TB Aftermath

我们的结核病后遗症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进行筛查的关键人群。接受结核病治疗的人有很高的复发率。最近对印度公共部门医院的结核病治疗级联进行的一项分析估计，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，在世界估计的300万未被发现的结核病病例中，印度占三分之一。因此，针对最近治疗的结核病病例的主动病例发现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规划（RNTCP）新的消除结核病战略计划强烈建议制定和实施可扩展的复发性结核病监测系统。世界卫生组织活动性结核病系统筛查指南建议，对已治疗的结核病患者进行复发性结核病筛查是一项“有条件的建议”；有条件只是因为缺乏证据。结核病后果将比较RNTCP目前正在考虑的用于发现复发性结核病的两种ACF战略的有效性、成本效益和可行性，并提供实施和扩大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，以衡量印度RNTCP目前正在考虑用于检测复发性结核病的两种潜在可实施策略的比较有效性：家庭ACF （HHACF）与定期电话访谈（TACF）进行ACF，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卫生保健人员进行健康筛查。在目标2中，我们将使用RE-AIM框架来了解实施这两项干预措施的障碍和促进因素，并确定干预措施最能覆盖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成员和卫生保健人员）对这些战略的可接受性来加强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目标和时机的潜在替代策略。我们将利用该试验的数据对ACF的潜在策略进行建模，并从预期诊断率、成本效益和对印度结核病控制的影响等方面进行比较。结核病后果将回答结核病社区在治疗完成后经常忽视的人群中的关键问题，尽管他们面临结核病复发的相当大风险。我们将为针对已治疗结核病例的卫生保健部门的有效和可扩展战略提供证据，这是RNTCP的一个高度优先事项。我们的高结核病负担环境、强大的多学科团队、与RNTCP和州结核病规划的沟通以及经过验证的研究基础设施确保了结核病善后工作的成功实施。

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.