Innovative Interdisciplinary Approaches to Sustainable Airborne Infection Control

描述（由申请人提供）：在艾滋病毒之后，结核病是当今世界上成年人最大的单一传染性杀手。在大多数低收入和中等收入国家，结核病控制的最重要方面之一是耐药结核病的空气传播，主要是在医院、诊所、监狱和难民营等机构中。机构空气传播感染控制是一个公共卫生问题，与其他几个学科交叉：建筑，工程和医学。然而，几十年来在空气传播感染控制方面一直没有真实的创新，也许是自20世纪90年代卫生保健工作者使用工业通风机以来。该提案旨在建立国际研究能力，以解决建筑物内空气传播感染的问题。 最令人关注的是耐药结核病的流行，但这项研究产生的大多数干预措施同样适用于其他具有空气传播潜力的感染，如大流行性流感。该提案继续在波士顿和南非进行的为期一年的刺激福格蒂创新框架资助下进行的空气消毒工程研究培训。它扩大了这项工作，包括在波士顿和南非的建筑师和工程师的研究培训，使用作为健康（PIH）在世界各地的临床网站的合作伙伴，以及通过我们的南非合作伙伴，科学和工业研究（CSIR）理事会和比勒陀利亚大学（UP）访问的研究网站。课程将通过UP提供。在多学科专家的指导下，我们的学员将开发和测试成功建筑设计的新指标，并与另一个合作伙伴，南非医学研究理事会（MRC），定量测试在波士顿和比勒陀利亚开发的新型空气消毒技术。我们的学员将在空气传播感染研究（AIR）设施（威特班克，SA）进行测试，这是MRC，美国CDC，UP和Brigham & Women's（BWH）医院之间的一个既定合作项目。如果这些创新显示出希望，我们将与我们的当地合作伙伴和两个过渡性研究合作伙伴（印度国家设计研究所和青蛙设计公司）合作，为当地制造优化和商业化产品，以便实施可持续发展。我们自己在AIR设施的研究已经证明了有效治疗对结核病传播的快速和强大的效果，即使是对耐药菌株。因此，另一种对耐药结核病空气传播的补充方法是通过咳嗽监测，随后进行快速分子检测和药物敏感性检测，使患者能够迅速接受有效治疗，以测试活动性病例发现对结核病传播的影响。我们的实习医生将在秘鲁利马的一家大型综合医院测试这种方法，该医院多年来一直密切监测其工作人员的结核病病例。我们在这个临床研究和培训项目的合作伙伴将是国家卫生研究所， 秘鲁（INS）和卫生社会学（SES），这是PIH的秘鲁分支机构，通过圣马科斯大学提供流行病学课程。

DESCRIPTION (provided by applicant): After HIV, tuberculosis is the single largest infectious killer of adults in the world today. Among the most important aspects of TB control in most low and middle-income countries is the airborne spread of drug resistant (DR) tuberculosis, substantially in institutions such as hospitals, clinics, jails, prisons, and refugee camps. Institutional airborne infection control is a public health problem that intersects with several oter disciplines: architecture, engineering, and medicine. However, there have been no real innovations in airborne infection control in many decades, perhaps since the adaptation of industrial respirators for health care worker use in the 1990s. This proposal seeks to build international research capacity to address the issue of airborne spread of infections in buildings. Of greatest concern is the DR TB epidemic, but most of the interventions that result from this research will be equally relevant to other infections with airborne potential, such as pandemic influenza. This proposal continues the air disinfection engineering research training conducted under a 1-year Stimulus Fogarty Innovations Framework grant in Boston and in South Africa. It expands that work to include research training for architects as well as engineers in Boston and South Africa, using as a Partners In Health (PIH) clinical sites around the world, as well as research sites accessible through our South African partners, the Council for Scientific and Industrial Research (CSIR) and the University of Pretoria (UP). Course work will be available through UP. Under expert multidisciplinary mentorship, our trainees will develop and test novel indicators of successful building designs and, with another partner, the Medical Research Council (MRC) of South Africa, quantitatively test novel air disinfection technology developed in Boston and Pretoria. Our trainees will perform testing at the Airborne Infections Research (AIR) Facility (Witbank, SA), an established collaborative project between the MRC, the US CDC, UP, and Brigham & Women's (BWH) Hospital. If these innovations show promise, we will work with our local partners and two transitional research partners (the National Institute of Design of Indi and Frog Design, Inc) to optimize and commercialize products for local manufacture so that implementation is sustainable. Our own research at the AIR facility has demonstrated the rapid and powerful effect of effective treatment on TB transmission, even for drug resistant strains. Therefore, another complementary approach to the airborne spread of DR TB will be to test the impact on TB transmission of active case finding through cough surveillance followed by rapid molecular testing and drug susceptibility testing that will allow patients to be rapidly placed on effective treatment. Our physician trainees will test this approach at a large general hospital in Lima, Peru that has carefully monitored TB cases among its workers over the years. Our partners in this clinical research and training project will be the National Institute of Health of Peru (INS) and Socios En Salud (SES), the Peru arm of PIH, with course work in epidemiology available through San Marcos University.