INnovative data Science to Impact the TB Epidemic - INSITE

项目总结 在非洲，使用规模化的常规临床和健康数据并制定 在这样一个环境中处理这些数据的专业知识，在这种环境中，疾病负担和治疗方法 计数和编码与利用常规数据进行流行病学调查的其他环境有很大不同 分析。结核病(TB)是南非和南非最重要的艾滋病毒相关共病 艾滋病毒携带者(PLH)的主要死因。孕产妇结核病(妊娠期和产后期) 有害地影响妇女和婴儿的发病率和死亡率。妊娠结局更糟，更糟 由艾滋病毒合并感染，占60%，围产期结核病和艾滋病毒传播的风险增加。 具有/不具有氟喹诺酮耐药的利福平耐药结核病是一个日益严重的全球公共卫生问题 南非西开普省结核病患病率为4.2%。南非行动迅速 将新的和重新调整用途的二线抗结核药物纳入常规指南，包括 孕妇和哺乳期的人。这些药物在怀孕和哺乳期间的安全性尚不确定，但 随着RR-TB发病率的上升，人们在怀孕期间大规模使用了这些药物。随之而来的用法 HIV治疗的抗逆转录病毒疗法(ART)引起了人们对潜在的具有安全性的药物-药物相互作用的担忧 以及功效方面的影响。尽管艾滋病毒和结核病在全球范围内造成负担，但孕产妇结核病在全球范围内仍未得到优先考虑 育龄妇女。 在这种高感染负担的背景下，其中新的/重新用途的抗分枝杆菌制剂用于预防 西开普省是在怀孕期间大规模使用结核病治疗的，通常与抗逆转录病毒治疗联合使用 在托管省卫生数据中心(PhDc)方面具有独特的优势，这是第一个全面链接的卫生数据中心 非洲的信息交流。PhDc利用在全省范围内发布的唯一患者标识 给健康服务的用户，以统一所有来自 公共部门设施，包括实验室、药房、行政管理和其他临床数据。这些数据是 集成和管理，以使用表型算法来推断健康状况，以及 合并并存和构建患者级别的级联可用于监测和 分析卫生服务利用模式和卫生保健结果。 开普敦大学传染病流行病学与研究中心之间的伙伴关系 西开普省政府卫生情报局(PhDc所在地)提供了 利用数据科学开发和评估强大的孕产妇结核病数据平台的独特机会：i)创建 可操作的临床工具，以优化人员级别的干预和监测计划；ii)产生大型、相互关联的 处理孕产妇结核病的流行病学问题和评估政策干预措施的影响的队列 以及人群和个人层面的临床工具。

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.