Challenge Cluster for Post-TB Lung Health in Children in sub-Sahara Africa.

2017年，全球估计有1000万新发结核病病例，160万人死于结核病。这使得结核病成为世界范围内单一传染性病原体导致死亡的主要原因。然而，大多数结核病病例和死亡发生在低收入和中等收入国家（LMICs），在这些国家，诊断和治疗方面的困难导致结核病患者预后不良。虽然全球结核病报告是基于对结核病治疗前或治疗期间死亡患者的估计，但现在有越来越多的证据表明，治愈或成功治疗的结核病患者存在持续的健康损害，治疗后的发病率和死亡率相对高于一般人群。在已发表的文献中，这些关于结核病治疗后不良健康后果风险可能升高的证据完全来自成人数据。在发生在15岁以下儿童中的100万结核病例中，肺结核至少占80%，但在结核病负担特别高的高收入国家和低收入国家中，目前没有关于完成结核病治疗的儿童和青少年的肺结核不良健康后果和/或长期影响（包括肺功能变化）的公开数据。要实现世卫组织终止结核病战略的宏伟目标，不仅需要关注结核病治疗前或治疗期间的不良结果，还需要关注结核病治疗后的发病率和死亡率。在这方面，“结核病后的生活和福祉”现已被采纳为世界结核病联盟肺健康部战略计划的两个总体优先主题之一。通过这一挑战集群提案，我们将汇集两个多国合作项目，这些项目由MRC GCRF基金会奖支持，具有非洲儿童结核病和肺部健康方面的专门知识，包括“惠及非洲儿童”（R4KA）和“非洲全生命周期肺部健康”（LuLi）。gcrf资助的合作伙伴还将与撒哈拉以南非洲国家结核病规划的合作伙伴以及受结核病影响社区的成员建立联系，并得到主要区域和国际合作研究网络的支持，包括泛非胸科学会（PATS）、国际防治结核病和肺病联盟（The Union）、西非儿科结核病网络（WApTBNet）和TB PROOF（南非领先的结核病倡导组织）。我们将开始开展宣传和研究，以提高对结核病后肺部健康的认识，重点关注撒哈拉以南非洲地区卫生保健工作者、受结核病影响的社区和决策者中的儿童。我们还将培养卫生保健工作者的能力和信心，以评估完成肺结核治疗的儿童的肺功能，并开始生成数据，准确描述撒哈拉以南非洲儿童中结核病导致的肺功能损害的流行情况。我们的建议将在项目活动的12个月内实现以下具体目标：(i)为来自我们提议的泛非GCRF挑战集群合作伙伴关系的儿科医生组织一次关于中低收入国家儿童结核病后肺部健康的讲习班；对撒哈拉以南非洲的儿科医生进行儿科肺活量测定学培训，以评估完成结核病治疗的儿童的肺功能；（三）为西非前结核病患者和受结核病影响的家庭组织一次参与性讲习班，采用探索性和描述性定性研究方法，探讨家庭产生的费用和为应对结核病造成的持续健康损害所采取的战略；（四）建立一个多地点泛非平台，以便将来为临床、流行病学和应用卫生研究建立前瞻性队列。

In 2017, there were an estimated 10 million new cases of tuberculosis (TB) disease globally, and 1.6 million peoples died from TB. This makes TB the leading cause of death from a single infectious agent worldwide. However, the majority of the TB cases and deaths occur in low- and middle-income countries (LMICs), where difficulties in diagnosis and treatment contribute to poor outcomes in TB patients. While global TB reports are based on estimates of patients who die either before or during TB treatment, there is now a growing body of evidence suggesting that patients cured or successfully treated for TB have persistent health impairment, and a relatively higher morbidity and mortality after treatment, than the general population.These evidence of potentially elevated risk of adverse health consequences after TB treatment in the published literature are exclusively derived from adult data. While pulmonary TB (PTB) accounts for at least 80% of the 1 million TB cases that occur in children aged less than 15 years, there are currently no published data about adverse health consequences and/or long-term impact of pulmonary TB, including changes in the lung function, in children and adolescents who have completed TB treatment in neither high- nor low-income countries, where the burden of TB disease is particularly high. Achieving the ambitious goals of the WHO End TB Strategy will require that attention is paid not only to poor outcomes before or during TB treatment, but also to morbidity and mortality after TB treatment. In this regard, "Life and Well-being after Tuberculosis" has now being adopted as one of the two overall priority themes in the strategic plan of the World TB Union's Lung Health Department.With this Challenge Cluster proposal, we will bring together two multi-country collaborative projects, supported by MRC GCRF Foundation Awards, with specific expertise in childhood TB and in lung health in Africa, including the Reach for Kids Africa (R4KA) and Lung Health in Africa across the Life Course (LuLi). The GCRF-funded partners will additionally link with partners in national TB programs from across sub-Sahara Africa and members of the TB-affected communities, underpinned by key regional and international collaborative research networks, including the Pan African Thoracic Society (PATS), International Union Against TB and Lung Disease (The Union), West African Paediatric TB Network (WApTBNet) and TB PROOF - a leading TB advocacy organisation in South Africa. We will begin advocacy and research toward increasing the awareness of post-TB lung health with a focus on children among health care workers, TB-affected communities and policy makers from across sub-Sahara Africa. We will also develop the capacity and confidence of health care workers to evaluate lung function in children who have completed treatment for PTB, and begin to generate data that will accurately describe the prevalence of lung function impairment attributable to TB in children in sub-Sahara Africa.Our proposal will deliver on the following specific objectives within 12 months of the project activities: (i) organise a workshop on post-TB lung health in children in LMICs for paediatricians drawn from our proposed pan-Africa GCRF Challenge Cluster collaborative partnerships; (ii) train paediatricians in sub-Sahara Africa on paediatric spirometry, in order to evaluate lung function in children who have completed TB treatment; (iii) organise a participatory workshop for former TB patients and TB-affected families in West Africa, using exploratory and descriptive qualitative research approaches, in relation to household-incurred costs and strategies adopted for coping with persistent health impairments due to TB; and (iv) set up a multi-site pan-African platform for the establishment of prospective cohorts in the future, for clinical, epidemiological and applied health research.