Innovative contact tracing strategies for detecting TB in mobile rural and urban South African populations

用于在南非农村和城市流动人口中检测结核病的创新接触者追踪策略

基本信息

批准号：
10451572
负责人：
David Wesley Dowdy
金额：
$ 58.61万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-07 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10451572
关键词：
Adult Africa South of the Sahara African Age Businesses Cause of Death Cessation of life Cities Communities Contact Tracing Cost Measures Country Data Diagnosis Dimensions Disease Effectiveness Enrollment Epidemic Family Frequencies Friends HIV Health Health care facility Holidays Home Hour Household Human Incidence Individual Infectious Agent Infrastructure Intervention Investigation Maintenance Measures Methods Modeling Movement Participant Patients Pattern Persons Play Population Prevalence Prisons Protocols documentation Province Public Health Randomized Recording of previous events Research Rest Risk Role Route Rural Seasons Site Source South Africa South African Testing Time Time trend Travel Trees Tuberculosis Underserved Population Ursidae Family Visit Work authority base budget impact care seeking case finding comparative cost effectiveness cost cost effectiveness disability-adjusted life years effectiveness evaluation falls genome sequencing health care availability high risk high risk population implementation cost implementation fidelity improved indexing innovation interdisciplinary approach markov model member men migration mortality novel novel strategies personalized approach population movement primary outcome prospective randomized trial rural South Africa rural setting screening simulation transmission process tv watching whole genome willingness to pay young adult

项目摘要

PROJECT SUMMARY Although largely a curable disease, tuberculosis (TB) remains the leading cause of death in South Africa and the leading single-agent infectious cause of death globally. Nevertheless, over one-third of people with TB – an estimated 3.6 million people worldwide – are never notified to health authorities. The demographic group at greatest risk for TB and also responsible for the majority of TB transmission consists of working-age adults (especially men). These individuals are often highly mobile, making it difficult to engage them with traditional TB case-finding activities such as screening at healthcare facilities or household contact investigation during business hours. Their patterns of movement, however, are highly regularized throughout sub-Saharan Africa and the rest of the world: young adults migrate to cities for work and travel home to rural homelands to visit families during the holidays. These predictable patterns of movement create an opportunity for innovative interventions to engage this high-risk, mobile population that bears a tremendous burden of undiagnosed TB and continues to fuel transmission in many communities. Specifically, mobile young adults can be found at their urban homes during non-working hours (on evenings and weekends) and visiting their families in rural settings during holiday times. Although most TB transmission occurs outside of households, household members of individuals diagnosed with TB remain the highest-risk population that can be identified, outside of congregate living settings (e.g., prisons). There is therefore no better place to look for the “missing 3.6 million” TB cases than in these households. We propose a randomized trial of two novel TB case-finding interventions among household members of patients diagnosed with active TB: holiday-based screening in a rural South African province (Limpopo) and off-peak (weekend/evening) screening in an urban settlement into which many residents of Limpopo migrate for work. We will enroll 2400 index cases of TB plus an estimated 4800 household contacts in each setting (7200 participants per setting, 14400 participants overall) and randomize them to novel versus standard contact investigation. In Specific Aim 1, we will use whole genome sequencing of all cases, overlaying transmission trees with data on human movement, to evaluate associations between mobility and TB transmission in this population. In Specific Aim 2, we will employ a multidisciplinary approach to compare novel versus standard contact investigation in each setting along the following dimensions: (a) effectiveness (number of secondary TB cases diagnosed and starting treatment); (b) implementation (reach, fidelity, and maintenance of contact investigation outside of business hours); (c) cost-effectiveness (cost per disability-adjusted life year) and budget impact; and (d) projected population-level impact on TB incidence. Successful completion of these aims will have long-term impact by characterizing the role of mobility in fueling TB epidemics and testing two tailored approaches to improve TB control in highly mobile populations – an underserved group that is increasingly recognized as playing a major role in global TB transmission.

项目概要尽管结核病（TB）在很大程度上是一种可以治愈的疾病，但它仍然是南非和南非的主要死亡原因。然而，超过三分之一的结核病患者是全球主要的单一传染性死亡原因。据估计，全球有 360 万人从未向卫生当局通报过。工作年龄的成年人是结核病的最大风险者，也是大多数结核病传播的罪魁祸首（尤其是男性）。这些人通常流动性很大，因此很难与传统的人接触。结核病病例发现活动，例如在医疗机构进行筛查或在疫情期间进行家庭接触者调查然而，他们的行动模式在整个撒哈拉以南非洲地区都高度规范化。以及世界其他地方：年轻人移居城市工作，然后回到农村家乡探亲假期期间的家庭活动模式为创新创造了机会。针对承受着未确诊结核病巨大负担的高风险流动人口采取干预措施并继续加剧许多社区的传播。具体而言，可以在以下位置找到流动的年轻人。在非工作时间（晚上和周末）到城市家中并探望农村的家人尽管大多数结核病传播发生在家庭之外，但家庭内。被诊断患有结核病的人仍然是可识别的最高风险人群，除了因此，没有比这更好的地方来寻找“失踪的 360 万人”了。我们建议对两种新型结核病病例发现干预措施进行随机试验。在被诊断患有活动性结核病的患者的家庭成员中：在南方农村地区进行假期筛查非洲省（林波波省）和非高峰（周末/晚上）在城市住区放映，许多人进入该住区我们将登记 2400 名结核病指示病例以及估计的 4800 名林波波省居民。每个环境中的家庭联系人（每个环境 7200 名参与者，总共 14400 名参与者）并随机化在具体目标 1 中，我们将使用全基因组测序。在所有案例中，将传播树与人类活动数据叠加，以评估之间的关联在具体目标 2 中，我们将采用多学科方法。沿着以下维度比较每个环境中的新型接触调查与标准接触调查：(a) 有效性（确诊并开始治疗的继发性结核病病例数）；(b) 实施情况（达到、 (c) 成本效益（每次成本）；残疾调整生命年）和预算影响；以及（d）预计人口水平对结核病发病率的影响。通过描述流动性在燃料方面的作用，成功完成这些目标将产生长期影响结核病流行并测试两种量身定制的方法来改善高流动人群的结核病控制—— 服务不足的群体日益被认为在全球结核病传播中发挥着重要作用。