Innovative Interdisciplinary Approaches to Sustainable Airborne Infection Control

描述(申请人提供)：结核病是当今世界成人的单一最大传染性杀手，仅次于艾滋病毒。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，主要是在医院、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，它与其他几个学科交叉：建筑学、工程学和医学。然而，几十年来，在空气传播感染控制方面一直没有真正的创新，可能是自20世纪90年代为卫生保健人员使用的工业呼吸器改装以来。这项提议旨在建立国际研究能力，以解决建筑物内感染的空气传播问题。 最令人担忧的是结核病的DR疫情，但这项研究产生的大多数干预措施将同样与其他具有空气传播潜力的感染有关，例如大流行性流感。这项提议延续了在波士顿和南非为期一年的刺激Fogarty创新框架赠款下进行的空气消毒工程研究培训。它扩大了这项工作，包括对波士顿和南非的建筑师和工程师进行研究培训，将其作为一项研究计划，在世界各地的卫生合作伙伴(PIH)临床站点，以及通过我们的南非合作伙伴、科学与工业研究委员会(CSIR)和比勒陀利亚大学(UP)访问的研究站点。课程作业将通过UP完成。在专家的多学科指导下，我们的学员将开发和测试成功建筑设计的新指标，并与另一个合作伙伴南非医学研究理事会(MRC)一起定量测试在波士顿和比勒陀利亚开发的新空气消毒技术。我们的受训人员将在空气传播感染研究(AIR)设施(Witbank，SA)进行测试，这是MRC、美国疾控中心、UP和布里格姆妇女医院(BWH)之间的一个既定合作项目。如果这些创新显示出希望，我们将与我们的当地合作伙伴和两个过渡性研究合作伙伴(国家设计研究院Indi和Frog Design，Inc.)合作，为当地制造优化产品并将其商业化，以便实施可持续。我们自己在空气设施中的研究已经证明了有效治疗对结核病传播的快速和强大的效果，即使是对耐药菌株也是如此。因此，对耐药结核病通过空气传播的另一种辅助方法将是通过咳嗽监测测试发现的活跃病例对结核病传播的影响，然后进行快速分子测试和药敏测试，使患者能够迅速得到有效的治疗。我们的医生实习生将在秘鲁利马的一家大型综合医院测试这种方法，该医院多年来一直在仔细监测其工作人员中的结核病病例。我们在这个临床研究和培训项目中的合作伙伴将是美国国立卫生研究院 秘鲁(INS)和PIH的秘鲁分支机构--社会福利机构(SES)，通过圣马科斯大学提供流行病学课程。

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.