INnovative data Science to Impact the TB Epidemic - INSITE

创新数据科学影响结核病流行 - INSITE

• 批准号: 10749076
• 负责人: Emma Kate Kalk
• 金额: $ 24.48万
• 依托单位: UNIVERSITY OF CAPE TOWN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749076
• 关键词: Address; Affect; Africa; Age; Algorithms; Anemia; Antimycobacterial Agents; Asphyxia; Cause of Death; Cessation of life; Childhood; Client; Clinical; Clinical Data; Clinical Management; Clinical Services; Code; Data; Data Science; Diagnosis; Discipline; Disease; Disease Outcome; Drug Combinations; Drug Interactions; Drug resistance; Drug resistance in tuberculosis; Effectiveness; Environment; Epidemic; Epidemiology; Feedback; Fluoroquinolones; Funding; Geography; Gestational Age; Government; Guidelines; HIV; HIV therapy; HIV/TB; Health; Health Information System; Health Services; Hospitalization; Human; Incidence; Individual; Infant; Infant Health; Infectious Disease Epidemiology; Intelligence; Intervention; Laboratories; Lactation; Linezolid; Link; Low Birth Weight Infant; Maternal Health; Maternal Health Services; Modeling; Monitor; Morbidity - disease rate; Mothers; Outcome; Patients; Pattern; Patterns of Care; Perinatal; Perinatal Infection; Persons; Pharmaceutical Preparations; Pharmacy facility; Policies; Population; Positioning Attribute; Postpartum Period; Pre-Eclampsia; Predisposition; Pregnancy; Pregnancy Outcome; Prevalence; Prevention; Preventive therapy; Process; Prophylactic treatment; Province; Public Health; Public Sector; Regimen; Relative Risks; Reporting; Research; Retreatment; Rifampicin resistance; Risk; Risk Factors; Safety; Services; South Africa; Spontaneous abortion; Techniques; Therapeutic Agents; Therapeutic Intervention; Time; Tuberculosis; United States National Institutes of Health; Universities; Woman; Work; adverse outcome; antenatal; antiretroviral therapy; burden of illness; care outcomes; child bearing; clinically actionable; co-infection; cohort; community engagement; comorbidity; dashboard; data centers; data harmonization; data infrastructure; data integration; data management; disease transmission; drug repurposing; electronic data; electronic health data; fluoroquinolone resistance; health data; health service use; high risk; infant outcome; innovation; maternal outcome; mortality; novel; novel therapeutics; perinatal HIV; phenotyping algorithm; pregnancy health; pregnant; premature; programs; screening; stillbirth; tool; transmission process; tuberculosis treatment

PROJECT SUMMARY There are limited opportunities in Africa to work with routine clinical and health data at scale, and to develop the expertise to process these data in an environment in which both the burden of disease and the approach to enumeration and coding are very different to other settings where routine data are exploited for epidemiological analyses. Tuberculosis disease (TB) is the most important HIV-associated comorbidity in South Africa and the leading cause of death in people living with HIV (PLH). Maternal TB (pregnancy and postpartum period) deleteriously affects morbidity and mortality in women and infants. Pregnancy outcomes are worse, exacerbated by HIV co-infection which is present in 60%, and there is increased risk of perinatal TB and HIV transmission. Rifampicin-resistant (RR)-TB with/without fluoroquinolone resistance is a growing global public health concern with prevalence rates at 4.2% of TB cases in the Western Cape Province, South Africa. South Africa was prompt to include novel and repurposed second-line therapeutic agents against RR-TB in routine guidelines, including pregnant and lactating people. The safety of these agents during pregnancy and lactation is uncertain but the rising incidence of RR-TB has seen the use of these agents during pregnancy at scale. The concomitant use of antiretroviral therapy (ART) for HIV treatment raises concerns about potential drug-drug interactions with safety and efficacy implications. Maternal TB remains under-prioritized globally despite the burden of HIV and TB in those of child-bearing age. In this context of high infectious burden in which novel/repurposed anti-mycobacterial agents for the prevention and treatment of TB are used at scale during pregnancy, often co-administered with ART, the Western Cape is uniquely positioned in hosting the Provincial Health Data Centre (PHDC), the first comprehensive linked health information exchange in Africa. The PHDC leverages the use of a province-wide unique patient identifier issued to users of the health services to harmonise all electronic health data from routine health information systems in public sector facilities, including laboratory, pharmacy, administrative and other clinical data. These data are integrated and curated to enable inference of health conditions using phenotype algorithms, as well as to enable the consolidation of co-morbidities and construction of patient-level cascades that can be used to monitor and analyse health service utilisation patterns and healthcare outcomes. The partnership between the Centre for Infectious Disease Epidemiology & Research, University of Cape Town and the Health Intelligence Directorate of the Western Cape Government which houses the PHDC offers a unique opportunity to develop and evaluate a robust maternal TB data platform, using data science to i) create actionable clinical tools to optimize person-level interventions and monitor programs; ii) generate large, linked cohorts to address the epidemiological questions of maternal TB and assess the impact of policy interventions and clinical tools at the population and individual levels.

项目概要 在非洲，大规模处理常规临床和健康数据以及开发 在疾病负担和治疗方法都受到影响的环境中处理这些数据的专业知识 枚举和编码与利用常规数据进行流行病学研究的其他环境有很大不同 分析。结核病（TB）是南非最重要的艾滋病毒相关合并症，也是南非最重要的艾滋病毒相关合并症。 艾滋病毒感染者 (PLH) 死亡的主要原因。孕产妇结核病（怀孕和产后） 严重影响妇女和婴儿的发病率和死亡率。怀孕结果更差、更严重 HIV 合并感染的比例为 60%，围产期结核病和 HIV 传播的风险增加。 具有/不具有氟喹诺酮耐药性的利福平耐药 (RR)-TB 是一个日益严重的全球公共卫生问题 南非西开普省结核病患病率为 4.2%。南非很及时 将针对 RR-TB 的新型和重新利用的二线治疗药物纳入常规指南，包括 怀孕和哺乳期的人。这些药物在怀孕和哺乳期间的安全性尚不确定，但 RR-TB 发病率的上升导致妊娠期间这些药物的大规模使用。伴随使用 用于艾滋病毒治疗的抗逆转录病毒疗法（ART）引发了对潜在药物间相互作用和安全性的担忧 和功效影响。尽管艾滋病毒和结核病给全球带来了负担，但孕产妇结核病在全球范围内仍然没有受到重视。 那些处于育龄期的人。 在这种高感染负担的背景下，新型/重新利用的抗分枝杆菌药物用于预防 在怀孕期间大规模使用结核病和治疗，通常与抗逆转录病毒疗法同时使用，西开普省 拥有独特的优势，托管省级健康数据中心 (PHDC)，这是第一个综合性的互联健康 非洲信息交流。 PHDC 利用发布的全省唯一患者标识符 卫生服务的用户需要协调来自常规卫生信息系统的所有电子卫生数据 公共部门设施，包括实验室、药房、行政和其他临床数据。这些数据是 集成和策划，以便能够使用表型算法推断健康状况，并能够 合并症的整合和患者级联的构建可用于监测和 分析卫生服务利用模式和医疗保健结果。 开普敦大学传染病流行病学与研究中心之间的合作伙伴关系 PHDC 所在的西开普省政府健康情报局提供了 开发和评估强大的孕产妇结核病数据平台的独特机会，利用数据科学 i) 创建 用于优化个人干预和监测计划的可行临床工具； ii) 生成大的、链接的 队列研究解决孕产妇结核病的流行病学问题并评估政策干预的影响 以及人群和个人层面的临床工具。