TB Aftermath

结核病后果

基本信息

批准号：
9895147
负责人：
JONATHAN E. GOLUB
金额：
$ 69.55万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-06-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/9895147
关键词：
Address Aftercare Alcohol consumption Clinic Collaborations Collection Communication Communities Data Detection Diabetes Mellitus Diagnosis Diagnostic Disease Ensure Epidemic Future Goals Guidelines Health Personnel Health Services Heterogeneity Home environment Hospitals Household Impairment Incidence India Intervention Knowledge Leadership Maintenance Measures Modeling Morbidity - disease rate Patients Periodicity Population Process Public Sector Recommendation Recurrence Recurrent disease Reporting Research Infrastructure Resources Risk Smoke Sputum Strategic Planning Symptoms System Telephone Telephone Interviews Time Tuberculosis Visit Work World Health Organization arm base case finding comparative effectiveness compare effectiveness cost cost effectiveness cost estimate disability-adjusted life years experience follow-up high risk high risk population improved indexing interest intervention cost markov model member mortality multidisciplinary outreach patient screening programs randomized trial respiratory scale up screening transmission process tuberculosis treatment

项目摘要

The overall goal of our tuberculosis (TB) Aftermath study is to identify, implement and measure feasible case finding strategies and identify key populations to screen among treated TB patients in India. People treated for TB have high incidence of recurrent disease. A recent analysis of the TB treatment cascade in Indian public-sector hospitals estimated that under 40% of cases were TB free one year following treatment completion and as much as 13% of reported TB per year in India is recurrent TB. Furthermore, India is home to one-third of the world’s estimated three million undetected TB cases. Thus, active case finding (ACF) approaches targeting recently treated TB cases may be an effective strategy to reduce the global burden of TB. The Indian National TB Control Programs (RNTCP) new strategic plan for TB elimination strongly recommends developing and implementing a scalable surveillance system for recurrent TB. The World Health Organization’s Systematic Screening for Active TB guidelines suggest that screening for recurrent TB in treated TB patients is a “conditional recommendation”; conditional only because there is a lack of evidence. TB Aftermath will compare effectiveness, cost-effectiveness and feasibility of two ACF strategies that are presently being considered by the RNTCP for detecting recurrent TB and provide evidence needed to implement and scale the preferred intervention. In Aim 1, we will conduct a randomized trial to measure the comparative effectiveness of two potentially implementable strategies that are presently being considered by the RNTCP for detecting recurrent TB in India: Household ACF (HHACF) vs. ACF by periodic telephonic interviews (TACF) followed by HH screen for HHs reporting any symptomatic members among treated TB patients and their HH contacts. In Aim 2, we will use the RE-AIM framework to understand barriers and facilitators to implementation of the two interventions and identify sub-populations that are best reached by the interventions and sub- populations who may benefit the most from the interventions. We will enhance the RE-AIM approach, by exploring the acceptability of the strategies in depth across three key stakeholder groups (TB patients, HH members, and health care personnel) to optimize implementation. In Aim 3, we will model the impact and cost- effectiveness of the ACF interventions evaluated in the trial, and of potential alternative strategies for the targeting and timing of those interventions. We will use data from the trial to model and compare potential strategies for ACF in terms of expected diagnostic yield, cost effectiveness, and impact on TB control in India. TB Aftermath will answer key questions in a population that is often ignored by the TB community once treatment is complete, despite being at considerable risk for recurrent TB disease. We will provide evidence for an effective and scalable strategy targeting HHs of treated TB cases, a high priority of the RNTCP. Our high TB burden setting, strong multidisciplinary team, communication with the RNTCP and state TB program, and proven research infrastructure ensures successful implementation of TB Aftermath.

我们的结核病（TB）后果研究的总体目标是确定、实施和衡量可行的病例发现策略，并确定在印度接受治疗的结核病患者中进行筛查的关键人群最近的分析。印度公立医院的结核病治疗级联估计，治疗完成一年后，不到 40% 的病例已消除结核病，印度每年报告的结核病中有多达 13% 是复发性结核病。据估计，全球 300 万未发现的结核病病例中有三分之一因此，针对最近治疗的结核病病例的主动病例发现（ACF）方法可能是减轻印度国家结核病控制计划（RNTCP）的全球负担的有效策略。新的消除结核病战略计划强烈建议开发和实施可扩展的复发性结核病监测系统。世界卫生组织的活动性结核病系统筛查指南表明，对接受治疗的结核病患者进行复发性结核病筛查是一项重要举措。 “有条件推荐”；有条件只是因为缺乏证据。 TB Aftermath 将比较 RNTCP 目前正在考虑的两种 ACF 策略的有效性、成本效益和可行性，并提供实施和扩展所需的证据。在目标 1 中，我们将进行一项随机试验，以衡量 RNTCP 目前正在考虑的两种潜在可实施策略的比较有效性，这两种策略用于检测印度的复发性结核病：家庭 ACF。 (HHACF) 与 ACF 的比较，通过定期电话访谈 (TACF)，然后对报告接受治疗的结核病患者及其 HH 接触者中任何有症状的成员进行 HH 筛查。在目标 2 中，我们将使用 RE-AIM 框架来了解障碍和促进因素。我们将通过探索干预措施的可接受性来加强 RE-AIM 方法。在目标 3 中，我们将对试验中评估的 ACF 干预措施以及潜在替代方案的影响和成本效益进行建模。我们将使用试验数据来模拟和比较 ACF 的潜在策略，包括预期诊断率、成本效益以及对印度结核病控制的影响。经常被忽视的人群结核病社区一旦治疗完成，尽管结核病复发的风险相当大，但我们将为针对已治疗结核病病例的家庭的有效且可扩展的策略提供证据，这是我们的高结核病负担环境的高度优先事项。多学科团队、与 RNTCP 和州结核病项目的沟通以及经过验证的研究基础设施确保了结核病后果的成功实施。