Finding and Treating Unsuspected and Resistant TB to Reduce Hospital Transmission

发现并治疗未被怀疑和耐药的结核病以减少医院传播

• 批准号: 9025677
• 负责人: Edward A. Nardell
• 金额: $ 70.09万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-02 至 2020-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9025677
• 关键词: Adoption; Breath Tests; Cause of Death; Consequences of HIV; Coughing; Diagnosis; Disease; Drug resistance; Drug resistance in tuberculosis; Early Diagnosis; Effectiveness; Elements; Exhalation; Extreme drug resistant tuberculosis; Foundations; General Population; Goals; Guidelines; Health; Health Personnel; Health care facility; Hip region structure; Hospitals; Infection; International; Investigation; Maintenance; Measures; Medical; Mission; Modeling; Molecular; Molecular Diagnostic Testing; Morbidity - disease rate; Multidrug-Resistant Tuberculosis; Patients; Perception; Peru; Pharmaceutical Preparations; Predictive Value; Predisposition; Public Health; Pulmonary Tuberculosis; Research; Research Personnel; Resistance; Resources; Risk; Site; Sputum; Teaching Hospitals; Testing; Time; Tuberculin Test; Urban Hospitals; accurate diagnosis; base; case finding; cost; cost effective; cost effectiveness; diagnosis standard; effective therapy; extensive drug resistance; improved; innovation; interest; mortality; novel; novel diagnostics; programs; rapid diagnosis; respiratory; screening; standard of care; tool; transmission process; tuberculosis drugs; uptake; ward

DESCRIPTION (provided by applicant): Multidrug resistant tuberculosis threatens global TB control, and transmission is responsible for more than half of all cases. Hospitals and other congregate settings are common foci of TB transmission, including spread to patients and health care workers. In the era of multidrug and extensively drug resistant TB and HIV, the consequences of TB transmission in hospitals are deadly. In addition to the morbidity, mortality and medical costs, active TB in health care workers also leads to workforce attrition and further exposes patients to infection. There is longstanding evidence that transmission is not from TB patients on effective treatment, but from unsuspected cases, and known cases with unsuspected drug resistance. Comprehensive international guidelines encourage early diagnosis, but tend to focus on known and suspected cases, environmental controls, and personal respiratory protection. A fundamentally different approach to TB control in hospitals and other congregate settings is urgently needed. In recent years, rapid molecular tests for TB and drug resistance have emerged and are being implemented. This proposal investigates the implementation of a refocused approach to TB transmission control called FAST (Find cases Actively, Separate temporarily, and Treat effectively based on molecular drug susceptibility testing) in a busy, urban hospital in a TB endemic setting. In addition to the investigation of rapd sputum based molecular diagnostic tests, the study will evaluate whether a novel, exhaled breath test for TB can avoid the need for sputum testing by reliably excluding TB. In parallel, the study will investigate the adoption of annual tuberculin skin testing (TST) of health care workers at the hospital to measure the impact of FAST on transmission. The analyses will incorporate the RE-AIM framework to identify the critical elements of the programs that will enhance the reach, effectiveness, adoption, implementation, and maintenance of these strategies in other hospitals. Three specific aims are proposed. The first aim is to evaluate FAST for reducing treatment delay and health care workers infections. The second aim is to evaluate the acceptability and barriers to FAST and health care worker TST. The third aim is to compare the cost and cost- effectiveness of FAST relative to smear and culture for TB diagnosis, drug resistance testing, and treatment initiation. The proposed research is significant because it seeks to create safer health care facilities in high- burden, resource-limited settings by reducing TB transmission to health care workers and patients. It is innovative because it shifts the focus of hospital based TB control to active case finding and prompt treatment of patients with unsuspected pulmonary TB and unsuspected drug resistance.

描述（由申请人提供）：多药耐药性结核病威胁着全球结核病控制，而传播则负责一半以上的情况。医院和其他聚集环境是结核病传播的常见焦点，包括传播给患者和卫生保健工作者。在多药和广泛的耐药结核病和艾滋病毒时代，医院中结核病传播的后果是致命的。除了发病率，死亡率和医疗费用外，医疗保健工作者的活跃结核病还导致劳动力损耗，并进一步暴露于患者感染。长期以来，有证据表明，传播不是来自结核病患者的有效治疗，而是来自未经使用的病例，也是来自未耐药性的已知病例。全面的国际准则鼓励早期诊断，但倾向于专注于已知和可疑的病例，环境控制和个人呼吸保护。迫切需要在医院和其他聚集环境中进行结核病控制的根本不同的方法。近年来，已经出现了针对结核病和耐药性的快速分子测试，并正在实施。该提案调查了在繁忙的城市医院中，在TB地方性环境中，调查了一种称为快速的结核病传输方法（积极地，暂时查找案例，暂时分离并有效治疗）。除了研究基于RAPD痰液的分子诊断测试外，该研究还将评估新型的TB呼出呼气测试是否可以通过可靠地排除TB来避免进行痰液测试。并行， 研究将调查医院医疗保健工作者的年度结核蛋白皮肤测试（TST），以衡量快速传播的影响。分析将纳入RE-AIM框架，以确定将增强其他医院中这些策略的影响力，有效性，采用，实施和维护的计划的关键要素。提出了三个具体目标。第一个目的是快速评估以减少治疗延迟和卫生保健工人感染。第二个目的是评估快速和卫生保健工作者TST的可接受性和障碍。第三个目的是比较快速相对于TB诊断，耐药性测试和治疗起始的快速和培养的成本和成本效益。拟议的研究之所以重要，是因为它试图通过降低高层，资源有限的环境来创建更安全的医疗保健设施 结核病向医疗保健工作者和患者传播。它具有创新性，因为它将基于医院的结核病控制的重点转移到了无用的肺结核和无引起耐药性患者的主动病例发现和迅速治疗。