Improving the control of multidrug-resistant tuberculosis through targeted screening and use of novel anti-tuberculosis drugs

通过针对性筛选和使用新型抗结核药物提高耐多药结核病的控制

• 批准号: 9109823
• 负责人: Reza YAESOUBI
• 金额: $ 13.1万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-15 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9109823
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adopted; Antibiotic Resistance; Antibiotics; Biological; Collaborations; Communicable Diseases; Communities; Complex; Computer Simulation; Conflict (Psychology); Consensus; Cost Effectiveness Analysis; Country; Data; Detection; Development; Diagnosis; Diagnostic tests; Doctor of Philosophy; Drug resistance; Early Diagnosis; Effectiveness; Employee Strikes; Employment; Epidemic; Epidemiology; Equilibrium; Goals; Guidelines; Health Policy; Household; Incidence; Interdisciplinary Study; Intervention; Investigation; K-Series Research Career Programs; Life; Measures; Mentors; Mentorship; Methods; Modeling; Moldova; Multidrug-Resistant Tuberculosis; New Agents; Notification; Patient-Focused Outcomes; Patients; Performance; Peru; Pharmaceutical Preparations; Phenotype; Policies; Population; Prevalence; Probability; Public Health; Public Health Schools; Quality-Adjusted Life Years; Regimen; Research; Resistance; Resource Allocation; Resources; Science; Scientist; Solid; Structure; System; Techniques; Time; Training; Treatment Protocols; Tuberculosis; Update; Work; bacterial resistance; base; care delivery; case finding; cost; cost effective; disease natural history; disease transmission; falls; global health; improved; infectious disease model; intervention effect; microbial disease; mid-career faculty; mortality; novel; novel diagnostics; novel therapeutics; population health; professor; programs; public health relevance; response; scale up; screening; simulation; skills; therapy design; tool; transmission process; tuberculosis drugs; tuberculosis treatment; years of life lost

 DESCRIPTION (provided by applicant): This proposal presents a four-year research career development award for Dr. Reza Yaesoubi, an Assistant Professor in the Department of Health Policy and Management at the Yale School of Public Health (YSPH). His proposal aims to address important policy questions to control the ongoing spread of multidrug-resistant tuberculosis (MDR-TB) strains, which are resistant to essential antibiotics included in the first-line TB treatment regimen. While global efforts to scale up the diagnosis and treatment of MDR-TB and confront the growing problem of drug resistance have been slow moving, the recent introduction of new tools to control the threat of MDR-TB offer promise to accelerate the response. These new tools include rapid diagnostic tests for drug resistance and the novel anti-TB drugs. This proposal describes a rigorous, model-based investigation to identify strategies that can maximize the beneficial impact of these novel tools for TB and MDR-TB control. To study the overall impact of different control policies on MDR-TB spread, the candidate will develop detailed mathematical and simulation models of TB epidemics and calibrate them using data from two high MDR-TB prevalence countries, Peru and The Republic of Moldova (Aim 1). The candidate will then use these models to i) identify cost-effective, adaptive policies which use updated epidemiological information to guide targeted screening for TB and MDR-TB (Aim 2); and ii) identify drug-introduction policies that maximize the societal benefits of novel anti-T drugs and regimens while minimizing the probability of the emergence of antibiotic resistance (Aim 3). The proposed work will be conducted under the co-mentorship of Dr. Ted Cohen, MD, MPH, DrPH, Associate Professor of Epidemiology of Microbial Diseases at YSPH, and Dr. A. David Paltiel, PhD, MBA, Professor of Public Health, and Health Policy and Management at YSPH, and will be done in collaboration with the Center for Interdisciplinary Research on AIDS, the Center for Infectious Disease Modeling at YSPH, and the Center for Communicable Disease Dynamics at the Harvard School of Public Health (HSPH).The candidate will also be advised by Dr. Marc Lipsitch, DPhill, Professor of Epidemiology at HSPH and Dr. Joshua Salomon, PhD, Professor of Global Health at HSPH. Dr. Yaesoubi's training goals are (1) to develop a solid understanding of the dynamics of infectious diseases and the biological mechanisms governing the emergence of resistant bacteria, in particular MDR-TB, (2) to become an expert in methods for modeling complex multi-agent systems and optimizing the overall performance of these systems through the efficient allocation of available resources, and (3) to improve his mentoring, management, and collaboration skills that are essential for his successful transition to independence. The candidate's long-term goal is to become an independent scientist developing and applying decision science techniques to improve policies for the management and eradication of infectious diseases.

 描述（由申请人提供）：该提案为耶鲁大学公共卫生学院 (YSPH) 卫生政策与管理系助理教授 Reza Yaesoubi 博士提供了为期四年的研究职业发展奖。他的提案旨在解决重要的政策问题，以控制耐多药结核病（MDR-TB）菌株的持续传播，这些菌株对一线结核病治疗方案中包含的基本抗生素具有耐药性，同时全球努力扩大结核病的诊断和治疗。耐多药结核病和日益严重的耐药性问题一直进展缓慢，最近推出的控制耐多药结核病威胁的新工具有望加快应对速度，这些新工具包括快速耐药性诊断测试和新型药物。该提案描述了一项严格的、基于模型的调查，以确定可以最大限度地发挥这些新工具对结核病和耐多药结核病控制的有益影响的策略，以研究不同控制政策对耐多药结核病传播的总体影响。 ，候选人将开发详细的 TB 数学和模拟模型候选人将使用这些模型来 i) 确定具有成本效益的适应性政策，并使用最新的流行病学信息来指导。有针对性地筛查结核病和耐多药结核病（目标 2）；以及 ii) 确定药物引进政策，最大限度地发挥新型抗 T 药物和治疗方案的社会效益，同时最大限度地减少出现抗生素耐药性的可能性（目标3) 拟议的工作将在 YSPH 微生物疾病流行病学副教授 Ted Cohen 博士（MD、MPH、DrPH）和 A. David Paltiel 博士（博士、MBA、教授）的共同指导下进行。 YSPH 的公共卫生、卫生政策和管理，将与艾滋病跨学科研究中心、YSPH 传染病模型中心和传染病中心合作完成哈佛大学公共卫生学院 (HSPH) 疾病动力学。该候选人还将得到 HSPH 流行病学教授 Marc Lipsitch 博士和 Yaesoubi 博士全球健康教授 Joshua Salomon 博士的建议。培训目标是 (1) 深入了解传染病的动态以及控制耐药细菌（特别是耐多药结核病）出现的生物机制，(2) 成为建模方法方面的专家复杂的多智能体系统，并通过有效的可用资源优化这些系统的整体性能，以及（3）提高他的指导、管理和协作技能，这对于他成功过渡到长期独立至关重要。目标是成为一名独立科学家，开发和应用决策科学技术来改进管理和根除传染病的政策。