Strategies for tuberculosis control in prisons

项目摘要 结核病仍然是全球主要的死亡原因之一，尽管 普遍提供有效的治疗和预防措施。监狱港湾 世界上结核病发病率最高的国家之一，在许多地区，结核病 惩教环境中的负担正在增加。世界卫生组织现在推荐活跃病例 在监狱和其他高负担环境中发现结核病，但缺乏 关于如何准确和有效地及早识别病例以减少传播的证据。 为了解决这些差距，我们建议在服刑人员中进行一项前瞻性队列研究 巴西中西部高结核病监狱中的个人将：1)评估 使用具有自动判读功能的便携式数字X光进行密集病例查找； 2)确定基因组数据是否可用于跟踪 种群水平；以及3)使用数学模型来确定有效、可扩展的 监狱结核病病例发现与预防策略。我们将测试 假设：1)具有自动解释的X射线可以达到世卫组织的目标产品 在被监禁个人中作为筛查测试的准确性的配置文件阈值，甚至 在那些无症状或早期疾病的人中；2)新兴的系统动力学方法 可用于监测传播趋势；以及3)系列筛查结合 预防性治疗将是治疗结核病的一种经济有效的方法。 全球高负担监狱的控制。总体而言，该项目将解决以下方面的关键差距 在服务不足的高危人群中进行结核病的诊断和预防， 以保护他们的健康和社区的健康。

Project Summary Tuberculosis remains one of the leading causes of death worldwide, despite the widespread availability of effective treatment and prevention measures. Prisons harbor among the highest rates of tuberculosis worldwide, and, in many regions, tuberculosis burden in correctional settings is growing. The WHO now recommends active case finding for tuberculosis in prisons and other high burden settings, but there is a dearth of evidence for how to accurate and efficiently identify cases early to reduce transmission. To address these gaps, we propose to a prospect cohort study among incarcerated individuals in high tuberculosis burden prisons in Central Western Brazil to: 1) evaluate the use of portable, digital x-rays with automated interpretation for intensive case finding; 2) determine whether genomic data can be used to track transmission rates at the population level; and 3) use mathematical models to identify effective, scalable strategies for tuberculosis case finding and prevention in prisons. We will test the hypotheses that: 1) x-ray with automated interpretation can achieve WHO target product profile thresholds for accuracy as a screening test among incarcerated individuals, even among those with asymptomatic or early disease; 2) emerging phylodynamic methods can be used to monitor trends in transmission; and 3) serial screening combined with preventive therapy would be a cost-effective and impactful approach for tuberculosis control in high-burden prisons globally. Overall, this project will address critical gaps in tuberculosis diagnosis and prevention among a large, underserved, high-risk population, to protect their health and the health of their communities.