Evaluating the tuberculosis epidemic in South Africa using a novel ten-year cohort

使用新的十年队列评估南非的结核病流行情况

• 批准号: 10594407
• 负责人: Helen E. Jenkins
• 金额: $ 31.45万
• 依托单位: WITS HEALTH CONSORTIUM (PTY), LTD
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-13 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10594407
• 关键词: Accounting; Address; Aftercare; Algorithms; Area; Benchmarking; Caring; Categories; Cessation of life; Clinic; Clinics and Hospitals; Communicable Diseases; Country; DNA; Data; Data Set; Data Sources; Databases; Diagnosis; Diagnostic; Disease; Disease Progression; Drug resistance in tuberculosis; Epidemic; Evaluation; Financial cost; Goals; HIV; HIV diagnosis; HIV/TB; Health; Health Professional; Human immunodeficiency virus test; Incidence; Income; Individual; Infection; Infrastructure; Intervention; Knowledge; Laboratories; Link; Location; Longitudinal cohort; Maps; Methods; Mission; Modeling; Moldova; Molecular; Monitor; Morbidity - disease rate; Movement; Mycobacterium tuberculosis; Natural History; Nature; Outcome; Patients; Pattern; Persons; Policies; Policy Maker; Poliomyelitis; Population; Prevalence; Province; Public Health; Records; Relapse; Reporting; Research; Risk Factors; Services; Smallpox; South Africa; South African; Temperature; Test Result; Testing; Time; Tuberculosis; United States National Institutes of Health; Variant; Viral; Work; World Health Organization; burden of illness; cohort; design; diagnostic algorithm; disorder risk; global health; improved; infection rate; innovation; longitudinal care; melting; migration; mortality; novel; novel diagnostics; novel therapeutics; prevent; programs; scale up; surveillance data; testing services; transmission process; treatment duration; tuberculosis diagnostics; tuberculosis treatment

Project Summary: Tuberculosis (TB) is the leading cause of infectious disease deaths globally. With TB incidence currently decreasing by 2% annually, achieving the World Health Organization’s ENDTB goal of TB elimination by 2050 will require a substantial reworking of our TB control approach. Previous elimination strategies for other diseases have only been successful once spatial variation in disease incidence was identified and then locally relevant interventions implemented. TB elimination strategies require longitudinal TB cohorts that incorporate detailed spatial information. South Africa is an ideal setting for our work with both the second highest TB incidence globally and a central National Health Laboratory Service (NHLS) database of routinely-collected laboratory results. We propose to develop a ten-year national TB cohort with the ability to track patients for up to ten years, including spatial location data and HIV status, using national NHLS data. We hypothesize that NHLS data can be used to identify key metrics in the TB care cascade, at the facility level, and evaluate the impact of HIV treatment scale-up and the roll-out of new diagnostics on the TB epidemic in South Africa. In aim 1a we will use probabilistic record linkage to create unique patient identifiers in the NHLS data for all TB patients, allowing us to link an individual’s test results and track those confirmed cases spatially and temporally, and incorporating HIV test results. In aim 1b, we will identify key steps in the TB care cascade and augment our ten-year cohort with data from clinic chart reviews. In aim 1c, we will identify locations with gaps in specific care cascade steps, common patient movement patterns during TB treatment and identify locations with potential higher burden of disease based on molecular test variables. In aim 2 we will quantify the relationship between HIV treatment levels and TB incidence, at the facility level. In aim 3 we will evaluate the association between GeneXpert Ultra “trace” results and repeat TB episodes to enhance the interpretation of these new diagnostic results. This contribution is significant because it will develop a national ten-year cohort of TB patients tracking them longitudinally and spatially during treatment, enabling local public health professionals to develop locally appropriate interventions to close gaps in the TB care cascade and understand the impact of interventions and new TB diagnostics. The proposed work is innovative because it will provide the first cohort of this kind in a high burden setting, with the longitudinal and spatial nature of these data allowing for unprecedented capture of TB care and the impact of interventions. This will allow policy makers to design locally-relevant interventions targeting specific gaps in TB care and highly mobile populations, preventing further spread and ultimately reducing disease and mortality due to TB. By using routinely collected laboratory data, our model adds minimal financial costs and can be adapted for similar TB high-burden, middle-income settings with large laboratory datasets.

项目摘要： 结核病（TB）是全球传染病死亡的主要原因。与结核病发生 目前每年减少2％，实现世界卫生组织的ENDTB目标 到2050年的结核病消除将需要对我们的结核病控制方法进行实质性的重制。 以前针对其他疾病的消除策略仅一旦空间才成功 鉴定出疾病事件的变化，然后局部相关的干预措施 实施的。 TB消除策略需要纵向结核病研究 详细的空间信息。南非是我们第二次工作的理想环境 全球结核病最高的发病率和中央国家卫生实验室服务（NHLS） 常规收集的实验室结果数据库。我们建议开发一个十年的国家 TB队列具有跟踪患者长达十年的能力，包括空间位置数据 和HIV状态，使用国家NHLS数据。我们假设NHLS数据可用于 在设施级别确定结核病护理级联的关键指标，并评估艾滋病毒的影响 治疗量表和对南非结核病流行的新诊断的推出。在 AIM 1A我们将使用概率记录链接来在NHLS中创建唯一的患者标识符 所有结核病患者的数据，使我们能够连接个人的测试结果并跟踪确认的结果 案件在空间和临时，并纳入HIV测试结果。在AIM 1B中，我们将确定 结核病护理级联的关键步骤，并通过诊所图中的数据增强我们的十年人群 评论。在AIM 1C中，我们将在特定的护理级联步骤中识别出空白的位置， 结核病治疗期间的患者运动模式并确定潜在的位置 基于分子测试变量的疾病负担。在AIM 2中，我们将量化关系 在设施水平上，在HIV治疗水平和结核病事件之间。在AIM 3中，我们将评估 GenExpert超“痕迹”结果与重复结核发作之间的关联以增强 这些新诊断结果的解释。这项贡献很重要，因为它将 开发全国十年的结核病患者，以纵向和空间跟踪他们 在治疗期间，使当地的公共卫生专业人员能够开发本地适当的 干预措施以缩小结核病护理级联的差距并了解干预的影响 和新的结核病诊断。拟议的工作是创新的，因为它将提供第一个 这种队列在高负担的环境中，具有这些的纵向和空间性质 数据允许对结核病护理的前所未有的捕获和干预措施的影响。这会 允许政策制定者设计针对结核病护理特定差距的本地与本地的干预措施 以及高度流动的人群，防止进一步传播并最终减少疾病 由于结核病而导致的死亡率。通过使用常规收集的实验室数据，我们的模型添加了最小 财务成本，可以适应类似的结核病高负荷，中等收入设置 大型实验室数据集。