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.

项目总结 2018年，结核病在全球造成145万人死亡。鉴于结核病发病率仅下降了 每年2%，实现世界卫生组织到2050年消除结核病的EndTB目标将需要 我们结核病控制方法的创新。以前针对其他疾病的消除策略只取得了成功 一旦确定了疾病发病率的空间差异并实施了当地相关的干预措施。结核病 消除战略需要包含详细空间信息的纵向结核病队列。乌克兰是一个 我们提案的理想环境是其高耐利福平(RR)结核病负担(全球第八高)，三分之一 欧洲艾滋病毒/结核病合并感染病例，集中收集人口、实验室、临床和空间数据 全国所有确诊为结核病患者的数据(“eTB管理者”)，以及结果对其他人的普适性 前苏联(FSU)国家。我们将制定一个为期六年的全国结核病队列来跟踪患者 使用eTB Manager，纵向和空间上包括结核病耐药性和艾滋病毒状况数据。我们 假设eTB Manager数据可用于在该地区确定结核病护理级联中的关键指标 水平，并评估人口流动与结核病/活动性肺结核之间的级联差距和 负担。在目标1a中，我们将汇编2015-2020年乌克兰确诊的约18万名结核病患者的六年队列。 在目标1b中，我们将评估结核病护理级联中的关键指标和按药物分层的治疗途径 耐药情况和艾滋病毒状况。在目标1c中，我们将按地区研究结核病护理级联，以确定空间 护理级联指标的变化。在目标2中，我们将绘制患者的活动图并了解它们之间的关系 转移和关键护理级联指标和结核病结局之间的关系，按耐药状况和 艾滋病毒状况。在目标2中，我们还将量化人口流动与结核病/结核病之间的联系。 负担，从而能够制定有针对性的干预措施，以降低结核病发病率和死亡率。这 贡献是巨大的，因为它将建立一个全国六年结核病患者队列跟踪他们 在治疗期间的纵向和空间上，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，以填补结核病护理级联中的差距，并了解干预措施和 新的结核病诊断方法。拟议的工作具有创新性，因为它将在 FSU国家/地区，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。这将使政策制定者能够设计与当地相关的干预措施 结核病护理和流动人口方面的具体差距，防止进一步传播并最终减少疾病 以及因结核病而死亡。通过使用常规收集的数据，我们的模型增加了最小的财务成本，并且可以 适用于具有常规收集的结核病数据的类似设置。这项工作将导致R01提案，以评估 能够填补结核病护理级联差距、改善结果和减轻人口影响的干预措施 关于结核病和RRTB在乌克兰传播的行动。