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.

项目概要： 结核病 (TB) 是全球结核病死亡的主要原因。 目前每年减少2%，实现世界卫生组织的ENDTB目标 要到 2050 年消除结核病，就需要对我们的结核病控制方法进行重大修改。 以前针对其他疾病的消除策略只有在空间 确定了疾病发病率的变化，然后采取当地相关的干预措施 实施结核病消除战略需要纳入纵向结核病队列。 南非是我们与第二个国家合作的理想环境。 全球最高的结核病发病率和中央国家卫生实验室服务 (NHLS) 我们建议建立一个为期十年的国家实验室结果数据库。 结核病队列能够跟踪患者长达十年，包括空间位置数据 和 HIV 状况，使用国家 NHLS 数据 我们勇敢地说 NHLS 数据可用于 确定设施层面结核病护理级联的关键指标，并评估艾滋病毒的影响 南非结核病流行的治疗规模扩大和新诊断方法的推出。 目标 1a 我们将使用概率记录链接在 NHLS 中创建唯一的患者标识符 所有结核病患者的数据，使我们能够链接个人的测试结果并跟踪确诊的结果 在目标 1b 中，我们将确定空间和时间上的病例，并结合 HIV 检测结果。 结核病护理级联的关键步骤，并利用临床图表中的数据扩充我们的十年队列 在目标 1c 中，我们将确定特定护理级联步骤中存在差距的位置、常见情况。 结核病治疗期间患者的移动模式并确定潜在较高风险的位置 在目标 2 中，我们将量化基于分子测试变量的疾病负担。 在目标 3 中，我们将在设施层面评估艾滋病毒治疗水平和结核病发病率之间的关系。 GeneXpert Ultra“追踪”结果与重复结核病发作之间的关联可增强 对这些新诊断结果的解释是重要的，因为它将。 建立一个为期十年的全国结核病患者队列，对他们进行纵向和空间跟踪 在治疗期间，使当地公共卫生专业人员能够制定适合当地情况的 采取干预措施来缩小结核病护理级联中的差距并了解干预措施的影响 拟议的工作具有创新性，因为它将提供第一个。 此类群体处于高负担环境中，具有纵向和空间性质 数据可以前所未有地捕获结核病护理和干预措施的影响。 允许政策制定者针对结核病治疗中的具体差距设计与当地相关的干预措施 和高度流动的人口，防止进一步传播并最终减少疾病和 通过使用常规收集的实验室数据，我们的模型增加了最小限度的死亡率。 财务成本，并且可以适应类似的结核病高负担、中等收入环境 大型实验室数据集。