PROJECT SUMMARY/ABSTRACT The burden of tuberculosis (TB) in children and adolescents is massive and current TB control strategies, even at full scale-up, are insufficient to address it.4,6-8,10 Novel strategies to expand TB control outside of the home and into the community, where children acquire an estimated 80% of new TB infections,11-12 are urgently needed. However, an incomplete understanding of where and from whom youth acquire TB, and how these drivers change throughout the early life-course, hampers the design of novel interventions. Thus, we propose the first-ever population-representative, longitudinal TB Infection Incidence Cohort of youth ages 1 to 18 years, in rural communities in Uganda. Using a combination of epidemiologic and network analytic techniques, this study will address key foundational knowledge gaps about TB transmission within 3 socio-spatial networks of youth: the household network, the non-household social network (close contacts), and the network of casual contacts encountered in community venues. In Aim 1 we will characterize the role of the household social network in TB infection throughout the early life course. In Aim 2 we will employ social network analysis to assess the relationships between child and adolescent TB infections and their community-based social network, and in Aim 3 we will use location-based networks to assess the relationships between community venues and incident TB infections in youth. Data from this proposal will directly inform novel, age-specific, community-based TB control strategies and will help optimize existing household-based strategies.

NARRATIVE There are significant gaps in our understanding of TB transmission dynamics among youth living in rural areas of East Africa. This proposal will use social and spatial network analysis to identify where, and from whom, children and adolescents acquire TB in rural Uganda. These foundational data will inform novel youth-specific interventions that are needed to expand TB control beyond the home to the community.