelines that countries can adopt to save babies’ lives. In addition to these studies, Klausner also serves as the director of The Infectious Disease Epidemiology and Applied Studies (I.D.E.A.S) Initiative and the Klausner Research Group, housed in the Division of Inequalities of Global Health  within the Department of Population and Public Health Sciences at the Keck School of Medicine of USC. His work here encompasses research and discovery in population health topics including hepatitis C, HIV prevention, sexual, reproductive, maternal, and newborn health, and COVID-19.