Transmission Of Tuberculosis Among illicit drug use Linkages (TOTAL)

非法药物使用中结核病的传播关联（总计）

• 批准号: 10458601
• 负责人: Karen R Jacobson
• 金额: $ 62.59万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10458601
• 关键词: Alcohol consumption; Boston; Cause of Death; Cessation of life; Characteristics; Clinic; Cluster Analysis; Communicable Diseases; Communities; Contact Tracing; Coughing; Crack Cocaine; Data; Diagnosis; Disease; Disease Outbreaks; Disease Progression; Dormutil; Drug user; Epidemiology; Foundations; Frequencies; Gene Expression Profile; General Population; HIV; HIV Infections; HIV/TB; Household; Illicit Drugs; Incidence; Individual; Infection; Interruption; Intervention; Interview; Investigation; Knowledge; Literature; Marijuana; Medical Research; Medical center; Messenger RNA; Methamphetamine; Methaqualone; Molecular; National Institute of Allergy and Infectious Disease; Opioid; Participant; Persons; Physiological; Population; Prevalence; Prospective Studies; Prospective cohort; Public Health Schools; Reporting; Research Personnel; Respondent; Risk; Sampling; Seeds; Site; Smoke; Smoking; Social Network; South Africa; South African; Study models; Surveys; Techniques; Time; Tobacco; Trees; Tuberculosis; United States National Institutes of Health; Universities; Whole Blood; arm; base; burden of illness; care seeking; case finding; cohort; community transmission; design; disease transmission; disorder risk; epidemiology study; genome sequencing; high risk; illicit drug use; insight; mathematical model; member; mortality; novel; particle; recruit; social contact; transcriptomics; transmission process; whole genome

PROJECT SUMMARY/ABSTRACT Tuberculosis (TB) is the leading infectious disease killer globally and leading cause of death in persons with HIV. The most effective way to reduce TB incidence and mortality is to interrupt transmission. However, this requires finding and treating individuals with TB disease early. The current primary approach to case finding— household contact tracing—identifies <20% of transmissions in high burden settings, leaving a clear and urgent need to identify new groups and settings where TB transmission occurs. Illicit drug use is associated with higher TB infection prevalence and disease incidence, likely due to significant within-group transmission and/or clustered vulnerability. Interrogation of illicit drug use networks for TB transmission, therefore, holds great potential as a target for early case identification and linkage to treatment, with potential benefit for halting transmission to the broader population. Investigators at Boston Medical Center, Stellenbosch University, the South African Medical Research Council, Boston University School of Public Health and the Desmond Tutu HIV Foundation propose to conduct the first study to assess TB risk and disease burden among illicit drug use networks in a high TB/HIV setting and to identify mechanisms for accelerated transmission in this population. We will use respondent driven sampling to recruit 750 individuals, with and without HIV disease, who smoke illicit drugs (methamphetamine and methaqualone) and assess their TB exposure, risk of disease progression, and TB disease burden. Among individuals found to have TB disease, we will leverage whole genome sequencing and social contact interviews to estimate the proportion of cases in this network resultant from recent transmission. We will capture cough frequency and use novel bioaerosol sampling techniques to compare physiologic characteristics of infectiousness between persons who smoke illicit drugs compared to those who do not. Knowledge from this study will provide the basis for a new, focused strategy to interrupt TB transmission in persons who smoke illicit drugs and provide insight into the degree that such transmission fuels overall community spread. These results have potential for generating interventions applicable to many settings where illicit drug use intersects with TB and HIV.

项目概要/摘要 结核病 (TB) 是全球头号传染病杀手，也是结核病患者死亡的主要原因 艾滋病病毒。降低结核病发病率和死亡率的最有效方法是阻断传播。然而，这 需要及早发现并治疗结核病患者。目前案件发现的主要方法—— 家庭接触者追踪——识别高负担环境中 <20% 的传播情况，留下清晰且明确的信息 迫切需要确定发生结核病传播的新群体和环境。非法药物使用有关联 结核病感染率和发病率较高，可能是由于群体内传播显着 和/或集群漏洞。因此，对结核病传播的非法药物使用网络进行调查是正确的 作为早期病例识别和与治疗联系的目标，具有巨大的潜力，并有可能有益于制止 传播给更广泛的人群。斯泰伦博斯大学波士顿医学中心的研究人员 南非医学研究委员会、波士顿大学公共卫生学院和德斯蒙德·图图 艾滋病毒基金会提议开展首项研究，评估非法药物使用中的结核病风险和疾病负担 结核病/艾滋病毒高发地区的网络，并确定在该人群中加速传播的机制。 我们将采用受访者驱动抽样方法招募 750 名吸烟者，无论是否感染艾滋病毒 非法药物（甲基苯丙胺和甲喹酮）并评估他们的结核病暴露、疾病进展的风险， 和结核病负担。在被发现患有结核病的个体中，我们将利用全基因组 排序和社会接触访谈，以估计该网络中由以下原因引起的病例比例 最近的传输。我们将捕获咳嗽频率并使用新颖的生物气溶胶采样技术来 比较吸毒者与吸毒者之间传染性的生理特征 那些不这样做的人。这项研究的知识将为阻断结核病的新的、有针对性的策略提供基础 吸食非法药物者的传播情况，并深入了解这种传播加剧的程度 整体社区传播。这些结果有可能产生适用于许多人的干预措施 非法药物使用与结核病和艾滋病毒交叉的环境。