Impact of Spatial Location and Movement Patterns on Tuberculosis Transmission in Urban Uganda

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PROJECT SUMMARY Tuberculosis (TB) is the leading cause of mortality by a single pathogen worldwide. Despite developments in TB diagnostics and treatment, TB incidence declines 2% annually, well below the rate needed to achieve the World Health Organization's End TB Goals. A better understanding of populations at risk for acquiring and transmitting TB is critical to targeting interventions for greatest impact. Location and movement patterns may play a key role in TB transmission; where people live as well as their travel habits influence their patterns of contact with others. Research to date has not integrated advanced spatial methods and measurement of geographic mobility to develop a comprehensive understanding of the relationship between spatial and mobility patterns and TB transmission. This proposal is nested within an existing study entitled, “A Comprehensive Snapshot of Tuberculosis Transmission in an Urban Ugandan Community” (STOMP-TB; R01HL138728, PI: Dowdy) being conducted in Kampala, Uganda. The STOMP-TB study enrolls adults (age≥15) diagnosed with TB at 4 health facilities and conducts active case finding in two waves in which all adults within the study area are eligible for TB testing. Specimens from all participants with positive cultures for M. tuberculosis are submitted for whole genome sequencing (WGS), providing data on transmission networks. This proposal consists of two Specific Aims, each with three sub-aims, and each with an associated Training Aim. In Aim 1 (spatial analysis of TB risk), I will quantify the association of residential location with TB transmission as a function of Euclidean distance, estimate the association between administrative zone of residence and TB transmission, and evaluate the potential impact of TB contact investigation based on a defined radius from an index case. My associated Training Aim 1 is to learn and apply advanced methods for spatial analysis and includes participation in short-course training on spatial analysis, participation in a spatial analysis workgroup, and practice in application of R code for spatial analysis with one of my mentors. In Aim 2 (assessment of geographic mobility and TB risk), I will conduct a systematic review to summarize existing methods of measuring mobility, estimate the association between mobility and TB transmission, and assess the role of biological sex as a modifier of the effect of mobility on TB disease. My associated Training Aim 2 is to learn to apply a social determinants of health framework to risk factors for TB, including mobility, through coursework on social epidemiology and causal inference and discussion of specified readings on this topic with one of mentors. My Training Aim 3 is to improve my scientific skills; the main activity is participating in grant development seminars and developing a K01 or equivalent application by the end of this fellowship. The successful completion of these aims will facilitate my progress toward becoming an independent researcher with unique expertise in the application of spatial epidemiology and geographic mobility measurement to improve our understanding of TB transmission in high-burden settings.