A new method for active tuberculosis case finding

活动性结核病病例发现的新方法

• 批准号: 10665861
• 负责人: Maryam Amour
• 金额: $ 13.49万
• 依托单位: MUHIMBILI UNIVERSITY/ ALLIED HLTH SCIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-06 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10665861
• 关键词: 15 year old; Adolescent; Adopted; Adoption; Africa South of the Sahara; Agreement; Ally; Biological Assay; Cause of Death; Cessation of life; Child; Collaborations; Communicable Diseases; Country; Detection; Developed Countries; Development; Diagnosis; Disease; Ensure; Epidemiologist; Goals; Health; Health Policy; Household; Incidence; Infection; Interferon Type II; Leprosy; Methods; Monitor; Newly Diagnosed; Notification; Outcome; Participant; Patients; Persons; Population; Public Health; Recommendation; Relapse; Reporting; Research; Schools; Science; Source; Tanzania; Testing; Tuberculosis; Universities; World Health Organization; active method; case finding; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; epidemiology study; experience; feasibility testing; global health; health goals; improved; infection rate; innovation; low and middle-income countries; low income country; medical schools; point of care; programs; research study; transmission process; treatment guidelines

PROJECT SUMMARY A critical component of the 2035 End TB Strategy is development of improved methods for Active Case Finding (ACF) of previously undiagnosed TB disease. Most ACF conducted by national tuberculosis control programs is based on testing household contacts (HCs) of remotely-acquired but newly-diagnosed cases of TB disease. This approach typically detects previously undiagnosed TB disease in 2-4% of HCs. We propose to test an entirely new method of ACF based on testing HCs of adolescents with recently-acquired and newly-diagnosed TB infection. This innovative method of ACF has the advantage that, since infections were recently acquired, the source cases are likely still among the close contacts of the new IGRA convertor. For this reason, we hypothesize that a source case will be found for as many as 50% of these new convertors. This approach is based on results of our recent 3-year study of serial testing for TB infection among 650 adolescent schoolchildren in Tanzania. The study was based on annual testing for TB infection using an interferon gamma release assay (IGRA). We showed that such testing was feasible and detected a 2.9% annual rate of infection. In the proposed new 5-year study we will perform baseline IGRA testing on 1200 Tanzanian adolescents followed by Q4 month IGRA testing x4 on the estimated 1020 who are IGRA negative at baseline. We anticipate detecting new TB infection (IGRA conversion to positive) in 50 participants. We will then test 200 of their household and other close contacts (collectively, their close contacts, CC) and predict that we will identify a source case of previously undiagnosed TB in a minimum of 25 or 50% of these 50 new adolescent infections. The predicted rate of new TB disease detection among CCs is therefore 25/200 or 12.5%, which is 3-6 times higher than the current approach for testing HCs of patients with TB disease. Cost-effectiveness will be analyzed and compared to the current approach used by the National Program on Tuberculosis and Leprosy. Successful completion of the proposed study with the hypothesized outcomes has the potential for a major impact on global tuberculosis outcomes. It is expected that the numerous new point-of-care IGRA tests under development will make serial testing feasible and economical at a programmatic level in low income countries. The research study will be conducted with the comprehensive DarDar Research Program, a 20-year research collaboration between Muhimbili University of Health and Allied Sciences (MUHAS, Tanzania) and the Geisel School of Medicine at Dartmouth (USA) and will include two consultant epidemiologists with extensive experience in evaluating TB control programs (Horsburgh, Whalen).

项目摘要 2035年终结结核病战略的一个关键组成部分是制定改进的 活动性病例发现（ACF）的方法，以前未确诊的结核病。最 国家结核病控制项目进行的ACF是基于检测 远程获得但新诊断的结核病病例的家庭接触者 疾病这种方法通常能在2-4%的患者中检出以前未诊断的结核病 的HC。 我们提出了一个全新的方法来测试ACF的基础上测试HC的 最近获得和新诊断的结核病感染的青少年。这一创新 ACF方法的优点在于，由于感染是最近获得的， 源病例可能仍在新IGRA感染者的密切接触者中。为 基于这个原因，我们假设将为多达50%的 这些新的转换器 这种方法是基于我们最近3年的系列测试研究结果， 坦桑尼亚650名青少年学童的结核病感染这项研究基于 使用干扰素γ释放试验（IGRA）进行结核病感染的年度检测。 我们表明，这种测试是可行的，并检测到2.9%的年增长率， 感染 在拟议的新的5年研究中，我们将对以下患者进行基线IGRA测试： 对1200名坦桑尼亚青少年进行第4季度IGRA检测x4， 1020例基线IGRA阴性患者。我们预计发现新的结核病感染 (IGRA转化为阳性）50例。然后我们将测试200个 家庭和其他密切接触者（统称为他们的密切接触者，CC）和预测 我们将在至少25年内确定以前未诊断的结核病的来源病例， 这50个新的青少年感染中的50%。新结核病的预测发病率 因此，CC中的检出率为25/200或12.5%，比 目前检测结核病患者HC的方法。成本效益将是 分析并比较了国家方案目前使用的方法， 肺结核和麻风病。 成功完成拟定研究并获得假设结局 有可能对全球结核病的结果产生重大影响。预计 正在开发的许多新的即时IGRA测试将使系列 在低收入国家的方案一级进行可行和经济的测试。 该研究将与全面的DarDar进行 研究计划，一个20年的研究合作之间的Muhimbili大学， 健康与相关科学（坦桑尼亚MUHAS）和Geisel医学院， 达特茅斯（美国），并将包括两名顾问流行病学家， 评估结核病控制项目的经验（Horsburgh、Whalen）。