EMERGING MDR TUBERCULOSIS ACROSS THE US/MEXICO BORDER

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DESCRIPTION: (provided by applicant) Our application will create dynamic databases to analyze and generate preliminary data on the precise patterns of transmission of tuberculosis (TB), especially multidrug resistant tuberculosis (MDR-TB), across South Texas and North Eastern Mexico. This will be achieved through a binational consortium that will share social, demographic, and geographic data on tuberculosis cases from each of their respective areas. The aims of the consortium are 1) aggregate existing sociodemographic, drug resistance and molecular fingerprinting databases currently held separately by consortium members 2) merge, geocode and analyze the aggregated database 3) establish common protocols and procedures for testing of drug resistance, extraction of M. tuberculosis DNA, and molecular characterization of isolates 4) evaluate social network analysis as a method for improving the tracking of MDR-TB transmission. These analyses link individual cases over 3-5 years with molecular fingerprints, drug susceptibility patterns, sociodemographic characteristics and geographic location, allowing regional understanding of the distribution and dynamics of DR and MDR-TB transmission across the border. These data will be used to improve control techniques and become the basis of hypotheses that will be tested in future, more elaborate research applications. These applications will include epidemiologic and translational research studies using common protocols for binational projects in emerging diseases, specifically MDR-TB. The geographic area of the consortium encompasses 5 counties of the Lower Rio Grande Valley (LRGV) from the Gulf of Mexico to Laredo, and the Mexican border states of Tamaulipas and Nuevo Leon. The consortium will be led by the Dean and faculty of the University of Texas School of Public Health Regional Campus at Brownsville, less than a mile from the border and contributing expertise in molecular microbiology, epidemiology, biostatistics, social network studies and spatial-temporal analyses. Leading tuberculosis researchers in Houston, San Antonio and Monterrey will play key roles in strengthening the capacity to conduct specialized public health, epidemiologic, and molecular based research on MDR-TB in the study area. Border consortium participants are from all the public health investigatorities responsible for TB elimination in both countries. An important defense of MDR introduction by bioterrorism is understanding how transmission of these organisms may differ from non resistant TB (if at all) and detailed knowledge of local strains of MDR that will allow quick distinction between known circulating strains of MDR TB and newly introduced strains. This application will be instrumental in addressing all of these issues.