Strategies for tuberculosis control in prisons

项目摘要 结核病仍然是全世界死亡的主要原因之一，尽管 广泛提供有效的治疗和预防措施。监狱港 世界上结核病发病率最高的国家之一，在许多地区， 惩教机构的负担越来越重。世卫组织现在建议活跃病例 在监狱和其他高负担环境中发现结核病，但缺乏 如何准确和有效地及早发现病例以减少传播的证据。 为了解决这些差距，我们提出了一个前景队列研究中的监禁 巴西中西部结核病高负担监狱中的个人：1）评估 使用便携式数字X光片，自动判读，以便深入查找病例; 2)确定基因组数据是否可以用于跟踪在 人口水平; 3）使用数学模型来确定有效的，可扩展的 监狱结核病发现和预防策略。我们将测试 假设：1）自动判读X射线可以达到WHO目标产品 在被监禁的个人中，作为筛选测试的准确性， 在无症状或早期疾病的患者中; 2）新兴的动态方法 可用于监测传播趋势; 3）系列筛查结合 预防性治疗将是一种具有成本效益和影响力的结核病治疗方法 全球高负荷监狱的控制。总体而言，该项目将解决以下方面的重大差距： 结核病的诊断和预防在一个庞大的，服务不足，高风险的人口， 来保护他们的健康和他们社区的健康。

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.