Abstract.
The goal of this career development plan is to support Dr. Leonardo Martinez, an infectious disease
epidemiologist, in developing an independent research program focused on increasing tuberculosis case
detection in high-risk groups. In active tuberculosis case finding studies, the majority of individuals are unable to
provide sputum. In our previous work in Brazilian prisons, mass screening for tuberculosis among incarcerated
individuals found a hyperendemic level of disease burden, 3,900 cases per 100,000 prisoners. We hypothesize
that the tuberculosis burden in these prisons is greater than our current estimates, as a majority of prisoners
were unable to produce sputum and therefore were not evaluated by diagnostic tools such as GeneXpert, culture,
and smear testing. A re-assessment of the tuberculosis burden is urgently needed in this setting as well as an
assessment of the feasibility and value of non-sputum-based diagnostic tools to increase case detection and
reduce ongoing transmission. Dr. Martinez proposes to: (1) measure the prevalence of undiagnosed TB and
characteristics of tuberculosis among Brazilian prisoners who are unable to provide sputum samples at the
baseline screening visit; (2) determine the feasibility and sensitivity of Mask Aerosol Sampling system (MASS),
a novel tool that directly captures exhaled Mycobacterium tuberculosis from patients, during a mass screening
intervention; and (3) identify cost-effective algorithms for tuberculosis screening in prisons. The proposed project
will leverage an NIH-funded R01 study (AI130058-01, PI, Andrews/Croda) by the primary mentors, which is
ongoing and enrolls adults in several prisons located in Mato Grosso do Sul, Brazil. This research plan forms
the basis of a 5-year career development plan for Dr. Martinez under the mentorship of Drs. Jason Andrews
(infectious diseases, epidemiology), Julie Parsonnet (adult infectious diseases), Julio Croda (infectious diseases,
health policy), Yvonne Maldonado (pediatric infectious diseases), and Upinder Singh (infectious diseases) with
consultants Robert Horsburgh (clinical epidemiology), Michael Barer (tuberculosis diagnostics), and Jeremy
Goldhaber-Fiebert (cost-effectiveness analyses). This interdisciplinary group has developed a career
development program for Dr. Martinez that includes: (1) fostering skills in designing field-based research and
data collection; (2) application of statistical methods for the study of novel diagnostics; (3) effective usage of and
experience with new advanced statistical methodologies related to decision-tree algorithmic creation, cost-
effectiveness analysis, and mathematical modeling; (4) regular meetings with mentors and consultants; (5)
presenting results at scientific meetings and seminars; (6) publishing in peer-reviewed journals; and (7) writing
and submitting an R01 grant. Completion of this career development plan will allow Dr. Martinez to successfully
compete for extramural funding in the future to continue researching non-sputum-based tuberculosis diagnostics
in high-risk populations.