Improving Isoniazid Preventive Therapy Penetration through Intensification of Cas

Philanjalo CDC赠款申请，FOA CDC-RFA-GH-11-005 项目摘要 “提高异烟肼预防治疗在艾滋病毒感染者中的渗透率 通过加强南非农村社区一级的病例发现“ 南非肆虐的艾滋病毒流行导致结核病(TB)发病率达到 几乎是美国水平的三百倍。南非拥有最大的 艾滋病毒/结核病混合感染的全球负担，以及耐药结核病的最高比率之一， 随之而来的高发病率和死亡率对 结核病控制和抗逆转录病毒治疗计划推出。世界卫生组织 推动了结核病控制的“3IS”：1)重症病例发现(ICF)，2)感染 控制和3)异烟肼预防治疗(IPT)，并强烈建议 对HIV阳性潜伏结核感染者实施IPT 这是控制结核病的一揽子综合服务的一部分。到目前为止，对IPT的吸收已经 非常需要有认真评估的新战略。ICF计划 可以增加活动性结核病病例的发现，当与艾滋病毒病例发现相结合时，还可以 潜在地检测出符合IPT条件的护理外HIV阳性患者，从而增加 IPT摄取。这一IPT集成战略嵌套在基于社区的ICF中 方案以创新的方式结合了三个I中的两个，尚未研究，并持有 承诺减少结核病发病率和死亡率，减少结核病传播，其中包括 艾滋病病毒感染者。我们提出了这样一种IPT的模型策略，嵌套到一个更大的 制定和实施了以社区为基础的艾滋病毒和结核病密集病例发现(ICF)计划 由Philanjalo和耶鲁大学在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毒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。 并提供关于两个创新结核病控制战略的新知识，以确定 符合条件的艾滋病毒感染者接受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。 这些相互关联的基于社区的ICF和IPT战略将通过以下方式进行衡量 主要结果：1)通过ICF确诊的HIV阳性患者接受IPT 模式2)启动、坚持和完成6个月的IPT方案3)进入和 监测艾滋病毒护理4)确定这种战略的成本效益和5) 提供经验数据，以便能够对战略对 研究人口和更远的地区。这一项目对公共卫生具有重大意义，并将 由Philanjalo与南非夸祖鲁·纳塔尔合作进行 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.