GHES U.S. Fellow 2014-2015
Fellowship Site: Universidade Federal da Grande Dourados, Brazil
U.S. Institution: Stanford University
Project Title: Transmission dynamics of tuberculosis in Brazilian prisons
Dr. Jason Andrews is currently an assistant professor of medicine and health research and policy at Stanford University.
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, he worked 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 provided 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, they 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.