Tracking tuberculosis patients in Ukraine to understand pathways through care and the impact of geographic movements

追踪乌克兰的结核病患者，了解护理途径以及地理流动的影响

• 批准号: 10286912
• 负责人: Helen E. Jenkins
• 金额: $ 8.25万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-07 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10286912
• 关键词: Accounting; Adherence; Caring; Cessation of life; Clinical; Collection; Communicable Diseases; Country; Data; Data Collection; Data Set; Data Storage and Retrieval; Data Store; Databases; Development; Diagnosis; Disease; Disease Progression; Drug resistance; Drug resistance in tuberculosis; Epidemic; Epidemiology; Europe; Evaluation; Financial cost; Frequencies; Geographic Locations; Geography; Goals; HIV; HIV/TB; Health Policy; Health Professional; Heterogeneity; Hot Spot; Incidence; Individual; Infection; Intervention; Laboratories; Length; Location; Longitudinal cohort; Maps; Methods; Migrant; Mission; Modeling; Moldova; Monitor; Morbidity - disease rate; Movement; Natural History; Nature; Outcome; Pathway interactions; Patients; Pattern; Policy Maker; Poliomyelitis; Population; Prevalence; Public Health; Recording of previous events; Regimen; Relapse; Research; Resistance development; Resistance profile; Rifampicin resistance; Smallpox; South Africa; Test Result; Time; Treatment Protocols; Treatment outcome; Tuberculosis; USSR; Ukraine; United States National Institutes of Health; Variant; Work; World Health Organization; co-infection; cohort; design; disorder risk; drug development; follow-up; global health; improved; improved outcome; infection burden; innovation; migration; mortality; novel diagnostics; population movement; prevent; programs; surveillance data; transmission process; tuberculosis diagnostics; tuberculosis drugs; tuberculosis treatment

PROJECT SUMMARY Tuberculosis (TB) caused 1.45 million deaths globally in 2018. Given that TB incidence is decreasing by only 2% annually, achieving the World Health Organization’s ENDTB goal of TB elimination by 2050 will require innovations in our TB control approach. Previous elimination strategies for other diseases were only successful once spatial variation in disease incidence was identified and locally relevant interventions implemented. TB elimination strategies require longitudinal TB cohorts that incorporate detailed spatial information. Ukraine is an ideal setting for our proposal with its high rifampin resistant (RR) TB burden (eighth highest globally), one third of Europe’s HIV/TB co-infected cases, centralized collection of demographic, laboratory, clinical and spatial data on all patients diagnosed with TB nationally (“eTB Manager”), and generalizability of results to other Former Soviet Union (FSU) countries. We will develop a six-year national TB cohort to track patients longitudinally and spatially including TB drug resistance and HIV status data, using eTB Manager. We hypothesize that eTB Manager data can be used to identify key metrics in the TB care cascade, at the district level, and evaluate the association between population movement and TB/RRTB care cascade gaps and burden. In aim 1a, we will compile a six-year cohort of ~180,000 TB patients diagnosed in Ukraine 2015-2020. In aim 1b, we will estimate key metrics in the TB care cascade and treatment pathways stratified by drug resistance profiles and HIV status. In aim 1c, we will examine the TB care cascade by district to identify spatial variation in care cascade metrics. In aim 2, we will map patient movements and understand the relationship between movements and key care cascade metrics and TB outcomes, stratified by drug resistance profile and HIV status. In aim 2, we will also quantify the association between population movement and TB/RRTB burden, allowing for development of targeted interventions to reduce TB morbidity and mortality. This contribution is significant because it will develop a national six-year cohort of TB patients tracking them longitudinally and spatially during treatment, enabling local public health professionals to develop locally appropriate interventions to close gaps in the TB care cascade and understand the impact of interventions and new TB diagnostics. The proposed work is innovative because it will provide the first cohort of this kind in a FSU country, with the longitudinal and spatial nature of these data allowing for unique assessment of TB care and the impact of interventions. This will allow policy makers to design locally-relevant interventions targeting specific gaps in TB care and migrant populations, preventing further spread and ultimately reducing disease and mortality due to TB. By using routinely collected data, our model adds minimal financial costs and can be adapted for similar settings with routinely-collected TB data. This work will lead to an R01 proposal to evaluate interventions that can close TB care cascade gaps, improve outcomes and mitigate the impact of population movement on the spread of TB and RRTB in Ukraine.

项目摘要 结核病（TB）在2018年全球造成145万人死亡。鉴于结核病的发病率仅减少 每年2％，到2050年实现世界卫生组织消除结核病的目标的目标 我们的结核病控制方法的创新。以前针对其他疾病的消除策略仅成功 一旦确定了疾病事件的空间变化并实施了局部相关的干预措施。 TB 消除策略需要纵向结核群体，并包含详细的空间信息。乌克兰是一个 我们的提案具有高利福平（RR）TB Burnen（全球排名第八）的理想设置，三分之一 欧洲的艾滋病毒/结核病共同感染案例，集中的人口，实验室，临床和空间收集 有关所有被诊断为全国结核病患者（“ ETB管理器”）的数据，以及结果对其他患者的推广性 前苏联（FSU）国家。我们将开发一个为期六年的国家结核病队列来跟踪患者 使用ETB Manager，在纵向和空间上包括TB药物抗性和HIV状态数据。我们 假设可以使用ETB Manager数据来识别该地区TB Care Cascade中的关键指标 水平，并评估人口运动与TB/RRTB护理级联差距之间的关联以及 负担。在AIM 1A中，我们将编译六年的六年组，其中约180,000名在乌克兰2015 - 2020年被诊断出的结核病患者。 在AIM 1B中，我们将估算TB护理级联和通过药物分层的治疗途径的关键指标 抵抗和艾滋病毒状况。在AIM 1C中，我们将检查区域的结核病护理级联以确定空间 护理级联指标的变化。在AIM 2中，我们将绘制患者运动并了解关系 在运动和关键护理级联指标和结核病结果之间，通过耐药性概况分层 艾滋病毒状况。在AIM 2中，我们还将量化人口运动与TB/RRTB之间的关联 负担，允许开发有针对性的干预措施，以降低结核病的发病率和死亡率。这 贡献很大，因为它将发展一个全国六年的结核病患者，跟踪他们 在治疗期间纵向和空间上，使当地的公共卫生专业人员能够在当地发展 适当的干预措施以弥合结核病护理级联的差距，并了解干预措施的影响 新的结核病诊断。拟议的工作具有创新性，因为它将在 FSU国家，具有这些数据的纵向和空间性质，允许对结核病护理进行独特的评估 以及干预措施的影响。这将使政策制定者可以设计针对本地的干预措施 结核病护理和移民种群中的特定差距，防止进一步扩散并最终减少疾病 和由于结核病引起的死亡率。通过使用常规收集的数据，我们的模型增加了最低的财务成本，可以是 使用常规收集的结核病数据适用于类似的设置。这项工作将导致R01提议评估 可以缩小结核病护理级联差距，改善结果并减轻人口影响的干预措施 TB和RRTB在乌克兰传播的运动。