HIV and Tuberculosis Transmission and Future Trends in the African Population in

描述(申请人提供)：撒哈拉以南非洲约占世界人口的10%，但在全世界每年估计新感染艾滋病毒的270万人中约占70%，在估计的880万新结核病(TB)病例中约占35%。非洲艾滋病毒和结核病的负担反映在与当地移民相比，移民到其他国家的非洲人感染这两种疾病的比率更高。这个职业发展奖的目标是获得结核病流行病学和控制方面的专业知识，以及研究方法方面的专业知识，这将扩大我在美国解决非洲人口中艾滋病毒、结核病和其他健康问题的能力。我的长期职业目标是通过研究和公共卫生实践改善这一人群的整体健康。这项拟议的研究解决了对为非洲出生人口制定有效的艾滋病毒和结核病预防和控制计划至关重要的问题。该提案的具体目的是：1)估计在非洲出生的人中艾滋病毒和结核病在抵达美国之前传播的程度，确定在非洲出生的美国居民中艾滋病毒检测的障碍和错过艾滋病毒诊断的机会，并确定在非洲出生的社区内外持续传播艾滋病毒和结核病的潜在风险；2)评估错过的结核病筛查和诊断机会，描述与非非洲人相比，非洲人在诊断活动性结核病方面的延误，并估计非非洲人口中非洲出生的患者中典型的结核病基因型的流行率；3)使用人口统计学和动态流行病模型相结合的方法，对未来20年美国非洲出生的艾滋病毒和结核病流行的规模和构成进行预测。该申请的职业发展部分旨在增强我在艾滋病毒和性传播疾病流行病学研究领域的现有技能。拟议的教育目标将使我能够在实现我的研究目标所需的四个特定领域培养技能，并包括以下培训：1)结核病流行病学和控制，2)人口学和数学建模，3)移民和卫生。华盛顿大学(UW)无与伦比的培训环境，华盛顿大学与西雅图和金县公共卫生部门艾滋病毒/STD和结核病项目之间密切而协作的关系，以及出色的导师和顾问团队将监督我的培训和研究，这将进一步有助于我的职业发展，并转变为一名成功的独立调查员。

DESCRIPTION (provided by applicant): Sub-Saharan Africa accounts for approximately 10% of the world's population, but is home to approximately 70% of the 2.7 million people estimated to be newly infected with HIV worldwide annually, and 35% of the estimated 8.8 million new tuberculosis (TB) cases. The burden of HIV and TB in Africa is reflected in higher rates of both infections in African emigrants to other countries when compared to their local counterparts. The goal of this career development award is to gain expertise in TB epidemiology and control, and research methodologies that will broaden my abilities to address HIV, TB, and other health issues in the African population in the US. My longer-term career objective is to improve the overall health of this population through both research and public health practice. The proposed research addresses questions crucial to the development of effective HIV and TB prevention and control programs for the African-born population. The specific aims of the proposal are to: 1) Estimate the extent to which transmission of HIV and TB occurs prior to arrival in the US among African-born persons, identify barriers to HIV testing and missed opportunities for HIV diagnoses among African-born US residents, and define the potential risk of ongoing HIV and TB transmission both within and outside of the African-born community; 2) Evaluate missed opportunities for TB screening and diagnosis, describe delays in diagnosis of active TB in the African population compared to non-Africans, and estimate the prevalence of TB genotypes typically seen in African- born patients in non-African populations; and 3) Develop projections for the size and composition of the African-born HIV and TB epidemics in the US over the next 20 years, using a combination of demographic and dynamic epidemic modeling. The career development component of the application is designed to augment my existing skills in the areas of HIV and STD epidemiologic research. The proposed educational aims will allow me to build skills in four specific areas necessary to carry out my research aims, and include training in: 1) TB epidemiology and control, 2) Demography and mathematical modeling, 3) Immigration and health. The unparalleled training environment at the University of Washington (UW), the close and collaborative relationships between the UW and the HIV/STD and TB Programs of Public Health - Seattle and King County, and the exceptional team of mentors and advisors that will supervise my training and research will further contribute to my career development and transition into a successful independent investigator.