INnovative data Science to Impact the TB Epidemic - INSITE

创新数据科学影响结核病流行 - INSITE

• 批准号: 10749076
• 负责人: Emma Kate Kalk
• 金额: $ 24.48万
• 依托单位: UNIVERSITY OF CAPE TOWN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749076
• 关键词: Address; Affect; Africa; Age; Algorithms; Anemia; Antimycobacterial Agents; Asphyxia; Cause of Death; Cessation of life; Childhood; Client; Clinical; Clinical Data; Clinical Management; Clinical Services; Code; Data; Data Science; Diagnosis; Discipline; Disease; Disease Outcome; Drug Combinations; Drug Interactions; Drug resistance; Drug resistance in tuberculosis; Effectiveness; Environment; Epidemic; Epidemiology; Feedback; Fluoroquinolones; Funding; Geography; Gestational Age; Government; Guidelines; HIV; HIV therapy; HIV/TB; Health; Health Information System; Health Services; Hospitalization; Human; Incidence; Individual; Infant; Infant Health; Infectious Disease Epidemiology; Intelligence; Intervention; Laboratories; Lactation; Linezolid; Link; Low Birth Weight Infant; Maternal Health; Maternal Health Services; Modeling; Monitor; Morbidity - disease rate; Mothers; Outcome; Patients; Pattern; Patterns of Care; Perinatal; Perinatal Infection; Persons; Pharmaceutical Preparations; Pharmacy facility; Policies; Population; Positioning Attribute; Postpartum Period; Pre-Eclampsia; Predisposition; Pregnancy; Pregnancy Outcome; Prevalence; Prevention; Preventive therapy; Process; Prophylactic treatment; Province; Public Health; Public Sector; Regimen; Relative Risks; Reporting; Research; Retreatment; Rifampicin resistance; Risk; Risk Factors; Safety; Services; South Africa; Spontaneous abortion; Techniques; Therapeutic Agents; Therapeutic Intervention; Time; Tuberculosis; United States National Institutes of Health; Universities; Woman; Work; adverse outcome; antenatal; antiretroviral therapy; burden of illness; care outcomes; child bearing; clinically actionable; co-infection; cohort; community engagement; comorbidity; dashboard; data centers; data harmonization; data infrastructure; data integration; data management; disease transmission; drug repurposing; electronic data; electronic health data; fluoroquinolone resistance; health data; health service use; high risk; infant outcome; innovation; maternal outcome; mortality; novel; novel therapeutics; perinatal HIV; phenotyping algorithm; pregnancy health; pregnant; premature; programs; screening; stillbirth; tool; transmission process; tuberculosis treatment

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.

项目摘要 非洲的机会有限，可以大规模处理常规临床和健康数据，并开发 在疾病负担和方法的环境中处理这些数据的专业知识 枚举和编码与其他常规数据用于流行病学的其他设置非常不同 分析。结核病疾病（TB）是南非最重要的HIV相关合并症 艾滋病毒（PLH）患者的主要死亡原因。母亲结核（怀孕和产后时期） 有害影响女性和婴儿的发病率和死亡率。怀孕结果恶化，恶化 通过HIV共感染，其存在于60％，并且围产期结核病和HIV传播的风险增加。 抗利福平耐药（RR）-TB，具有氟喹诺酮类抗性，这是全球公共卫生的日益严重的关注 南非西开普省的结核病病例的患病率为4.2％。南非及时迅速 包括在常规准则中包括针对RR-TB的新颖和重新利用的二线治疗剂，包括 怀孕和哺乳的人。怀孕和泌乳期间这些药物的安全是不确定的，但是 RR-TB的发病率上升已在妊娠期间大规模使用这些药物。伴随的使用 用于HIV治疗的抗逆转录病毒疗法（ART）引起了人们对潜在的药物相互作用与安全的担忧 和功效含义。尽管艾滋病毒和结核病负担 那些年龄的人。 在这种高度感染负担的情况下，新颖/重新利用的抗细菌剂用于预防剂 在怀孕期间使用结核病的治疗，通常与艺术共同管理，西斗篷为 独特地位于托管省级健康数据中心（PHDC）中，这是第一个全面联系的健康 非洲的信息交流。 PHDC利用了发行的全省唯一患者标识符的使用 给卫生服务的用户，在常规健康信息系统中协调所有电子健康数据 公共部门的设施，包括实验室，药房，行政和其他临床数据。这些数据是 整合和策划以使用表型算法来推断健康状况，并启用 合并的合并和患者级级联的构造，可用于监视和 分析卫生服务利用模式和医疗保健结果。 开普敦大学传染病流行病学与研究中心之间的伙伴关系 以及拥有PHDC的西开普政府的健康情报局 使用数据科学来开发和评估强大的母体结核数据平台的独特机会，i）创建 可行的临床工具，以优化人级干预措施和监视程序； ii）产生较大的链接 群体以解决母体结核病的流行病学问题并评估政策干预的影响 以及人口和个人级别的临床工具。