Grant Proposal for Tuberculosis Prevention through an Examination of Migration Patterns in Mexico, within the Border State of Tamaulipas Open Access

Abstract

This project is in response to the National Institutes of Health (NIH) Funding Opportunity Announcement (FOA) PA-13-303, "NIH Exploratory/Developmental Research Grant Program (Parent R21)". The National Institute of Allergy and Infectious Disease (NIAID) is interested in supporting meritorious investigator-initiated research directed toward improving knowledge about tuberculosis (TB) and how it affects humans. As well, the NIAID is interested in supporting research to assess factors influencing the occurrence, distribution, and transmission of drug sensitive/resistant mycobacterium tuberculosis (Mtb). In support of these goals, the aim of this project is to conduct an uncontrolled cross-sectional cohort study that will investigate the contribution of population migration within Mexico to the prevalence of TB in the Mexican state of Tamaulipas. Tamaulipas borders the southernmost tip of Texas. The state of Tamaulipas was selected because it has one of the highest TB prevalence rates (30 per 100,000) versus Mexico's national average of 13.5 per 100,000, and the highest rate of multi-drug resistant TB (MDR-TB) cases in Mexico. While it is alluded that migration from the poorest states in Mexico may be responsible for a significant proportion of TB cases in the Mexican states bordering the U.S., this has never been systematically evaluated. In addition, the epidemiology of TB in the border regions of Tamaulipas, including: a) sociodemographics, b) medical characteristics, and c) adverse TB outcomes (re-infection or treatment failure) will be evaluated. This fact along with the importance of TB prevention in Mexican border communities underscores a clear need for this research project. Additionally, the research findings will help inform the prevention of TB in communities throughout Mexico along both sides of the U.S./Mexico border.

Table of Contents

Definition of Terms. 1

List of Abbreviations. 2

Chapter 1: Introduction and Rationale. 4

Introduction. 4

Problem Statement. 4

Purpose Statement. 7

Project Goals. 8

Significance Statement. 9

Chapter 2: Review of the Literature. 11

TB Global Burden. 11

TB in the Americas. 12

TB Along the U.S.-Mexico Border. 14

Migration in Mexico. 17

Transmission and Pathogenesis of TB. 19

Population Mobility Can Shape TB Transmission Dynamics. 24

Number of TB Studies in Mexico. 26

TB Prevention and Control in Mexico. 28

Conclusion. 31

Chapter 3: Methodology of the Review Process. 33

Description of Grant Announcement. 33

Review of Funding Agency. 35

Grant Review Process. 36

Grant Proposal Reviewers. 39

Protection of Human Subjects. 42

Chapter 4: Reviewer Comments. 47

Reviewer 1 Comments. 47

Reviewer 2 Comments. 54

Reviewer 3 Comments. 60

Reviewer 4 Comments. 65

Reviewer 5 Comments. 69

Chapter 5: Final Version of the Proposal. 75

Cover Letter. 76

Project Summary. 78

Project Narrative. 79

Facilities and Other Resources. 80

Biographical Sketch - Jennifer Curry. 81

Biographical Sketch - Blanca Restrepo. 83

Biographical Sketch - Bassent Abdelbary. 93

Specific Aims. 97

Research Strategy. 99

1. Significance. 99

2. Multidisciplinary Team. 103

3. Innovation. 104

4. Approach. 105

5. Work Plan. 110

6. Resolution of Challenges. 111

Budget and Budget Justification. 113

Protection of Human Subjects. 116

Targeted/Planned Enrollment Table. 119

Resource Sharing. 121

References. 122

Appendices. 130

Appendix A: Developmental Research Grant Program (Parent R21). 130

Appendix B: RPG Critique Template. 149

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Tuberculosis Population Health U.S.-Mexico Border Health Population Migration
Committee Chair / Thesis Advisor	Blais, Linelle, Emory University
Committee Members	Restrepo, Blanca, University of Texas Health Science Center at Houston, School of Public Health in Brownsville

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