Social and biomedical risk factors for multi-drug resistant TB in rural China

中国农村耐多药结核病的社会和生物医学危险因素

• 批准号: 7673864
• 负责人: Biao Xu
• 金额: $ 8.17万
• 依托单位: FUDAN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-15 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7673864
• 关键词: Acute; Adherence; Africa South of the Sahara; Asia; Biological Factors; Caring; Case-Control Studies; China; Chinese People; Clinical; Clinical Trials; Complex; Country; Cross-Sectional Studies; Disease; Distal; Drug Resistant Tuberculosis; Drug resistance; Drug resistance in tuberculosis; Drug usage; Economics; Education; Educational Background; Epidemic; Epidemiologic Methods; Epidemiologic Studies; Epidemiology; Extreme drug resistant tuberculosis; Focus Groups; Genotype; HIV; HIV Infections; Health; Health Services; Health Services Accessibility; High Prevalence; Immunity; Incidence; Income; Individual; Infection; Joints; Lead; Medical; Methods; Molecular; Morbidity - disease rate; Multi-Drug Resistance; Multidrug-Resistant Tuberculosis; Mutation; Mycobacterium tuberculosis; Nature; Pan Genus; Patient Education; Patients; Pattern; Play; Population; Population Study; Poverty; Predisposition; Prevalence; Provider; Public Health; Qualitative Methods; Recording of previous events; Reporting; Research Design; Resistance; Resistance Process; Restriction fragment length polymorphism; Risk; Risk Factors; Role; Rural; Rural Population; Site; Social Impacts; Socioeconomic Factors; Socioeconomic Status; Stochastic Processes; System; Time; Treatment Effectiveness; Treatment Protocols; Tuberculosis; Underserved Population; Ursidae Family; antimicrobial; base; case control; case finding; compliance behavior; design; epidemiologic data; field study; health disparity; high risk behavior; improved; intervention program; mortality; programs; prospective; resistant strain; rural area; social; socioeconomics; success; transmission process; tuberculosis treatment

DESCRIPTION (provided by applicant): Tuberculosis (TB) remains one of the leading causes of morbidity and mortality globally. Both treatment and control of this deadly disease are increasingly hampered by the emergence of mutltidrug resistant (MDR) and more recently extensively drug resistant (XDR) strains of M. tuberculosis, the causative agent of TB. China bears the 2nd highest case burden of TB and the largest number of MDR-TB cases worldwide. In general the TB situation in China is more severe in rural areas. HIV prevalence in China is relatively low however is rising rapidly and will likely lead to more TB and MDR-TB. While poor compliance and/or inadequate TB therapy are clearly involved in the emergence of drug-resistance, the process is complex, likely involving socioeconomic and other patient factors as well. We hypothesize that the high prevalence/incidence of MDR-TB in selected regions of China is inversely associated with the patients' socioeconomic conditions (e.g. poverty, access to healthcare), in addition to medical (e.g. previous TB, HIV) and bacterial (e.g. drug-resistant genotypes) factors. Our overall aims are to describe the MDR-TB situation in rural China and define social or medical determinants that contribute to the ongoing MDR-TB epidemic. We propose to 1) characterize the natural distribution of drug-resistant TB (including MDR-TB) in a well-defined Chinese rural population with high endemic TB; 2) carry out a case-control study to determine the biomedical and social determinants that are associated with MDR-TB; and 3) describe the transmission dynamics of drug-resistant TB in rural China. To that end, we will use cross-sectional, case-control and qualitative (Focus Group Discussion) study designs involving field epidemiological, molecular epidemiologic and sociological qualitative methods. The scale of the Chinese MDR-TB problem juxtaposed with rising HIV rates and the emergence of XDR-TB underscores the need to conduct field studies aimed at identifying both proximal and distal factors fueling this epidemic. MDR-TB is associated with high morbidity and mortality. Globally, China bears the largest number of MDR-TB cases that is more severe in rural areas. This scenario can worsen as the HIV rates increase. It is imperative to find not only biological factors but also social factors that more distally fuel this ongoing epidemic. Results of this study can contribute directly to improving TB control strategies aimed at reducing MDR-TB.

描述（由申请人提供）：结核病（TB）仍然是全球发病率和死亡率的主要原因之一。这种致命疾病的治疗和控制越来越受到抗Mutltidrug（MDR）的出现和最近广泛的抗药性（XDR）结核分枝杆菌病（TB的病原体）的抗药性（XDR）菌株。中国承担了结核病的第二大案件负担，以及全球MDR-TB案件的最多案件。通常，在农村地区，中国的结核病情况更为严重。中国的艾滋病毒患病率相对较低，但是迅速增长，可能会导致更多的结核病和MDR-TB。尽管依从性差和/或结核病治疗不足显然参与了抗药性的出现，但该过程很复杂，可能涉及社会经济和其他患者因素。我们假设中国选定区域中MDR-TB的高患病率/发生率与患者的社会经济状况（例如贫困，获得医疗保健）成反比，除了医学（例如先前的TB，HIV）和细菌（例如，药物抗药性基因型）因素。我们的总体目的是描述中国农村地区的MDR-TB状况，并定义有助于持续的MDR-TB流行的社会或医疗决定因素。我们提出1）表征在较高的特有结核病的明确定义的中国农村人口中，耐药结核病（包括MDR-TB）的自然分布； 2）进行一项病例对照研究，以确定与MDR-TB相关的生物医学和社会决定因素； 3）描述中国农村抗药性结核病的传播动态。为此，我们将使用横截面，病例对照和定性（焦点小组讨论）研究设计，涉及田间流行病学，分子流行病学和社会学定性方法。中国MDR-TB问题的规模与艾滋病毒率上升并置的XDR-TB的出现强调了进行旨在确定促进这种流行病的近端和远端因素的现场研究。 MDR-TB与高发病率和死亡率有关。在全球范围内，中国拥有最多的MDR-TB病例，而农村地区则更为严重。随着艾滋病毒率的增加，这种情况可能会恶化。必须不仅要找到生物学因素，而且还必须找到这种持续流行的社会因素。这项研究的结果可以直接有助于改善旨在减少MDR-TB的结核病控制策略。