A new method for active tuberculosis case finding

活动性结核病病例发现的新方法

• 批准号: 10665861
• 负责人: Maryam Amour
• 金额: $ 13.49万
• 依托单位: MUHIMBILI UNIVERSITY/ ALLIED HLTH SCIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-06 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10665861
• 关键词: 15 year old; Adolescent; Adopted; Adoption; Africa South of the Sahara; Agreement; Ally; Biological Assay; Cause of Death; Cessation of life; Child; Collaborations; Communicable Diseases; Country; Detection; Developed Countries; Development; Diagnosis; Disease; Ensure; Epidemiologist; Goals; Health; Health Policy; Household; Incidence; Infection; Interferon Type II; Leprosy; Methods; Monitor; Newly Diagnosed; Notification; Outcome; Participant; Patients; Persons; Population; Public Health; Recommendation; Relapse; Reporting; Research; Schools; Science; Source; Tanzania; Testing; Tuberculosis; Universities; World Health Organization; active method; case finding; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; epidemiology study; experience; feasibility testing; global health; health goals; improved; infection rate; innovation; low and middle-income countries; low income country; medical schools; point of care; programs; research study; transmission process; treatment guidelines

PROJECT SUMMARY A critical component of the 2035 End TB Strategy is development of improved methods for Active Case Finding (ACF) of previously undiagnosed TB disease. Most ACF conducted by national tuberculosis control programs is based on testing household contacts (HCs) of remotely-acquired but newly-diagnosed cases of TB disease. This approach typically detects previously undiagnosed TB disease in 2-4% of HCs. We propose to test an entirely new method of ACF based on testing HCs of adolescents with recently-acquired and newly-diagnosed TB infection. This innovative method of ACF has the advantage that, since infections were recently acquired, the source cases are likely still among the close contacts of the new IGRA convertor. For this reason, we hypothesize that a source case will be found for as many as 50% of these new convertors. This approach is based on results of our recent 3-year study of serial testing for TB infection among 650 adolescent schoolchildren in Tanzania. The study was based on annual testing for TB infection using an interferon gamma release assay (IGRA). We showed that such testing was feasible and detected a 2.9% annual rate of infection. In the proposed new 5-year study we will perform baseline IGRA testing on 1200 Tanzanian adolescents followed by Q4 month IGRA testing x4 on the estimated 1020 who are IGRA negative at baseline. We anticipate detecting new TB infection (IGRA conversion to positive) in 50 participants. We will then test 200 of their household and other close contacts (collectively, their close contacts, CC) and predict that we will identify a source case of previously undiagnosed TB in a minimum of 25 or 50% of these 50 new adolescent infections. The predicted rate of new TB disease detection among CCs is therefore 25/200 or 12.5%, which is 3-6 times higher than the current approach for testing HCs of patients with TB disease. Cost-effectiveness will be analyzed and compared to the current approach used by the National Program on Tuberculosis and Leprosy. Successful completion of the proposed study with the hypothesized outcomes has the potential for a major impact on global tuberculosis outcomes. It is expected that the numerous new point-of-care IGRA tests under development will make serial testing feasible and economical at a programmatic level in low income countries. The research study will be conducted with the comprehensive DarDar Research Program, a 20-year research collaboration between Muhimbili University of Health and Allied Sciences (MUHAS, Tanzania) and the Geisel School of Medicine at Dartmouth (USA) and will include two consultant epidemiologists with extensive experience in evaluating TB control programs (Horsburgh, Whalen).

项目摘要 2035 End TB策略的关键组成部分是开发改进的 先前未诊断的结核病的主动病例发现方法（ACF）。最多 国家结核病控制计划进行的ACF基于测试 TB的远程但新诊断的病例的家庭接触（HCS） 疾病。这种方法通常检测到2-4％的先前未诊断的结核病疾病 HCS。 我们建议基于测试的HCS测试一种全新的ACF方法 最近获得且新诊断的结核病感染的青少年。这种创新 ACF方法的优势是，由于最近获得了感染， 源案件可能仍在新的IGRA转换器的密切联系中。为了 这个原因，我们假设将发现多达50％的来源案例 这些新的转换器。 这种方法是基于我们最近三年的串行测试研究的结果 坦桑尼亚650个青少年学童中的结核病感染。该研究是基于 使用干扰素伽马释放分析（IGRA）对结核病感染的年度测试。 我们表明，这种测试是可行的，并且每年2.9％ 感染。 在拟议的新的5年研究中，我们将对 1200个坦桑尼亚青少年，然后是第4个月IGRA测试X4 1020在基线时IGRA负面。我们预计会发现新的结核病感染 （IGRA转换为阳性）在50名参与者中。然后，我们将测试他们的200个 家庭和其他紧密的联系（共同是他们的密切联系，CC），并预测 我们将在至少25或 在这50种新的青少年感染中，有50％。新结核病的预测率 因此，CC之间的检测为25/200或12.5％，比 当前测试结核病患者HC的方法。成本效益将是 分析并与国家计划有关的当前方法进行了比较 结核病和麻风病。 通过假设的结果成功完成了拟议的研究 有可能对全球结核病结果产生重大影响。预计 正在开发的众多新的IGRA测试将成为序列号 在低收入国家的程序水平上测试可行且经济的。 研究研究将与综合性达达进行 研究计划，Muhimbili University的20年研究合作 健康与盟友科学（坦桑尼亚穆哈斯）和Geisel医学院 达特茅斯（美国），将包括两位顾问流行病学家 评估结核病控制计划的经验（Horsburgh，Whalen）。