IMPACT OF DIAGNOSIS AND PROPHYLAXIS OF TB AMONG HIV PATIENTS IN SOUTH AFRICA

结核病诊断和预防对南非艾滋病毒患者的影响

• 批准号: 7478227
• 负责人: Melissa A Bender
• 金额: $ 13.72万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-03 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7478227
• 关键词: Acquired Immunodeficiency Syndrome; Africa South of the Sahara; Caring; Cause of Death; Clinical; Communicable Diseases; Data; Decision Modeling; Development; Diagnosis; Disease Outcome; Epidemic; Faculty; General Hospitals; HIV; Individual; International; Massachusetts; Melissa; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; Natural History; Outcome; Patients; Policies; Polymerase Chain Reaction; Prevalence; Prevention; Prevention strategy; Preventive; Prophylactic treatment; Rate; Records; Relapse; Research; Research Personnel; Resources; Screening procedure; South Africa; Sputum; Standards of Weights and Measures; Techniques; Training; base; career; cost; cost effectiveness; experience; improved; markov model; medical schools; member; mortality; novel; prevent; skills

DESCRIPTION (provided by candidate): South Africa lies at the epicenter of both the HIV and TB epidemics, each fueling the other. AIDS is the leading cause of death in sub-Saharan Africa, and TB is the region's leading cause of HIV-related morbidity and mortality. Despite considerable data, the optimal strategy for TB diagnosis and prevention among HIV-infected patients in highly endemic, resource-limited settings remains unclear. Dr. Melissa A. Bender, guided by mentors Kenneth A. Freedberg, MD, MSc and C. Robert Horsburgh, MD, MUS will apply decision-analytic methods to evaluate different strategies for TB diagnosis and prevention in HIV-infected individuals. The four specific aims of this K01 proposal are: 1) To build a CD4- specific decision-analytic model of different strategies for diagnosis of subclinical TB in HIV-infected patients in South Africa; 2) To determine the clinical and cost parameters associated with TB/HIV coinfection in South Africa, including the natural history of TB as well as TB relapse and reinfection rates; 3) To use the model developed in Aim 1 and input parameters defined in Aim 2 to estimate clinical outcomes and costs associated with alternative strategies for TB diagnosis among HIV-infected individuals in South Africa; 4) To develop a CD4-specific Markov model of HIV/TB coinfection to project survival, costs, and cost-effectiveness associated with alternative strategies for prevention of active TB in South Africa. The candidate is a junior faculty member in the Division of Infectious Diseases at Massachusetts General Hospital with a demonstrated commitment to improving infectious disease outcomes in resource-limited settings. She already has strong training in decision modeling methods, as well as a clear plan to develop the additional quantitative skills needed to apply a novel, CD4-specific approach to these critically important questions. Dr. Bender will benefit from the expertise of the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) group based at Harvard Medical School, and the mentorship of two senior investigators with exceptional track records of guiding young investigators toward productive and independent research careers. Completion of this research has the potential to add substantially to the current approach to TB diagnosis and prevention in the developing world.

描述（由候选人提供）：南非位于艾滋病毒和结核病流行病的中心，彼此助长。艾滋病是撒哈拉以南非洲死亡的主要原因，结核病是该地区与HIV相关的发病率和死亡率的主要原因。尽管有大量数据，但在高度流行，资源限制的设置中，HIV感染患者中结核病诊断和预防的最佳策略尚不清楚。 Melissa A. Bender博士在导师的指导下，医学博士Kenneth A. Freedberg和医学博士C. Robert Horsburgh，MUS将采用决策分析方法来评估HIV感染者中TB诊断和预防的不同策略。该K01提案的四个具体目的是：1）在南非的HIV感染患者中，建立不同策略的CD4-特定的决策分析模型； 2）确定南非与结核病/HIV共感染相关的临床和成本参数，包括结核病的自然病史以及结核病复发和再感染率； 3）使用在AIM 1中开发的模型以及在AIM 2中定义的输入参数来估计南非的HIV感染者中与TB诊断的替代策略相关的临床结果和成本； 4）开发一种CD4特异性的Markov艾滋病毒/结核病共同感染模型，以与预防南非的替代策略相关的项目生存，成本和成本效益。该候选人是马萨诸塞州综合医院传染病科的初级教职员工，表现出致力于改善资源有限环境中传染病结果的承诺。她已经在决策建模方法方面接受了强大的培训，以及制定了将新颖的，特定于CD4的方法应用于这些至关重要的问题所需的其他定量技能的明确计划。 Bender博士将从哈佛医学院预防艾滋病并发症（CEPAC）小组的成本效益的专业知识中受益，以及两位高级调查员的指导，并具有指导年轻调查员迈向生产和独立研究职业的出色记录。这项研究的完成有可能大大增加发展中国家当前的结核病诊断和预防方法。