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: 8681578
• 负责人: Karen R Jacobson
• 金额: $ 14.34万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8681578
• 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.

项目概要 本申请旨在为该部门的医学助理 Karen Jacobson（医学博士、公共卫生硕士）申请 K01 奖项 马萨诸塞州总医院传染病科主任，正在接受培训以成为一名独立的医生 耐药结核病（TB）流行病学研究者。结核病仍然是导致 全球死亡率。目前降低结核病发病率的方法是早期发现和治疗。 由于耐药菌株的出现而受到损害。为了提高治疗效果，首先 有必要确定耐药病例在何处发生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生物学方面的创新方法 流行病学识别耐药结核病“热点”，以加深对疾病传播地点的了解 和医疗保健服务失败正在发生。研究的目的是： 1) 估计药物负担 南非西开普省的耐药结核病，并评估疾病负担的异质性 不同的地理位置； 2) 检查宿主危险因素与群体决定因素的关联 耐药结核病负担高的地区； 3) 描述菌株的空间和分子聚类 该省耐药结核病情况。雅各布森博士的指导团队将由两名主要导师组成，一名是 美国和南非分别有一位：梅根·默里 (Megan Murray)，医学博士、科学博士，该大学流行病学副教授 哈佛大学公共卫生学院 (HSPH)，从事分子和社会流行病学研究 结核病和罗宾·沃伦博士，分子生物学和人类遗传学系副教授 斯泰伦博斯大学分子生物学家，研究结核病遗传学和结核病动态 流行病社区。雅各布森博士的三位共同导师是助理教授 Marcia Castro 博士 HSPH 人口学博士，利用空间方法研究传染病动态；特德·科恩, M.D.、Dr.P.H.、HSPH 流行病学助理教授，其研究重点是结核病传播 动力学;托马斯·维克多博士，分子生物学和人类学系副教授 斯泰伦博斯大学遗传学，过去 20 年一直在研究耐药结核病分子生物学 年。雅各布森博士制定了与她的研究目标相关的三个领域的培训计划：空间 统计学、调查和人口普查数据分析以及分子流行病学技术，她将参加课程 并在每个领域接受指导。她在培训期间将接受的培训和指导 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 制定旨在减少该地区和全球耐药结核病负担的干预措施。