Cost-effective Screening in International Adoptees

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DESCRIPTION (provided by applicant): The candidate is a junior academic clinician, trained in pediatrics and epidemiology, whose long-term career goals are to conduct patient oriented research that will improve health care delivery to vulnerable children in the US and in the developing world. The proposed training program was designed to enable the candidate to transition from novice to independent researcher in epidemiology with expertise in international child heath. The specific objectives are to obtain maundered practical experience in patient oriented research and rigorous methodological training in decision analytic methods with an experienced team of mentors and national experts. The training plan describes activities (advanced degree coursework, independent study and patient oriented research) focused on further developing skills in epidemiology with immediate applications to cost- effective screening in internationally adopted (IA) children. Two complementary studies are proposed that address the clinical and cost- effectiveness of hepatitis B virus (HBV) and tuberculosis (TB) screening in IA children. These studies are based on the hypothesis that focused, rational screening can provide a cost-effective means for improving the long-term health outcomes of immigrant children and is consonant with public health imperatives. Each study involves primary collection of new data that address important gaps regarding the prevalence and risk factors for infectious diseases in IA children, and the utility of markers (skin tests and immunization history) to predict infection, disease or protective immunity. This will provide new information regarding the infectious disease burden, and its expression, in the growing group of IA children in the US. These new data also will provide estimates necessary for cost-effectiveness analyses that will be developed to assess the utility of alternative approaches for immunization and TB screening. The proposal addresses important knowledge gaps about the health of children immigrating to the US from resource-poor environments and may provide important new data for rational and cost- effective screening in IA children. The cohort of children developed in this proposal may be followed in future research designed to answer challenging questions with respect to the long-term impact of early screening and preventive TB therapy. Finally, the proposal will provide a key training opportunity to foster the candidate s career development as an epidemiologist with a commitment to patient oriented research.