INnovative data Science to Impact the TB Epidemic - INSITE

项目摘要 在非洲，利用常规临床和健康数据进行大规模工作的机会有限， 在一个疾病负担和治疗方法都很复杂的环境中， 计数和编码与利用常规数据进行流行病学调查的其他环境有很大不同。 分析。结核病（TB）是南非最重要的艾滋病毒相关并发症， 艾滋病毒感染者（PLH）的主要死亡原因。产妇结核病（妊娠期和产后） 对妇女和婴儿的发病率和死亡率产生不利影响。妊娠结局更糟， 艾滋病毒合并感染的比例为60%，围产期结核病和艾滋病毒传播的风险增加。 具有/不具有氟喹诺酮类耐药性的利福平耐药（RR）-TB是一个日益严重的全球公共卫生问题 南非西开普省结核病患病率为4.2%。南非迅速 在常规指南中纳入针对RR-TB的新型和重新用途的二线治疗药物，包括 孕妇和哺乳期的人。这些药物在妊娠期和哺乳期的安全性尚不确定， 随着RR-TB发病率的上升，妊娠期大规模使用这些药物。伴随使用 抗逆转录病毒疗法（ART）治疗艾滋病毒引起了人们对潜在的药物相互作用与安全性的担忧 和功效影响。尽管艾滋病毒和结核病的负担在全球范围内仍然没有得到重视， 生育年龄的人。 在这种高感染负担的背景下，用于预防的新型/再利用的抗分枝杆菌药物 和结核病的治疗在怀孕期间大规模使用，通常与ART共同管理，西开普省是 在托管省卫生数据中心（PHDC）方面具有独特的地位，这是第一个全面的联网卫生数据中心。 非洲信息交流。PHDC利用全省范围内发布的唯一患者标识符， 卫生服务的用户协调来自常规卫生信息系统的所有电子卫生数据， 公共部门设施，包括实验室、药房、行政和其他临床数据。这些数据 整合和策划，使健康状况的推理使用表型算法，以及使 合并症的巩固和患者水平级联的建设，可用于监测和 分析医疗服务使用模式和医疗结果。 开普敦大学传染病流行病学与研究中心 以及PHDC所在的西开普省政府卫生情报局提供了 利用数据科学开发和评估一个强大的孕产妇结核病数据平台的独特机会， 可操作的临床工具，以优化个人层面的干预措施和监测计划; ii）产生大的， 队列，以解决孕产妇结核病的流行病学问题，并评估政策干预措施的影响 和临床工具在人群和个体水平。

PROJECT SUMMARY There are limited opportunities in Africa to work with routine clinical and health data at scale, and to develop the expertise to process these data in an environment in which both the burden of disease and the approach to enumeration and coding are very different to other settings where routine data are exploited for epidemiological analyses. Tuberculosis disease (TB) is the most important HIV-associated comorbidity in South Africa and the leading cause of death in people living with HIV (PLH). Maternal TB (pregnancy and postpartum period) deleteriously affects morbidity and mortality in women and infants. Pregnancy outcomes are worse, exacerbated by HIV co-infection which is present in 60%, and there is increased risk of perinatal TB and HIV transmission. Rifampicin-resistant (RR)-TB with/without fluoroquinolone resistance is a growing global public health concern with prevalence rates at 4.2% of TB cases in the Western Cape Province, South Africa. South Africa was prompt to include novel and repurposed second-line therapeutic agents against RR-TB in routine guidelines, including pregnant and lactating people. The safety of these agents during pregnancy and lactation is uncertain but the rising incidence of RR-TB has seen the use of these agents during pregnancy at scale. The concomitant use of antiretroviral therapy (ART) for HIV treatment raises concerns about potential drug-drug interactions with safety and efficacy implications. Maternal TB remains under-prioritized globally despite the burden of HIV and TB in those of child-bearing age. In this context of high infectious burden in which novel/repurposed anti-mycobacterial agents for the prevention and treatment of TB are used at scale during pregnancy, often co-administered with ART, the Western Cape is uniquely positioned in hosting the Provincial Health Data Centre (PHDC), the first comprehensive linked health information exchange in Africa. The PHDC leverages the use of a province-wide unique patient identifier issued to users of the health services to harmonise all electronic health data from routine health information systems in public sector facilities, including laboratory, pharmacy, administrative and other clinical data. These data are integrated and curated to enable inference of health conditions using phenotype algorithms, as well as to enable the consolidation of co-morbidities and construction of patient-level cascades that can be used to monitor and analyse health service utilisation patterns and healthcare outcomes. The partnership between the Centre for Infectious Disease Epidemiology & Research, University of Cape Town and the Health Intelligence Directorate of the Western Cape Government which houses the PHDC offers a unique opportunity to develop and evaluate a robust maternal TB data platform, using data science to i) create actionable clinical tools to optimize person-level interventions and monitor programs; ii) generate large, linked cohorts to address the epidemiological questions of maternal TB and assess the impact of policy interventions and clinical tools at the population and individual levels.