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）：本申请旨在为布莱根妇女医院 (BWH) 全球健康公平部研究员 Helen Jenkins 博士申请 K01 奖。结核分枝杆菌 (TB) 的耐药菌株威胁着结核病的控制。耐药结核病 (DR-TB) 的检测和成功治疗因目前大多数环境中可用的检测方法昂贵且耗时而受到影响。对这一疫情的严重低估是有效控制的障碍。未确诊的耐药结核病病例的预后较差，并且可能传播疾病的时间更长。在大多数情况下，当药物敏感性测试的获得或使用受到限制时，识别耐药性热点是很困难的。该项目旨在开发对耐药结核病数据进行空间分析的方法，以解释诊断测试中的地理差异，并能够识别耐药结核病的高发病率。来自世界上两个最令人担忧的地区的数据集 对于耐药结核病，将采用东欧和撒哈拉以南非洲地区。具体目标是：（A） 描述和理解诊断水平高的地区的耐药结核病的异质性和聚集性，(B) 开发在诊断使用中具有地理异质性的地区估计耐药结核病负担的方法，(C) 描述和理解耐药结核病的异质性结核病负担导致诊断检测中存在巨大的地理差异，(D) 确定结核病治疗期间耐药性发展和获得的风险因素。这项工作将为分析这些地区的类似数据集提供一个方法框架。拟议的项目可以帮助确定耐药结核病的出现机制，从而促进确定干预措施，确保更多患者得到及时和适当的治疗，并限制耐药疾病的传播。 Jenkins 博士的导师是哈佛大学公共卫生学院 (HSPH) 生物统计学系统计计算教授 Marcello Pagano 博士，其研究重点是 Ted Cohen 博士，医学博士、公共卫生硕士、公共卫生博士、HSPH 流行病学助理教授和 BWH 医学副教授，从事结核病流行病学和耐药结核病监测研究。 Jenkins 博士的顾问委员会将包括 Marc Lipsitch 博士、HSPH 流行病学教授、Jeff Blossom 理学硕士、哈佛大学地理分析中心 GIS 专家以及 Sonya Shin 博士（医学博士、公共卫生硕士、BWH 副医师） 。詹金斯博士的培训目标是（1）成为空间数据分析专家，（2）对传染病生物学有深入的了解，她将参加课程来实现这些目标。 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研究员，在传染病流行病学中开发和应用生物统计空间方法。