Jason Andrews, MD, MPH

andrewsGHES US Fellow 2014-2015

Email: jasonandr@gmail.com
Fellowship Site: Universidade Federal da Grande Dourados, Brazil
U.S. Institution: Stanford University

Project Title: Transmission dynamics of tuberculosis in Brazilian prisons

Brazil has made substantial progress in the control of tuberculosis, with an estimated annual incidence of 42 cases per 100,000 population in 2012. However, the burden of disease has been increasingly concentrated in high-risk subpopulations, including individuals living in slums, indigenous populations, and prisoners. In the 24 prisons of Mato Grosso do Sul, where this research proposal is focused, the notification rate in 2012 was 2,180 cases per 100,000, one of the highest rates reported anywhere in the world. For the Global Health Equity Scholars Fellowship, I will work closely with Dr. Julio Croda to examine the transmission dynamics of tuberculosis in prisons of Mato Grosso do Sul. Dr. Croda is currently the principal investigator of a prospective cohort study involving 3,500 inmates in 12 prisons. This study is providing individual-level data on: inmate location within prisons, cross-sectional active and latent tuberculosis prevalence, as well as incident latent and active tuberculosis infections. Working with Dr. Croda, we have outlined three specific aims for this project: 1. To assess the role of prisoner movement patterns on tuberculosis transmission dynamics and project the impact of restrictive reassignment policies. 2. To evaluate the potential impact of latent tuberculosis testing and cohorting policies as a strategy to reduce the burden of tuberculosis in prisons 3. To project the impact of active tuberculosis screening strategies among individuals upon incarceration and through periodic mass screening.

These are selected publications associated with this fellowship:

Prisons as reservoir for community transmission of tuberculosis, Brazil.

The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons.

A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities.

Active and latent tuberculosis in Brazilian correctional facilities: a cross-sectional study.

Impact of mass-screening on tuberculosis incidence in a prospective cohort of Brazilian prisoners.