Directly Observed Therapy(DOT) for TB and HIV in Kenya

描述(由申请人提供)：这项研究将主要在肯尼亚埃多雷特的莫伊大学与马里兰州的拉梅克·迪耶罗合作进行，作为#RO1 DA13767号NIH补助金的延伸。结核病是全世界H1V/A1DS感染者的主要死亡原因，是与艾滋病毒一起发生的最早的机会性感染之一，是艾滋病毒复制和随后免疫系统恶化的促进剂。撒哈拉以南非洲的这两种流行病交汇在一起，给已经背负着贫困负担的国家带来了巨大的发病率和死亡率，并因此导致卫生基础设施不佳。关于在这些国家采用抗逆转录病毒疗法的可行性展开了激烈的辩论。然而，已经存在以结核病控制系统的形式提供这种护理的基础设施。直接观察治疗(DOT)是世卫组织推荐的全球结核病控制战略的重要组成部分。DOT是一种提供护理的系统，确保结核病治愈和避免耐药性。就需要复杂的多种药物治疗方案而言，结核病和艾滋病毒之间的相似之处表明，DOT作为一种可成功用于艾滋病毒治疗的递送系统的概念。F1RCA(药物滥用者直接观察的HAART)(DA 13767-01)的父母赠款是针对美国艾滋病毒感染的吸毒者使用DOT护理提供系统的。该项目旨在支持肯尼亚埃尔多雷特开展的联合DOT治疗结核病和艾滋病毒的试点可行性项目。这种方法的优势是多方面的：1)结核病往往是将HLV感染患者带到肯尼亚卫生保健系统的哨兵事件。2.)肯尼亚的结核病DOT基础设施已经存在。3.)肯尼亚结核病患者中艾滋病毒血清阳性率为60%。4.)尽管患者的结核病可能会被治愈，但他们因艾滋病毒而导致的死亡率随后会增加。因此，结合结核病和艾滋病毒治疗的DOT计划的设计不仅为进入卫生保健系统的高危人群提供服务，而且还利用和扩展了现有的卫生保健基础设施方法(DOT)。此外，莫伊大学健康科学学院(MUFHS)与其美国合作机构之间的长期合作为该项目在撒哈拉以南非洲的发展提供了理想的基础，在那里它的潜在影响和普及性是巨大的。

DESCRIPTION (provided by applicant): This research will be done primarily in EIdoret, Kenya at Moi University in collaboration with Lameck Diero, MD as an extension of NIH grant # RO1 DA13767. Tuberculosis is the leading cause of death in people living with H1V/A1DS worldwide, one of the earliest opportunistic infections occurring in conjunction with HIV, and is an accelerant for the replication of HIV and subsequent deterioration of the immune system. The intersection of the two epidemics in Sub-Saharan Africa has brought tremendous morbidity and mortality to countries already burdened by poverty and resultant poor health infrastructure. Debate has raged as to the feasibility of the introduction of HIV treatment in the form of ART in these countries. Yet, there already exists an infrastructure for delivery of such care in the form of the TB control systems. Directly observed therapy (DOT) is a crucial part of the recommended WHO strategy for TB control worldwide. DOT is a delivery system of care that ensures TB cure as well as the avoidance of drug resistance. The parallel between TB and HIV, in terms of requiring complex multidrug treatment regimens, suggests the concept of DOT as a delivery system that may be adapted successfully to use in HIV treatment. The parent grant of this F1RCA (Directly Observed HAART for Substance Abusers (DA 13767-01) is addressing use of the DOT care delivery system in HiV infected drug abusers in the United States. This FlRCA is to support a pilot feasibility project of combined DOT for the treatment of TB and HIV in Eldoret, Kenya. The advantages of this approach are multiple: 1.) TB is often the sentinel event that brings HlV infected patients to the health care systems of Kenya. 2.) Infrastructure in Kenya for TB DOT already exists. 3.) HIV seroprevalence in TB cases in Kenya is 60%. 4.) Despite the fact that patients may be cured of their TB, their mortality due to HIV is subsequently increased. Thus, the design of a DOT program that combines TB and HIV treatment not only serves a high-risk population at their point of entry into the health care system but also utilizes and expands an existing health care infrastructure approach (DOT). In addition, the longstanding collaboration between the Moi University Faculty of Health Sciences (MUFHS) and its US collaborating institutions supplies the ideal underpinnings for development of this project in Sub-Saharan Africa where it's potential impact and generalizabiiity is enormous.