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筛查的关键人群。接受结核病治疗的人复发率很高。最近对印度公共部门医院结核病治疗级联的分析估计，在完成治疗一年后，不到40%的病例没有结核病，印度每年报告的结核病中多达13%是复发性结核病。此外，印度是世界上估计300万未发现结核病病例的三分之一。因此，针对最近治疗的结核病例的主动病例发现（ACF）方法可能是减少全球结核病负担的有效策略。印度国家结核病控制计划（RNTCP）消除结核病的新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建议，在接受治疗的结核病患者中筛查复发性结核病是一种“有条件的建议”;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，以检测复发性TB，并提供实施和扩展首选干预措施所需的证据。在目标1中，我们将进行一项随机试验，以测量RNTCP目前正在考虑的两种可能实施的策略在印度检测复发性结核病的比较有效性：家庭ACF（HHACF）与ACF通过定期电话访谈（TACF），然后对接受治疗的结核病患者及其HH接触者中报告任何症状成员的HH进行HH筛查。在目标2中，我们将使用RE-AIM框架来了解实施这两种干预措施的障碍和促进因素，并确定干预措施最适合的亚人群和可能从干预措施中受益最多的亚人群。我们将通过深入探索三个关键利益相关者群体（结核病患者、HH成员和医疗保健人员）对策略的可接受性来增强RE-AIM方法，以优化实施。在目标3中，我们将模拟试验中评估的ACF干预措施的影响和成本效益，以及这些干预措施的靶向和时机的潜在替代策略。我们将使用试验数据来模拟和比较ACF在预期诊断率、成本效益和对印度结核病控制影响方面的潜在策略。结核病后果将回答结核病社区一旦完成治疗后经常忽视的人群中的关键问题，尽管他们有相当大的复发结核病的风险。我们将提供证据，为一个有效的和可扩展的战略，目标为结核病治疗病例的高危人群，一个高度优先的RNTCP。我们的高结核病负担环境，强大的多学科团队，与RNTCP和国家结核病计划的沟通，以及经过验证的研究基础设施，确保结核病后果的成功实施。

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.