Innovative Interdisciplinary Approaches to Sustainable Airborne Infection Control

描述（由申请人提供）：结核病是当今世界上仅次于艾滋病毒的最大单一传染病杀手。在大多数低收入和中等收入国家，结核病控制的最重要方面之一是耐药结核病的空气传播，主要发生在医院、诊所、监狱、监狱和难民营等机构。机构空气传播感染控制是一个公共卫生问题，与其他几个学科交叉：建筑、工程和医学。然而，几十年来，在空气传播感染控制方面没有真正的创新，也许是自20世纪90年代适应卫生保健工作者使用工业呼吸器以来。该提案旨在建立国际研究能力，以解决建筑物中感染的空气传播问题。

DESCRIPTION (provided by applicant): After HIV, tuberculosis is the single largest infectious killer of adults in the world today. Among the most important aspects of TB control in most low and middle-income countries is the airborne spread of drug resistant (DR) tuberculosis, substantially in institutions such as hospitals, clinics, jails, prisons, and refugee camps. Institutional airborne infection control is a public health problem that intersects with several oter disciplines: architecture, engineering, and medicine. However, there have been no real innovations in airborne infection control in many decades, perhaps since the adaptation of industrial respirators for health care worker use in the 1990s. This proposal seeks to build international research capacity to address the issue of airborne spread of infections in buildings. Of greatest concern is the DR TB epidemic, but most of the interventions that result from this research will be equally relevant to other infections with airborne potential, such as pandemic influenza. This proposal continues the air disinfection engineering research training conducted under a 1-year Stimulus Fogarty Innovations Framework grant in Boston and in South Africa. It expands that work to include research training for architects as well as engineers in Boston and South Africa, using as a Partners In Health (PIH) clinical sites around the world, as well as research sites accessible through our South African partners, the Council for Scientific and Industrial Research (CSIR) and the University of Pretoria (UP). Course work will be available through UP. Under expert multidisciplinary mentorship, our trainees will develop and test novel indicators of successful building designs and, with another partner, the Medical Research Council (MRC) of South Africa, quantitatively test novel air disinfection technology developed in Boston and Pretoria. Our trainees will perform testing at the Airborne Infections Research (AIR) Facility (Witbank, SA), an established collaborative project between the MRC, the US CDC, UP, and Brigham & Women's (BWH) Hospital. If these innovations show promise, we will work with our local partners and two transitional research partners (the National Institute of Design of Indi and Frog Design, Inc) to optimize and commercialize products for local manufacture so that implementation is sustainable. Our own research at the AIR facility has demonstrated the rapid and powerful effect of effective treatment on TB transmission, even for drug resistant strains. Therefore, another complementary approach to the airborne spread of DR TB will be to test the impact on TB transmission of active case finding through cough surveillance followed by rapid molecular testing and drug susceptibility testing that will allow patients to be rapidly placed on effective treatment. Our physician trainees will test this approach at a large general hospital in Lima, Peru that has carefully monitored TB cases among its workers over the years. Our partners in this clinical research and training project will be the National Institute of Health of Peru (INS) and Socios En Salud (SES), the Peru arm of PIH, with course work in epidemiology available through San Marcos University.