TB fast track: effect of a point-of-care TB test-and-treat algorithm on early mortality in people with HIV accessing ART

结核病快速通道：护理点结核病检测和治疗算法对接受抗逆转录病毒治疗的艾滋病毒感染者早期死亡率的影响

• 批准号: G1100689/1
• 负责人: Alison Grant
• 金额: $ 408.07万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2012
• 资助国家: 英国
• 起止时间: 2012 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=G1100689%2F1
• 关键词: TB; fast; track; effect; point

Treatment for HIV (antiretroviral therapy, or ART), has greatly reduced death rates among people with HIV worldwide. However in low-resource settings, death rates continue to be high even for people taking ART, particularly in the first few months on treatment. Tuberculosis (TB) is the most important cause of these early deaths, and people who are due to start ART are recommended to be screened for TB first. However, TB is hard to diagnose because the tests which are most widely available do not work well for people with HIV. As a result, people with HIV may have to go through lots of tests for TB, which delays the start of TB treatment; it also delays the start of ART. Both of these delays increase the risk that the patient dies. We propose a study to try to reduce this high death rate. In 20 primary care clinics in South Africa, we will enrol people with advanced HIV who have come to start ART to our study. In 10 of the clinics (intervention), selected at random, we will use simple, inexpensive tests (a new urine test for TB, weight and height, and a blood test for anaemia) which can be done on site with immediate results, to identify those patients who are at highest risk of having TB, and of dying early. People who are high risk will start TB treatment straight away, then ART as soon as possible afterwards; people who are low TB risk will start ART straight away. People with medium TB risk will be given antibiotics while a chest X-ray and sputum (spit) test for TB are done, and will come back after a week to decide if they should start TB treatment followed by ART, or just start ART. At the other 10 (control) clinics, patients will be looked after in the normal way, following national guidelines. We will follow all patients up for 6 months. We will compare the death rate at 6 months in the 10 intervention clinics, using our new approach, to death rates in the 10 control clinics, using the routine approach. If our new approach reduces the death rate, clinics throughout low resource settings could use this low-cost strategy to save lives among people with HIV.

艾滋病毒治疗（抗逆转录病毒疗法，或ART）大大降低了全世界艾滋病毒感染者的死亡率。然而，在资源匮乏的情况下，即使是接受抗逆转录病毒疗法的人，死亡率仍然很高，特别是在接受治疗的头几个月。结核病（TB）是这些早期死亡的最重要原因，建议开始ART的人首先进行结核病筛查。然而，结核病很难诊断，因为最广泛使用的测试对艾滋病毒感染者效果不佳。因此，艾滋病毒感染者可能不得不接受大量的结核病检测，这推迟了结核病治疗的开始，也推迟了抗逆转录病毒治疗的开始。这两种延迟都增加了患者死亡的风险。我们提出一项研究，试图降低这一高死亡率。在南非的20个初级保健诊所，我们将招募已经开始ART的晚期HIV患者参加我们的研究。在随机选择的10个诊所（干预）中，我们将使用简单、廉价的测试（一种新的结核病、体重和身高尿液测试，以及贫血血液测试），这些测试可以在现场进行，并立即产生结果，以确定哪些患者患结核病和早逝的风险最高。高风险的人将立即开始结核病治疗，然后尽快进行抗逆转录病毒治疗;低风险的人将立即开始抗逆转录病毒治疗。有中等结核病风险的人将在进行胸部X光和痰液（唾液）结核病测试时给予抗生素，并将在一周后回来决定他们是否应该开始结核病治疗，然后进行ART，或者只是开始ART。在其他10个（对照）诊所，患者将按照国家指南以正常方式接受治疗。我们将对所有患者进行为期6个月的随访。我们将比较10个干预诊所6个月时的死亡率，使用我们的新方法，以及10个对照诊所的死亡率，使用常规方法。如果我们的新方法降低了死亡率，那么资源匮乏地区的诊所就可以使用这种低成本策略来挽救艾滋病毒感染者的生命。