Improving Isoniazid Preventive Therapy Penetration through Intensification of Cas

Philanjalo CDC资助申请，FOA CDC-RFA-GH-11-005 项目摘要 “提高艾滋病毒感染者中异烟肼预防治疗的普及率 通过加强南非农村社区一级的病例发现” 南非肆虐的艾滋病疫情导致结核病（TB）发病率上升， 几乎是美国的三百倍。南非拥有最大的 艾滋病毒/结核病合并感染的全球负担和耐药结核病的最高比率， 其结果是发病率和死亡率高，对人类造成严重后果， 结核病控制和抗逆转录病毒疗法推广方案。世界卫生组织 促进了结核病控制的“3 Is”：1）强化病例发现（ICF），2）感染 对照和3）异烟肼预防性治疗（IPT），并强烈建议 为潜伏结核感染的艾滋病毒阳性者实施IPT， 这是控制结核病综合服务方案的一部分。到目前为止，IPT的使用 我们的战略一直很差，迫切需要经过认真评估的新战略。ICF项目 可以提高活动性结核病例的发现率，当与艾滋病毒病例发现相结合时， 有可能检测出符合IPT条件的HIV阳性患者，从而增加 IPT摄取。这一综合战略的IPT嵌套在一个社区为基础的ICF 程序结合了2的3个我的创新方式，还没有被研究，并举行 降低结核病发病率和死亡率以及减少结核病传播的希望， 艾滋病毒感染者。我们提出了这样一个模型策略的IPT，嵌套到一个更大的 制定了基于社区的艾滋病毒和结核病密集病例发现方案， 由Philanjalo和耶鲁大学在一个资源有限的农村地区实施和评估， 它是世界上结核病和艾滋病发病率最高的国家之一。 本运筹学提案旨在论证整合的可行性 并提供有关两项创新结核病控制战略的新知识， 符合条件的HIV感染者接受IPT，将这些患者与临床护理联系起来，并促进 结核病预防治疗和艾滋病毒护理和治疗都取得了成功。的有效性 这些以社区为基础的ICF和IPT战略将通过以下方式进行衡量 主要结局：1）通过ICF诊断的HIV+个体接受IPT 模型2）6个月IPT方案的开始、坚持和完成3）进入和 监测艾滋病毒护理，4）确定这种战略的成本效益，5） 提供经验数据，以便对战略对 研究人口和超越。该项目对公共卫生具有重要意义， 由Philanjalo与南非夸祖鲁纳塔尔省合作进行 省卫生厅和耶鲁大学。

Philanjalo CDC Grant Application, FOA CDC-RFA-GH-11-005 Project Abstract "Improving Isoniazid Preventive Therapy Penetration among HIV infected Individuals through Intensification of Case Finding at the Community Level in Rural South Africa" South Africa's raging HIV epidemic has resulted in tuberculosis (TB) rates that are nearly three hundred times the levels in the United States. South Africa has the largest global burden of HIV/TB coinfection and among the highest rates of drug resistant TB, with consequent high rates of morbidity and mortality that have severe consequences for TB control and antiretroviral therapy roll out programs. The World Health Organization has promoted the "3Is" for TB control: 1) intensive case finding (ICF), 2) infection control and 3) isoniazid preventive therapy (IPT), and has strongly recommended implementation of IPT for HIV positive individuals with latent TB infection (LTBI) as part of a comprehensive package of services to control TB. The uptake of IPT to date has been poor and new strategies with careful evaluation are critically needed. ICF programs can increase active TB case detection and when integrated with HIV case finding can also potentially detect out of care HIV positive patients eligible for IPT and thereby increase IPT uptake. This integrated strategy of IPT nested within a community based ICF program combines 2 of the 3 I's in an innovative manner, has not been studied, and holds promise of reducing TB morbidity and mortality and decreasing TB transmission, among HIV infected individuals. We propose such a model strategy of IPT, nested into a larger community based HIV and TB intensive case finding (ICF) program developed and being implemented and evaluated by Philanjalo and Yale University in a rural, resource limited setting with among the highest rates of TB and HIV in the world. This operational research proposal aims to demonstrate the feasibility of integrating and to provide new knowledge regarding two innovative TB control strategies to identify eligible HIV infected individuals for IPT, link these patients to clinical care, and facilitate successful both TB preventive therapy and HIV care and treatment. The effectiveness of these linked community-based ICF and IPT strategies will be measured by the following primary outcomes: 1) uptake of IPT among HIV+ individuals diagnosed through the ICF model 2) initiation, adherence and completion of a 6 month IPT regimen 3) entry into and monitoring of HIV care 4) determine the cost effectiveness of such a strategy and 5) provide empiric data to enable mathematical modeling of the strategy's impact on the study population and beyond. This project is of great public health importance and will be conducted by Philanjalo, in collaboration with the South African KwaZulu Natal provincial Department of Health, and Yale University.