The goal of this proposed K01 mentored career development award is to support Dr. Jennifer Ross?s research training in the advanced epidemiologic methods of geospatial and mathematical modeling of HIV and tuberculosis (TB) to further her goal of developing targeting strategies for prevention of TB among people living with HIV (PLHIV). Dr. Ross is currently an Acting Instructor/Senior Fellow in infectious diseases at the University of Washington. This award will support her development in modeling methods and implementation science to facilitate her transition to becoming an independent investigator. She will receive mentorship from Dr. Ruanne Barnabas, Professor Simon Hay, Dr. David Dowdy, and Dr. Judith Wasserheit for this award. The research goal of the award is to maximize the public health impact of preventive therapy (PT), either with isoniazid alone or with rifapentine, for TB prevention in HIV-infected individuals using cutting-edge geospatial models that integrate existing epidemiologic information. TB is the leading cause of death among PLHIV in sub-Saharan Africa, including those recently started on antiretroviral (ART) therapy in Uganda. PT prevents tuberculosis and TB-associated mortality among PLHIV, but fewer than 5% of eligible Ugandans receive it due to limited resources to successfully implement PT programs. This award will marry the expanding sources of TB and HIV surveillance data in Uganda with the expertise at UW and the Institute for Health Metrics and Evaluation in spatiotemporal and mathematical modeling to produce novel tools that guide PT implementation. This K01 proposal will inform the prioritization of PT through three research aims. In the first aim, Dr. Ross will examine the relationship between ART coverage and geographic predictors of TB with TB prevalence, incidence, and mortality among PLHIV using geospatial and mathematical models. In the second aim, Dr. Ross will estimate the impact of PT implementation on HIV-TB mortality using mathematical models of a regionally- targeted implementation strategy versus uniform roll-out. Finally, in the third aim, Dr. Ross will engage stakeholders to inform model development, evaluate the effect of engagement with the model on stakeholder support of modeling, and facilitate implementation of targeted TB prevention. This award will support Dr. Ross to dedicate more than 75% of her effort to research as she furthers her learning in the methods and application of state-of-the-art geospatial and mathematical modeling techniques. Acquiring these advanced skills will facilitate her future R01 proposals. With her clinical training in infectious disease, her outstanding mentorship, and the support of this award to further develop her expertise, Dr. Ross will be well-positioned to contribute to the control of TB and HIV epidemics in sub-Saharan Africa.
This study will develop mapping and modeling tools to guide use of the antibiotic isoniazid for preventing tuberculosis (TB) among people with HIV infection. This study takes place in Uganda, where TB is the leading cause of death among people with HIV, and is important for global health because TB is among the leading causes of death for the more than 35 million people living with HIV worldwide. The tools developed may help to stretch limited health resources by identifying the places where prioritizing isoniazid use could have the greatest health impact.