Transmission Of Tuberculosis Among illicit drug use Linkages (TOTAL)

项目概要/摘要 结核病（TB）是全球主要的传染病杀手，也是结核病患者死亡的主要原因。 艾滋病。降低结核病发病率和死亡率的最有效方法是阻断传播。但这 需要及早发现和治疗结核病患者。目前的主要方法是寻找病例- 家庭接触追踪-在高负荷环境下识别<20%的传输， 迫切需要确定发生结核病传播的新群体和环境。非法药物使用与 结核病感染率和发病率较高，可能是由于群体内传播严重 和/或集群脆弱性。因此，对结核病传播的非法药物使用网络的调查仍然有效 作为早期病例识别和与治疗联系的目标的巨大潜力， 传播到更广泛的人群。波士顿医学中心，斯泰伦博斯大学， 南非医学研究理事会、波士顿大学公共卫生学院和德斯蒙德·图图 艾滋病毒基金会建议进行第一项研究，以评估非法药物使用中的结核病风险和疾病负担 在结核病/艾滋病高发的环境中建立一个网络，并确定在这一人群中加速传播的机制。 我们将采用受试者驱动的抽样方法，招募750名吸烟者，包括艾滋病患者和非艾滋病患者 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，以估计该网络中的病例比例， 最近的传输。我们将捕捉咳嗽频率，并使用新的生物气溶胶采样技术， 比较吸食非法药物的人与吸食非法药物的人之间的传染性生理特征， 那些没有的人。这项研究的知识将为一项新的、有针对性的结核病防治战略提供基础 在吸食非法药物者中的传播，并提供对这种传播在多大程度上助长了 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。

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.