Pulmonary impairment after tuberculosis in Georgia: Enhancing clinical research capacity to address the intersection of non-communicablediseases and tuberculosis

项目总结 结核病(TB)与非传染性疾病的交叉，包括慢性肺病 损害，已成为严重的临床和公共卫生障碍。快速扩展的非传染性疾病 疾病流行威胁着低收入和中等收入国家的结核病控制，包括格鲁吉亚，在那里预防 治疗结核病仍然是一个巨大的负担。然而，到目前为止，结核病可能会增加 慢性非传染性疾病的风险尚未得到很好的研究。我们将确定在多大程度上 耐多药结核病、吸烟和肺部炎症的生物标志物导致患病率增加 在格鲁吉亚国家，结核病后肺损害的风险。这项研究将促进对DUAL的理解 减轻传染病和非传染性疾病的负担，建设个人和机构研究能力 在佐治亚州。 本研究的长期目标是阐明结核病患者与结核病致病因素之间的关系 结核病后慢性肺损害，并加强研究能力，为未来的工作，以确定治疗 和预防战略，降低结核病治疗后患慢性非传染性疾病的风险 完成了。这项建议的具体目标是：(1)确定负担、预测因素和发展轨迹 肺结核治疗后肺损害；(2)探讨肺部炎症生物标志物之间的关系 以及结核病治疗完成时的肺破坏和肺损害的严重程度；和(3)建立 增加格鲁吉亚的研究基础设施和能力，专注于结核病和慢性疾病的交叉 肺功能受损。该项目的目标将通过招募一组患者(n=130)在 结核病治疗完成时间及前瞻性随访一年。在这两个时间点上，这项研究将 测量接受药物敏感结核病治疗的患者的肺活量、脉搏血氧饱和度和生活质量 (n=65)和在耐多药结核病治疗患者中(n=65)。分析将包括多种建模策略，以 评估患者和宿主因素与慢性肺损伤风险之间的关系。 拟议的研究将有助于确定结核病在多大程度上导致慢性肺损伤 并将确定哪些现有的临床呼吸康复干预措施可以用于改善生活质量 在结核病患者的整个生命周期中。此外，这款R21将利用现任和前任干部 Fogarty支持的学员，并在结核病和慢性病领域提供宝贵的指导性培训经验 肺部疾病。拟议工作的一个长期目标是为患者后续的前瞻性研究做准备 在结核病诊断时、在结核病治疗期间和在结核病治疗后几年开始的队列。

PROJECT SUMMARY The intersection of tuberculosis (TB) disease with non-communicable disease, including chronic pulmonary impairment, has emerged as a critical clinical and public health obstacle. Rapidly expanding non-communicable disease epidemics threaten TB control in low- and middle-income countries, including Georgia, where preventing and treating TB disease remains a great burden. However, to date, the notion that TB disease may increase the risk of chronic non-communicable disease has not been well explored. We will determine the extent to which multidrug-resistant (MDR) TB, smoking, and biomarkers of lung inflammation contribute to increased prevalence of pulmonary impairment post-TB in the country of Georgia. This research will advance understanding of dual burdens of communicable and non-communicable diseases and build individual and institutional research capacity in Georgia. The long-term objective of this research is to elucidate the relationship between TB patient and TB pathogen factors with post-TB chronic pulmonary impairment, and strengthen research capacity for future work to identify treatment and prevention strategies that reduce the risk of chronic non-communicable diseases after TB treatment completion. The specific aims of this proposal are to: (1) determine the burden, predictors, and trajectory of pulmonary impairment post-TB treatment; (2) explore the relationship between biomarkers of lung inflammation and lung destruction at time of TB treatment completion with severity of pulmonary impairment; and (3) build increased research infrastructure and capacity for Georgia that is focused on the intersection of TB and chronic pulmonary impairment. The aims of this project will be achieved by enrolling a cohort of patients (n=130) at the time of TB treatment completion and following them prospectively for one year. At both time points this study will measure spirometry, pulse oximetry, and quality of life among patients who were treated for drug susceptible TB (n=65) and among patients treated for MDR TB (n=65). The analysis will include multiple modeling strategies to assess the relationship between patient and host factors and the risk of chronic pulmonary impairment. The proposed study will help to characterize the extent to which TB contributes to chronic pulmonary impairment and will identify which existing clinical respiratory rehabilitation interventions may be used to improve quality of life throughout the lifespan among patients with TB. In addition, this R21 will leverage a cadre of current and former Fogarty-supported trainees and provide invaluable mentored training experiences in the areas of TB and chronic pulmonary diseases. A long term goal of the proposed work is to prepare for prospective studies that follow patient cohorts beginning at the time of TB diagnosis, during TB treatment, and several years after TB treatment.