Understanding spatial heterogeneity of drug resistant tuberculosis

了解耐药结核病的空间异质性

• 批准号: 9060890
• 负责人: Helen E. Jenkins
• 金额: $ 12.83万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-06 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9060890
• 关键词: Accounting; Address; Advisory Committees; Africa South of the Sahara; Antibiotics; Appearance; Area; Award; Biology; Biometry; Characteristics; Communicable Diseases; Country; Data; Data Set; Decision Making; Detection; Development; Diagnostic; Diagnostic tests; Disease; Doctor of Philosophy; Drug resistance; Drug resistance in tuberculosis; Drug usage; Eastern Europe; Elements; Enrollment; Ensure; Epidemic; Epidemiology; Extreme drug resistant tuberculosis; Flowers; Funding; Future; Goals; HIV; Health; Heterogeneity; Hospitals; Hot Spot; Incidence; Individual; Infectious Disease Epidemiology; Intervention; Investigation; Isoniazid resistance; Logistic Regressions; Medicine; Mentored Research Scientist Development Award; Mentors; Methodology; Methods; Modeling; Moldova; Multidrug-Resistant Tuberculosis; Mycobacterium tuberculosis; Outcome; Paper; Patients; Pharmaceutical Preparations; Physicians; Population; Population Characteristics; Predisposition; Prevalence; Province; Public Health Schools; Publishing; Reporting; Research; Research Personnel; Resistance; Resources; Rifampin; Risk; Risk Factors; Series; Solid; South Africa; Statistical Computing; Statistical Methods; Surveillance Methods; Survival Analysis; Testing; Time; Training; Treatment Protocols; Tuberculosis; Universities; Variant; Woman; Work; World Health Organization; burden of illness; cost; design; experience; geographic difference; global health; health equity; high risk; laboratory facility; mid-career faculty; professor; programs; resistant strain; restraint; skills; tuberculosis treatment

DESCRIPTION (provided by applicant): This application is for a K01 Award for Dr. Helen Jenkins, a Research Fellow in the Global Health Equity Division at Brigham and Women's Hospital (BWH). Drug resistant strains of Mycobacterium tuberculosis (TB) threaten TB control. The detection and successful treatment of drug resistant TB (DR-TB) are compromised by the costly and time-consuming detection methods that are currently available in most settings. The severe under-estimation of this epidemic is a barrier to effective control. Undiagnosed DR-TB cases have poorer outcomes and may transmit disease for longer. Identifying hotspots of drug resistance is difficult when either access to or usage of drug susceptibility testing is limited, a in most settings. This project aims to develop methods for the spatial analysis of DR-TB data that account for geographic variation in diagnostic testing and allow identification of high DR-TB incidence. Datasets from two of the most concerning regions of the world with regard to DR-TB, Eastern Europe and sub-Saharan Africa, will be used. The specific aims are: (A) Describe and understand heterogeneity and clustering of DR-TB in an area with high levels of diagnostics, (B) Develop methods for estimating DR-TB burden in an area with geographic heterogeneity in diagnostic use, (C) Describe and understand heterogeneity in DR-TB burden accounting for substantial geographic variation in diagnostic testing, (D) Identify risk factors fo the development and acquisition of drug resistance during TB treatment. This work will provide a methodological framework for analyzing similar datasets in these regions. The proposed project can help identify the mechanisms by which DR-TB emerges thus facilitating identification of interventions that ensure more patients receive timely and appropriate treatment and limit spread of resistant forms of disease. Dr. Jenkins' mentors will be Dr. Marcello Pagano, PhD, Professor of Statistical Computing in the Department of Biostatistics, Harvard School of Public Health (HSPH) whose research focuses on surveillance and statistical methods for infectious diseases and Dr. Ted Cohen, MD, MPH, DrPH, Assistant Professor of Epidemiology at HSPH and Associate Professor of Medicine at BWH who conducts research on TB epidemiology and DR-TB surveillance. Dr. Jenkins's advisory committee will include Dr. Marc Lipsitch, DPhil, Professor of Epidemiology at HSPH, Jeff Blossom, MSc, GIS expert at the Center for Geographic Analysis, Harvard University and Dr. Sonya Shin, MD, MPH, Associate Physician at BWH. Dr. Jenkins' training goals are (1) to become an expert in the analysis of spatial data and (2) obtain a solid understanding of the biology of infectious disease and she will take courses to achieve these. The research experience and training that Dr. Jenkins receives will provide her with the skills and preliminary data necessary to apply for R01 funding in the U.S. towards the end of the Award period. In the long-term, Dr. Jenkins aims to become an independent researcher developing and applying bio-statistical spatial methods in infectious disease epidemiology.

描述（由申请人提供）：此申请是为Helen Jenkins博士颁发的K01奖，他是Brigham and Hospital（BWH）全球健康平等部门的研究员。结核分枝杆菌（TB）的耐药菌株威胁性结核病控制。耐药性结核病（DR-TB）的检测和成功治疗被当前在大多数情况下可用的昂贵且耗时的检测方法损害。这种流行病的严重低估是有效控制的障碍。未诊断的DR-TB病例的预后较差，并且可能会延长疾病。当在大多数情况下，识别耐药性热点或使用药物敏感性测试是有限的。该项目的目的是开发用于DR-TB数据空间分析的方法，该数据解释了诊断测试中的地理变化并允许鉴定高DR-TB发病率。来自世界上最重要地区的两个数据集 关于DR-TB，东欧和撒哈拉以南非洲，将使用。具体目的是：（a） Describe and understand heterogeneity and clustering of DR-TB in an area with high levels of diagnostics, (B) Develop methods for estimating DR-TB burden in an area with geographic heterogeneity in diagnostic use, (C) Describe and understand heterogeneity in DR-TB burden accounting for substantial geographic variation in diagnostic testing, (D) Identify risk factors fo the development and acquisition of drug resistance during TB treatment.这项工作将为分析这些区域中的类似数据集提供方法学框架。拟议的项目可以帮助确定DR-TB出现的机制，从而促进鉴定干预措施，以确保更多患者接受及时，适当的治疗，并限制抗性疾病形式的传播。詹金斯博士的导师将是哈佛公共卫生学院（HSPH）生物统计学系统计计算学教授Marcello Pagano博士，其研究重点是 传染病的监视和统计方法和医学博士Ted Cohen博士，MPH，DRPH，HSPH流行病学助理教授以及BWH医学副教授，他们对TB流行病学和DR-TB监测进行了研究。 Jenkins博士的咨询委员会将包括HSPH的Marc Lipsitch博士，DPHIL，DPHIL，DPHIL博士，HSPH的流行病学教授，Jeff Blossom，MSC，GIS地理分析中心的GIS专家，哈佛大学，MD，MPH，MPH，MPH，MPH，BWH的副医师。詹金斯博士的培训目标是（1）成为空间数据分析的专家，并且（2）对传染病的生物学有着深入的了解，她将要开设课程来实现这些疾病。詹金斯（Jenkins）博士接受的研究经验和培训将为她提供在奖励期结束时在美国申请R01资金所需的技能和初步数据。从长远来看，詹金斯博士的目标是成为一名独立的研究人员，在传染病流行病学中开发和应用生物统计的空间方法。