Closing -TB GAPs - for people living with HIV: TB Guidance for Adaptable Patient-Centered Service

为艾滋病毒感染者缩小结核病差距：以患者为中心的适应性服务结核病指南

• 批准号: 10649556
• 负责人: ANNA M MANDALAKAS
• 金额: $ 95.52万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649556
• 关键词: Closing; TB; GAPs; people; living

PROJECT SUMMARY Tuberculosis (TB) is the world’s leading infectious cause of mortality and responsible for 1/3 of deaths in people living with HIV (PLHIV). Children and adolescents living with HIV are disproportionately affected due to inadequate preventive services, large case detection gaps, adherence challenges, and knowledge gaps. Our project will generate evidence to inform interventions targeting these weaknesses in the TB/HIV cascade of care. Early detection and treatment of TB improves outcomes in PLHIV. A key challenge in the detection of HIV-associated TB has been implementation of screening that identifies the correct population to complete diagnostic testing. Increasing evidence demonstrates the poor performance of recommened symptom screens and diagnostic approaches. Hence, we aim to define a more accurate TB screening and testing strategy among PLHIV. TB preventive treatment (TPT) averts HIV-associated TB. Nevertheless, among PLHIV, TPT initiation and completion rates are sub-optimal and effective delivery strategies are not defined. As such, we aim to identify the most effective TPT delivery strategy by leveraging approaches effective at improving HIV treatment adherence. Although evidence demonstrates that isoniazid preventive therapy is cost-effective in young children living in a TB/HIV high burden setting, the cost-effectiveness of newer short-course TPT has primarily been studied in the context of a TB low-burden, high income setting. We aim to generate evidence to fill this gap and inform policy. To ensure that our work makes a sustainable impact, we will provide mentorship on best practices in accordance with evolving country guidelines and harnessing the proven capacity of our indigenous Baylor Foundation partners to provide quality mentorship on HIV associated TB care. As a regional leader in HIV associated TB care, we will develop an online resource that will serve as the TB GAPS Echo Hub to provide regional expert consultation, guideline updates, and emerging evidence for providers managing children and adolescents with HIV associated TB in the region. Our team is uniquely positioned to develop, implement, and evaluate evidence-based, innovative approaches to prevent, find, and cure HIV-associated TB in five CDC target priority countries. Our proposed project capitalizes upon our well-harmonized clinical network that is linked with a common electronic medical record to maximize project deliverables.

项目概要 结核病 (TB) 是世界上导致死亡的主要传染病，占世界死亡人数的 1/3 艾滋病毒感染者（PLHIV）。感染艾滋病毒的儿童和青少年因以下原因受到不成比例的影响： 预防服务不足、病例发现差距大、依从性挑战和知识差距。我们的 该项目将产生证据，为针对结核病/艾滋病毒级联护理中这些弱点的干预措施提供信息。 结核病的早期发现和治疗可改善艾滋病毒携带者的预后。检测的一个关键挑战 HIV 相关结核病已实施筛查，确定需要完成的正确人群 诊断测试。越来越多的证据表明推荐症状筛查的效果不佳 和诊断方法。因此，我们的目标是在人群中制定更准确的结核病筛查和检测策略 艾滋病毒感染者。 结核病预防治疗 (TPT) 可避免艾滋病毒相关结核病。然而，在 PLHIV 中，TPT 启动 完成率不是最优的，并且没有定义有效的交付策略。因此，我们的目标是确定 通过利用有效改善艾滋病毒治疗的方法，制定最有效的 TPT 实施策略 坚持。 尽管有证据表明异烟肼预防性治疗对于幼儿来说具有成本效益 生活在结核病/艾滋病毒高负担环境中，新型短期 TPT 的成本效益主要是 在结核病低负担、高收入环境的背景下进行了研究。我们的目标是产生证据来填补这一空白 告知政策。 为了确保我们的工作产生可持续的影响，我们将提供有关最佳实践的指导 符合不断发展的国家指导方针并利用我们本土贝勒的经过验证的能力 基金会合作伙伴提供有关艾滋病毒相关结核病护理的优质指导。作为艾滋病毒领域的地区领导者 相关的结核病护理，我们将开发一个在线资源，作为 TB GAPS Echo Hub 来提供 区域专家磋商、指南更新以及管理儿童和儿童的提供者的新证据 该地区患有艾滋病毒相关结核病的青少年。 我们的团队具有独特的优势，能够开发、实施和评估基于证据的创新型 在五个疾病预防控制中心目标优先国家中预防、发现和治疗艾滋病毒相关结核病的方法。我们提出的 该项目利用了我们协调一致的临床网络，该网络与通用电子医疗相连 记录以最大化项目可交付成果。