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传染病莱昂纳多·马丁内斯博士 流行病学家，在制定一项专注于增加结核病病例的独立研究计划时 在高危人群中进行检测。在活动性结核病病例发现研究中，大多数人无法 提供痰。在我们之前在巴西监狱的工作中，在被监禁的人中进行结核病的大规模筛查 个人发现疾病负担处于高度流行水平，每10万名囚犯中有3900例。我们假设 这些监狱中的结核病负担比我们目前的估计更大，因为大多数囚犯 不能产生痰，因此没有通过诸如GeneXpert，培养， 和涂片检测。在这一背景下，迫切需要重新评估结核病负担以及 评估非痰诊断工具的可行性和价值，以增加病例发现和 减少持续传播。马丁内斯博士建议：(1)衡量未确诊结核病的患病率，并 无法在监狱提供痰样本的巴西囚犯中的结核病特征 基线筛查访问；(2)确定面罩气溶胶采样系统(MASS)的可行性和灵敏度， 一种在大规模筛查过程中直接捕获患者呼出的结核分枝杆菌的新工具 干预；以及(3)确定监狱结核病筛查的成本效益算法。拟议中的项目 将利用NIH资助的主要导师进行的R01研究(AI130058-01，PI，Andrews/Croda)，这是 目前正在进行中，在巴西南马托格罗索州的几所监狱招收成年人。这项研究计划形成 在杰森·安德鲁斯博士的指导下，马丁内斯博士的五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)、Yvonne Maldonado(儿童传染病)和Upinder Singh(传染病) 顾问Robert Horsburgh(临床流行病学)、Michael Beller(结核病诊断)和Jeremy Goldhaber-Fiebert(成本效益分析)。这个跨学科的小组已经发展了一段职业生涯 马丁内斯博士的发展计划，包括：(1)培养设计实地研究和 数据收集；(2)统计方法在新诊断学研究中的应用；(3)有效利用和 具有与决策树算法创建、成本- 有效性分析和数学建模；(4)与导师和顾问的定期会议；(5) 在科学会议和研讨会上发表成果；(6)在同行评议的期刊上发表文章；(7)写作 并提交R01拨款。完成这一职业发展计划将使马丁内斯博士成功地 竞争未来的外部资金，继续研究非痰结核病诊断 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.