Directly Observed Therapy(DOT) for TB and HIV in Kenya

描述（由申请人提供）：本研究将主要在肯尼亚的莫伊大学与医学博士Lameck Diero合作进行，作为NIH资助#RO 1 DA 13767的扩展。结核病是全世界H1 V/A1 DS患者死亡的主要原因，是与艾滋病毒一起发生的最早的机会性感染之一，并且是艾滋病毒复制和随后免疫系统恶化的加速剂。在撒哈拉以南非洲，这两种流行病的交叉给那些本已贫困不堪、卫生基础设施落后的国家带来了巨大的发病率和死亡率。关于在这些国家采用抗逆转录病毒疗法治疗艾滋病毒的可行性，辩论十分激烈。然而，已经存在以结核病控制系统的形式提供这种护理的基础设施。直接观察治疗（DOT）是世卫组织推荐的全球结核病控制战略的重要组成部分。DOT是一种护理提供系统，可确保结核病治愈并避免耐药性。结核病和艾滋病毒之间的平行，在需要复杂的多药治疗方案，建议的概念DOT作为一个交付系统，可以成功地适应用于艾滋病毒治疗。本F1 RCA（药物滥用者直接观察HAART（DA 13767-01））的母基金旨在解决美国在HIV感染药物滥用者中使用DOT护理提供系统的问题。该FLRCA将支持肯尼亚埃尔多雷特的一个联合DOT治疗结核病和艾滋病毒的试点可行性项目。这种方法的优点是多方面的：1）。TB通常是将HIV感染患者带到肯尼亚卫生保健系统的前哨事件。2.）的情况。肯尼亚的结核病DOT基础设施已经存在。3.）第三章在肯尼亚，结核病例中的艾滋病毒血清阳性率为60%。4.）尽管结核病患者可以治愈，但艾滋病毒导致的死亡率随后增加。因此，结合结核病和艾滋病毒治疗的DOT计划的设计不仅在进入卫生保健系统时为高危人群提供服务，而且还利用和扩展了现有的卫生保健基础设施方法（DOT）。此外，莫伊大学健康科学学院（MUFHS）及其美国合作机构之间的长期合作为该项目在撒哈拉以南非洲的发展提供了理想的基础，该项目的潜在影响和普遍性是巨大的。

DESCRIPTION (provided by applicant): This research will be done primarily in EIdoret, Kenya at Moi University in collaboration with Lameck Diero, MD as an extension of NIH grant # RO1 DA13767. Tuberculosis is the leading cause of death in people living with H1V/A1DS worldwide, one of the earliest opportunistic infections occurring in conjunction with HIV, and is an accelerant for the replication of HIV and subsequent deterioration of the immune system. The intersection of the two epidemics in Sub-Saharan Africa has brought tremendous morbidity and mortality to countries already burdened by poverty and resultant poor health infrastructure. Debate has raged as to the feasibility of the introduction of HIV treatment in the form of ART in these countries. Yet, there already exists an infrastructure for delivery of such care in the form of the TB control systems. Directly observed therapy (DOT) is a crucial part of the recommended WHO strategy for TB control worldwide. DOT is a delivery system of care that ensures TB cure as well as the avoidance of drug resistance. The parallel between TB and HIV, in terms of requiring complex multidrug treatment regimens, suggests the concept of DOT as a delivery system that may be adapted successfully to use in HIV treatment. The parent grant of this F1RCA (Directly Observed HAART for Substance Abusers (DA 13767-01) is addressing use of the DOT care delivery system in HiV infected drug abusers in the United States. This FlRCA is to support a pilot feasibility project of combined DOT for the treatment of TB and HIV in Eldoret, Kenya. The advantages of this approach are multiple: 1.) TB is often the sentinel event that brings HlV infected patients to the health care systems of Kenya. 2.) Infrastructure in Kenya for TB DOT already exists. 3.) HIV seroprevalence in TB cases in Kenya is 60%. 4.) Despite the fact that patients may be cured of their TB, their mortality due to HIV is subsequently increased. Thus, the design of a DOT program that combines TB and HIV treatment not only serves a high-risk population at their point of entry into the health care system but also utilizes and expands an existing health care infrastructure approach (DOT). In addition, the longstanding collaboration between the Moi University Faculty of Health Sciences (MUFHS) and its US collaborating institutions supplies the ideal underpinnings for development of this project in Sub-Saharan Africa where it's potential impact and generalizabiiity is enormous.