Identifying effective and efficient approaches to tuberculosis screening in Brazilianprisons

抽象的。 这个职业发展计划的目标是支持列奥纳多马丁内斯博士，传染病 流行病学家，在制定一项独立的研究计划，重点是增加结核病病例 检测高危人群。在活动性结核病病例发现研究中，大多数人无法 提供痰液。在我们以前在巴西监狱的工作中， 个人发现，疾病负担处于高发水平，每100 000名囚犯中有3 900例。我们假设 这些监狱的结核病负担比我们目前的估计要大，因为大多数囚犯 无法产生痰液，因此未通过诊断工具（如GeneXpert、培养）进行评价， 和涂片测试。在这种情况下，迫切需要重新评估结核病负担， 评估非痰液诊断工具的可行性和价值，以提高病例发现率， 减少正在进行的传播。Martinez博士建议：（1）测量未确诊结核病的患病率， 无法提供痰液样本的巴西囚犯的结核病特征 基线筛查访视;（2）确定面罩气溶胶采样系统（MASS）的可行性和灵敏度， 一种新的工具，在大规模筛查期间， 干预;（3）确定监狱结核病筛查的成本效益算法。拟建项目 将利用NIH资助的R 01研究（AI 130058 -01，PI，Andrews/Croda），由主要导师进行， 该方案正在进行，并在巴西南马托格罗索的几所监狱招收成年人。本研究计划形成 在Jason Andrews博士的指导下，Martinez博士5年职业发展计划的基础 （传染病，流行病学），Julie Parsonnet（成人传染病），Julio Croda（传染病， 卫生政策），伊冯马尔多纳多（儿科传染病），和Upinder辛格（传染病）， 顾问Robert Horsburgh（临床流行病学）、Michael Barer（结核病诊断）和Jeremy Goldhaber-Fiebert（成本效益分析）。这个跨学科的团体已经发展出了一种职业 马丁内斯博士的发展计划，包括：（1）培养设计基于实地研究的技能， 数据收集;（2）应用统计方法研究新的诊断;（3）有效使用和 有经验的新的先进的统计方法有关的决策树算法的创建，成本， 有效性分析和数学建模;（4）定期与导师和顾问举行会议;（5） 在科学会议和研讨会上介绍结果;（6）在同行评审的期刊上发表;以及（7）写作 并提交R 01补助金。完成这一职业发展计划将使马丁内斯博士成功地 在未来争取校外资助，继续研究非痰基结核病诊断 在高危人群中。

Abstract. The goal of this career development plan is to support Dr. Leonardo Martinez, an infectious disease epidemiologist, in developing an independent research program focused on increasing tuberculosis case detection in high-risk groups. In active tuberculosis case finding studies, the majority of individuals are unable to provide sputum. In our previous work in Brazilian prisons, mass screening for tuberculosis among incarcerated individuals found a hyperendemic level of disease burden, 3,900 cases per 100,000 prisoners. We hypothesize that the tuberculosis burden in these prisons is greater than our current estimates, as a majority of prisoners were unable to produce sputum and therefore were not evaluated by diagnostic tools such as GeneXpert, culture, and smear testing. A re-assessment of the tuberculosis burden is urgently needed in this setting as well as an assessment of the feasibility and value of non-sputum-based diagnostic tools to increase case detection and reduce ongoing transmission. Dr. Martinez proposes to: (1) measure the prevalence of undiagnosed TB and characteristics of tuberculosis among Brazilian prisoners who are unable to provide sputum samples at the baseline screening visit; (2) determine the feasibility and sensitivity of Mask Aerosol Sampling system (MASS), a novel tool that directly captures exhaled Mycobacterium tuberculosis from patients, during a mass screening intervention; and (3) identify cost-effective algorithms for tuberculosis screening in prisons. The proposed project will leverage an NIH-funded R01 study (AI130058-01, PI, Andrews/Croda) by the primary mentors, which is ongoing and enrolls adults in several prisons located in Mato Grosso do Sul, Brazil. This research plan forms the basis of a 5-year career development plan for Dr. Martinez under the mentorship of Drs. Jason Andrews (infectious diseases, epidemiology), Julie Parsonnet (adult infectious diseases), Julio Croda (infectious diseases, health policy), Yvonne Maldonado (pediatric infectious diseases), and Upinder Singh (infectious diseases) with consultants Robert Horsburgh (clinical epidemiology), Michael Barer (tuberculosis diagnostics), and Jeremy Goldhaber-Fiebert (cost-effectiveness analyses). This interdisciplinary group has developed a career development program for Dr. Martinez that includes: (1) fostering skills in designing field-based research and data collection; (2) application of statistical methods for the study of novel diagnostics; (3) effective usage of and experience with new advanced statistical methodologies related to decision-tree algorithmic creation, cost- effectiveness analysis, and mathematical modeling; (4) regular meetings with mentors and consultants; (5) presenting results at scientific meetings and seminars; (6) publishing in peer-reviewed journals; and (7) writing and submitting an R01 grant. Completion of this career development plan will allow Dr. Martinez to successfully compete for extramural funding in the future to continue researching non-sputum-based tuberculosis diagnostics in high-risk populations.