Innovative contact tracing strategies for detecting TB in mobile rural and urban South African populations

用于在南非农村和城市流动人口中检测结核病的创新接触者追踪策略

• 批准号: 10211118
• 负责人: David Wesley Dowdy
• 金额: $ 56.18万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-07 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10211118
• 关键词: Adult; Africa South of the Sahara; African; Age; Businesses; Cause of Death; Cessation of life; Cities; Communities; Contact Tracing; Cost Measures; Country; Data; Diagnosis; Dimensions; Disease; Effectiveness; Enrollment; Epidemic; Family; Frequencies; Friends; HIV; Health; Health care facility; Holidays; Home; Hour; Household; Human; Incidence; Individual; Infectious Agent; Infrastructure; Intervention; Investigation; Maintenance; Measures; Methods; Modeling; Movement; Participant; Patients; Pattern; Play; Population; Prevalence; Prisons; Protocols documentation; Province; Public Health; Randomized; Recording of previous events; Research; Rest; Risk; Role; Route; Rural; Seasons; Site; Source; South Africa; South African; Testing; Time; Time trend; Travel; Trees; Tuberculosis; Underserved Population; Ursidae Family; Visit; Work; authority; base; budget impact; care seeking; case finding; comparative cost effectiveness; cost; cost effectiveness; disability-adjusted life years; effectiveness evaluation; falls; genome sequencing; health care availability; high risk; high risk population; implementation cost; implementation fidelity; improved; indexing; innovation; interdisciplinary approach; markov model; member; men; migration; mortality; novel; novel strategies; personalized approach; population movement; primary outcome; prospective; randomized trial; rural South Africa; rural setting; screening; simulation; transmission process; tv watching; whole genome; willingness to pay; young adult

PROJECT SUMMARY Although largely a curable disease, tuberculosis (TB) remains the leading cause of death in South Africa and the leading single-agent infectious cause of death globally. Nevertheless, over one-third of people with TB – an estimated 3.6 million people worldwide – are never notified to health authorities. The demographic group at greatest risk for TB and also responsible for the majority of TB transmission consists of working-age adults (especially men). These individuals are often highly mobile, making it difficult to engage them with traditional TB case-finding activities such as screening at healthcare facilities or household contact investigation during business hours. Their patterns of movement, however, are highly regularized throughout sub-Saharan Africa and the rest of the world: young adults migrate to cities for work and travel home to rural homelands to visit families during the holidays. These predictable patterns of movement create an opportunity for innovative interventions to engage this high-risk, mobile population that bears a tremendous burden of undiagnosed TB and continues to fuel transmission in many communities. Specifically, mobile young adults can be found at their urban homes during non-working hours (on evenings and weekends) and visiting their families in rural settings during holiday times. Although most TB transmission occurs outside of households, household members of individuals diagnosed with TB remain the highest-risk population that can be identified, outside of congregate living settings (e.g., prisons). There is therefore no better place to look for the “missing 3.6 million” TB cases than in these households. We propose a randomized trial of two novel TB case-finding interventions among household members of patients diagnosed with active TB: holiday-based screening in a rural South African province (Limpopo) and off-peak (weekend/evening) screening in an urban settlement into which many residents of Limpopo migrate for work. We will enroll 2400 index cases of TB plus an estimated 4800 household contacts in each setting (7200 participants per setting, 14400 participants overall) and randomize them to novel versus standard contact investigation. In Specific Aim 1, we will use whole genome sequencing of all cases, overlaying transmission trees with data on human movement, to evaluate associations between mobility and TB transmission in this population. In Specific Aim 2, we will employ a multidisciplinary approach to compare novel versus standard contact investigation in each setting along the following dimensions: (a) effectiveness (number of secondary TB cases diagnosed and starting treatment); (b) implementation (reach, fidelity, and maintenance of contact investigation outside of business hours); (c) cost-effectiveness (cost per disability-adjusted life year) and budget impact; and (d) projected population-level impact on TB incidence. Successful completion of these aims will have long-term impact by characterizing the role of mobility in fueling TB epidemics and testing two tailored approaches to improve TB control in highly mobile populations – an underserved group that is increasingly recognized as playing a major role in global TB transmission.

项目摘要 虽然结核病在很大程度上是一种可治愈的疾病，但它仍然是南非的主要死亡原因， 是全球主要的单一病原体感染性死亡原因。然而，超过三分之一的结核病患者-- 据估计，全世界有360万人从未被告知卫生当局。人口统计组在 工作年龄的成年人是结核病的最大风险，也是大多数结核病传播的原因 （尤其是男性）。这些人通常具有高度移动的性，因此很难让他们参与传统的 结核病病例发现活动，如在卫生保健设施进行筛查或在 营业时间然而，在整个撒哈拉以南非洲，他们的行动模式高度正规化 和世界其他地区：年轻人迁移到城市工作，并返回农村家园访问 假期期间的家庭。这些可预测的运动模式为创新创造了机会。 采取干预措施，使这一高风险、移动的人群承担着未确诊结核病的巨大负担 并继续在许多社区助长传播。具体来说，移动的年轻人可以在 在非工作时间（晚上和周末）， 设置在假日期间。虽然大多数结核病传播发生在家庭以外， 被诊断患有结核病的个人成员仍然是可以确定的最高风险人群， 聚集生活环境（例如，监狱）。因此，没有更好的地方来寻找“失踪的360万人”。 肺结核病例比这些家庭多。我们提出了一个随机试验的两个新的结核病病例发现干预措施 诊断为活动性结核病患者的家庭成员中：南方农村地区以日为基础的筛查 非洲省（林波波）和非高峰期（周末/晚上）在城市定居点进行筛查，许多人 林波波的居民为了工作而迁移。我们将招募2400例结核病指标病例， 每个环境中的家庭接触者（每个环境7200名参与者，总共14400名参与者），并随机分配 他们对新的与标准接触调查。在具体目标1中，我们将使用全基因组测序 在所有情况下，将传输树与人体运动数据叠加，以评估 流动性和结核病传播。在具体目标2中，我们将采用多学科方法 在每种设置中，沿以下维度沿着比较新型与标准接触调查：（a） 有效性（确诊和开始治疗的继发性结核病例数）;（B）执行情况（覆盖率， （c）成本效益（每名雇员的成本 残疾调整生命年）和预算影响;以及（d）预计人口水平对结核病发病率的影响。 成功完成这些目标将产生长期的影响，因为流动性在推动 结核病流行和测试两种有针对性的方法，以改善高度移动的人群中的结核病控制-- 越来越多的人认识到，在全球结核病传播中发挥着重要作用。