TB IN IV DRUG ABUSERS--A THREE-CITY STREET-BASED STUDY

这项多点研究将在外地人群中进行结核病(TB)研究 从三个社区招募的吸毒者期间注射治疗(IDU) 在美国西部：旧金山湾区、波特兰和丹佛。 具体的研究目标是确定：(1) 按地区、性别、种族/民族、 年龄和HIV感染状况；(2)新发M。 结核感染，如结核菌素皮试转换所示； (3)与结核病感染有关的行为和人口统计因素，包括 无家可归、监禁和吸毒模式；(4) 注射吸毒者的皮肤试验无反应，按艾滋病毒状态和免疫水平划分 抑制(反映在DC4+淋巴细胞计数)；和(4)行为 皮试无能的相关因素。这份提案中的所有三个地点都是 目前正在进行基于社区的注射吸毒者研究，包括 访谈和艾滋病毒抗体检测；结核病研究将被整合 这些现有的项目。在这项为期三年的研究中， 我们将用纯化的蛋白衍生物进行结核菌素皮肤测试 (PPD)符合我们纳入标准的1633名静脉吸毒者；所有PPD阴性的静脉吸毒者 将通过接受助推器皮肤测试来确认这一结果 一个月后。157名感染艾滋病毒的注射者和一个随机的 将对314名艾滋病毒阴性注射吸毒者的样本进行皮试无效性评估 使用两种标准对照(皮肤癣菌和腮腺炎)；CD4+淋巴细胞 将确定所有艾滋病毒阳性受试者的计数。全部PPD阳性 受试者将被转介进行胸部X光检查和其他医学评估 以确定是否存在活动性结核病以及(如果不存在) 预防性抗结核治疗指征。所有PPD阴性的注射吸毒者 将在六个月后接受另一次结核菌素皮肤测试以进行随访 寻找新的结核分枝杆菌感染病例。PPD阴性受试者来自 旧金山将在12点和12点后接受额外的结核病筛查 18个月的随访期。除了满足研究人员的要求 上述目标，这项研究将建立一个结核病模型 检测注射吸毒者和社区中其他难以接触的人群- 基于设置。

This multi-site study will conduct for tuberculosis (TB) among out-of- treatment injection during users (IDUs) recruited from three communities in the western U.S.: The San Francisco Bay Area, Portland and Denver. Specific research objectives are to determine: (1) The prevalence of Mycobacterium tuberculosis infection by region, gender, race/ethnicity, age and HIV-infection status; (2) The incidence of the new M. tuberculosis infection, as indicated by tuberculin skin test conversions; (3) Behavioral and demographic correlates of TB infection, including homelessness, incarceration and drug use patterns; (4) The prevalence of skin test anergy among IDUs, by HIV-status and level of immune suppression (as reflected in DC4+ lymphocyte count); and (4) Behavioral correlates of skin test anergy. All three sites in this proposal are currently conducting community-based studies of IDUs which include interviews and HIV-antibody testing; studies for TB will be integrated with these existing projects. Over the course of this three-year study, we will perform tuberculin skin tests with purified protein derivative (PPD) on 1633 IDUs who meet our inclusion criteria; all PPD-negative IDUs will have this result confirmed by receiving a booster skin test one month later. One hundred fifty-seven HIV-infected IDUs and a random sample of 314 HIV-negative IDUs will be evaluated for skin test anergy using two standard controls (dermatophyton and mumps); CD4+ lymphocyte counts will be determined on all HIV-positive subjects. All PPD-positive subjects will be referred for chest X-rays and other medical evaluation to determine if active tuberculosis is present and (if not) whether preventive antituberculous therapy is indicated. All PPD-negative IDUs will receive another tuberculin skin test after six months to follow-up to look for new M. tuberculosis infections. PPD-negative subjects from San Francisco will receive additional screening for TB after twelve and eighteen months of follow-up. In addition to meeting the research objectives described above, this study will establish a model for TB testing of IDUs and other difficult-to-access populations in community- based settings.