Tuberculosis in teens: a geospatial approach to predict community transmission

Modified Project Summary/Abstract Section
Adolescents—individuals 10-19 years old—are a unique population undergoing dynamic cognitive, social, psychological, and physical changes. Yet there is a dearth of research on adolescent tuberculosis (TB) epidemiology. Standard TB research reporting conventions make it difficult to examine this group: 10-14 year olds are grouped with children, while 15-19 year olds with adults. Notably, research findings in children and adults may have limited applicability to adolescents, leaving large knowledge gaps about TB during adolescence. With their ability to spread TB and expanding social networks, adolescents may be an important group to target in order to break cycles of TB transmission. By using geospatial and genotypic analyses of transmission networks around adolescents with TB, we can better characterize local TB transmission in high burden settings. These methods will elucidate important person, place, and time interactions of TB transmission in adolescents. I propose to complete three aims, focused in epidemiology and data science, using existing data from Lima, Peru. In Aim 1, I will characterize the spatial heterogeneity of TB transmission events in adolescents. I will identify spatial clusters of genotypically matched TB cases, using MIRU-VNTR- and whole genome sequencing-based data, to identify locations where recent transmission has occurred. I will visualize these spatial clusters using non-parametric distance-based mapping. In Aim 2, I will predict the spatial distribution of TB transmission events in adolescents. I will assess the association between spatial distributions of individual-, household-, and population-level characteristics with the spatial variability of TB transmission events in adolescents using hierarchical Bayesian spatial models. Then, I will build an integrated model combining random forests and ordinary kriging to generate spatial predictions of TB transmission events in adolescents. In Aim 3, I will estimate and compare the impact of screening and treatment interventions tailored for adolescents on reducing community TB transmission. I will conduct a simulation study, calibrated to the local epidemic curve and spatiotemporal clustering pattern of adolescent TB transmission events. I will quantify how a set of interventions tailored to adolescents can reduce TB transmission in a community. Interventions include active screening efforts, increasing TB preventive treatment, and treatment support to increase treatment completion rates. My K01 portfolio of mentored research and training will enable me to develop expertise in adolescent tuberculosis epidemiology, spatial analysis, and TB transmission dynamics. This award will enable me to take the next critical step toward becoming an independent and influential scientist, including a research grant (R01) proposal to test novel, targeted interventions in high-risk populations, like adolescents. I have defined a detailed career development plan and assembled an experienced team of mentors: Prof. Megan Murray and Prof. Mercedes Becerra, globally renowned experts in TB transmission dynamics and pediatric TB epidemiology, respectively.

Grant Number: 3K01AI151083-04S1
NIH Institute/Center: NIH
Principal Investigator: Meredith Brooks