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).

项目概要 2035 年终结结核病战略的一个重要组成部分是开发改进的 以前未确诊的结核病的主动病例发现（ACF）方法。最多 国家结核病控制规划进行的 ACF 以检测为基础 远程感染但新诊断的结核病病例的家庭接触者 (HC) 疾病。这种方法通常可以检测出 2-4% 的先前未诊断的结核病 HC。 我们建议在测试 HC 的基础上测试一种全新的 ACF 方法 最近获得和新诊断出结核感染的青少年。这种创新的 ACF 方法的优点是，由于感染是最近获得的，因此 源病例可能仍属于新 IGRA 转炉的密切接触者。为了 因此，我们假设多达 50% 的病例将被发现为源病例。 这些新的转换器。 该方法基于我们最近 3 年系列测试研究的结果 坦桑尼亚 650 名青少年学童感染结核病。该研究基于 使用干扰素γ释放测定（IGRA）进行年度结核感染检测。 我们证明这种测试是可行的，并检测到年增长率为 2.9% 感染。 在拟议的新 5 年研究中，我们将进行基线 IGRA 测试 对 1200 名坦桑尼亚青少年进行了第四季度 IGRA 测试 x4，预计结果为 1020 基线时 IGRA 呈阴性的人。我们预计会发现新的结核感染 （IGRA 转换为正）在 50 名参与者中。然后我们将测试他们的 200 个 家庭和其他密切接触者（统称为他们的密切接触者，CC）并预测 我们将在至少 25 或 这 50 例新的青少年感染者中的 50%。新发结核病的预测率 因此，CC 之间的检测率为 25/200 或 12.5%，比普通检测高 3-6 倍 目前检测结核病患者 HC 的方法。成本效益将是 与国家计划当前使用的方法进行了分析和比较 结核病和麻风病。 成功完成拟议的研究并取得假设的结果 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即时护理 IGRA 测试将使系列化 在低收入国家的计划层面测试可行性和经济性。 该研究将通过综合 DarDar 进行 研究计划是穆辛比利大学长达 20 年的研究合作 健康与相关科学（MUHAS，坦桑尼亚）和盖塞尔医学院 达特茅斯（美国），将包括两名具有广泛经验的流行病学顾问 评估结核病控制计划的经验（Horsburgh、Whalen）。