Geospatial clustering and molecular and social epidemiology of drug resistant TB

耐药结核病的地理空间聚类以及分子和社会流行病学

• 批准号: 8334634
• 负责人: Karen R Jacobson
• 金额: $ 5.41万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-17 至 2013-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8334634
• 关键词: African; Alcohol consumption; Applications Grants; Area; Censuses; China; Clinic; Clinical; Communicable Diseases; Communities; Crowding; Data; Data Analyses; Data Set; Databases; Demography; Development; Diagnosis; Directly Observed Therapy; Disease; Doctor of Medicine; Doctor of Philosophy; Doctor of Public Health; Drug Resistant Tuberculosis; Drug resistance; Drug resistance in tuberculosis; Early Diagnosis; Early treatment; Education; Epidemic; Epidemiology; Extreme drug resistant tuberculosis; Failure; General Hospitals; Geographic Locations; Goals; Grant; HIV; Health; Health Policy; Health Surveys; Healthcare Systems; Hereditary Disease; Heterogeneity; Hot Spot; Human Genetics; Incidence; India; Individual; Institution; Intervention; Intervention Studies; Laboratories; Lead; Link; Malnutrition; Maps; Massachusetts; Master of Public Health; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Mission; Molecular; Molecular Biology; Molecular Epidemiology; Molecular Profiling; Multi-Drug Resistance; Multidrug-Resistant Tuberculosis; Municipalities; Personal Communication; Pharmaceutical Preparations; Population; Poverty; Poverty Areas; Predisposition; Province; Public Health Schools; Relative (related person); Reporting; Research; Research Personnel; Resistance; Resources; Restriction fragment length polymorphism; Risk Factors; Robin bird; Rural; Rural Community; Sampling; Services; Smoking; South Africa; Sputum; Surveys; Techniques; Testing; Training; Translating; Treatment outcome; Tuberculosis; Universities; Weight; Work; base; burden of illness; care delivery; community burden; design; diabetes mellitus genetics; disease transmission; health care delivery; improved; innovation; international center; low socioeconomic status; migration; mortality; multilevel analysis; professor; public health relevance; resistant strain; skills; social; statistics; transmission process; tuberculosis drugs

PROJECT SUMMARY This application is for a K01 award for Karen Jacobson, M.D., M.P.H., an Assistant in Medicine in the Division of Infectious Diseases at the Massachusetts General Hospital, who is training to become an independent investigator in the epidemiology of drug resistant tuberculosis (TB). TB continues to be a major cause of mortality globally. The current approach to decreasing TB incidence, early detection and treatment, is being compromised by the emergence of drug resistant strains. In order to improve treatment outcomes, it is first necessary to identify where drug resistant cases occur disproportionately and what factors characterize these spatial clusters. The proposed study will use innovative methods in spatial statistics and molecular epidemiology to identify drug resistant TB "hotspots" to advance understanding of where disease transmission and heath care delivery failure are occurring. The aims of the study are: 1) To estimate the burden of drug resistant TB in the Western Cape Province, South Africa, and assess the heterogeneity of disease burden in different geographic locations; 2) To examine the association of host risk factors and population determinants with regions of high drug resistant TB burden; and 3) To describe the spatial and molecular clustering of strains of drug resistant TB in this province. Dr. Jacobson's mentoring team will consist of two primary mentors, one in the U.S. and one in South Africa: Megan Murray, M.D., Sc.D., Associate Professor of Epidemiology at the Harvard School of Public Health (HSPH), who conducts research on the molecular and social epidemiology of TB, and Robin Warren, Ph.D., Associate Professor in the Division of Molecular Biology and Human Genetics at Stellenbosch University, a molecular biologist who has studied TB genetics and disease dynamics in TB epidemic communities. Dr. Jacobson's three co-mentors will be Marcia Castro, Ph.D., an Assistant Professor of Demography at HSPH, who has used spatial methods to study infectious disease dynamics; Ted Cohen, M.D., Dr.P.H., an Assistant Professor of Epidemiology at HSPH whose research focuses on TB transmission dynamics; and Thomas Victor, Ph.D., an Associate Professor in the Division of Molecular Biology and Human Genetics at Stellenbosch University, who has studied the drug resistant TB molecular biology for the past 20 years. Dr. Jacobson has developed a training plan in three areas that link to her research aims: spatial statistics, survey and census data analysis, and molecular epidemiologic techniques, and she will take courses and receive mentoring in each of these areas. The training and mentoring she will receive during the implementation of this project will provide Dr. Jacobson with the necessary skills and preliminary data to prepare an R01 grant application to study the modifiable factors identified in the proposed study, with the goal of developing interventions aimed at decreasing drug resistant TB burden in the region and globally.

项目总结 本申请书旨在为Karen Jacobson，M.D.，M.P.H.颁发K01奖项，她是该部门的医学助理 马萨诸塞州总医院的传染病科医生，他正在接受培训，准备成为一名独立的 耐药结核病(TB)流行病学研究员。结核病仍然是导致 全球范围内的死亡率。目前减少结核病发病率、及早发现和治疗的方法是 由于耐药菌株的出现而受到影响。为了改善治疗结果，它是第一 有必要确定耐药病例在哪里发生得不成比例，以及这些病例的特征是什么 空间集群。拟议的研究将使用空间统计和分子方面的创新方法 流行病学找出耐药结核病“热点”以提高对疾病在哪里传播的了解 医疗保健提供失败的情况正在发生。研究的目的是：1)估计药物的负担 南非西开普省的耐药结核病，并评估#年疾病负担的异质性 不同地理位置；2)检查宿主风险因素和人口决定因素之间的关系 具有高耐药结核病负担的区域；以及3)描述菌株的空间和分子聚集 该省耐药结核病的发病率最高。雅各布森博士的指导团队将由两名主要导师组成，一名 在美国和南非分别是：Megan Murray，医学博士，SC.D.，美国大学流行病学副教授 哈佛大学公共卫生学院(HSPH)，他从事猪流感的分子和社会流行病学研究 Tb和Robin Warren博士，分子生物学和人类遗传学系副教授 StellenBosch大学，研究结核病遗传学和结核病疾病动力学的分子生物学家 流行病社区。雅各布森博士的三位共同导师将是Marcia Castro博士，助理教授 他使用空间方法研究传染病动力学；泰德·科恩， 医学博士，P.H.博士，HSPH流行病学助理教授，主要研究结核病传播 以及托马斯·维克托博士，分子生物学和人类学部副教授 在过去的20年里，他一直在研究耐药结核病的分子生物学 好几年了。雅各布森博士在三个领域制定了与她的研究目标相联系的培训计划：空间 统计学，调查和普查数据分析，以及分子流行病学技术，她将参加课程 并在这些领域中的每一个领域接受指导。她将在培训期间接受的培训和指导 该项目的实施将为雅各布森博士提供必要的技能和初步数据 准备R01拨款申请，以研究拟议研究中确定的可修改因素，目标是 制定旨在减少该区域和全球耐药结核病负担的干预措施。