Nutritional Interventions to End Tuberculosis among persons with HIV in India (NUTRIENT-India)

项目摘要 印度是艾滋病毒感染者人数第三高的国家。四分之一的死亡病例是艾滋病毒感染者 都是因为肺结核营养不良是印度结核病的主要危险因素。艾滋病毒阴性者传播结核病 这些人可能助长了印度艾滋病毒感染者中的结核病流行。我假设人口规模 营养干预措施将降低艾滋病毒感染者和非感染者的结核病发病率和死亡率。我也 假设在印度情况下，实物补充营养比 现金转账 模型使我们能够用数学语言生成现实世界问题的表示， 被用来获得洞察力和做出预测。建议的营养干预措施，以结束结核病 印度艾滋病毒感染者研究（NUTRIENT-India）的目标如下： 1.量化人口规模营养干预对结核病发病率和死亡率的长期影响 在印度泰米尔纳德邦的艾滋病毒感染者和非艾滋病毒感染者中， 2.评估减少结核病的各种营养干预措施的影响和成本效益 感染和未感染艾滋病毒者的发病率和死亡率 对于目标1，我们将开发微观模拟模型并对其进行验证。 来自国家健康调查的数据和来自正在进行的结核病学习营养的影响的主要数据 （LION）营养干预研究。对于目标2，我们将综合有关现金影响的证据 根据受援者的营养状况提供援助和实物援助。接下来，我们将采用现有的马尔可夫模型 模拟三种不同的营养干预：1）2600千卡（Kcal）/天的食物，750千卡/天的食物， 500卢比/月现金转移。我们将从TB-LION研究和NTEP计划中获得成本估算 成本在使用TB-LION和区域前瞻性观测数据校准模型后， 结核病研究（报告）-印度财团，我们将进行成本效益分析， 三种不同的营养干预。 印度营养研究将有助于量化营养干预对结核病的长期影响 印度结核病患者和非结核病患者的发病率和死亡率，该研究还将确定最大的成本- 在印度的情况下采取有效的营养干预措施。因此，它将告知政策制定者， 解决这个关键的结核病风险因素，使结核病在印度根深蒂固，以及他们如何能够干预，同时使 最大限度地利用现有资源。

PROJECT SUMMARY India has the third-highest number of persons with HIV. One-quarter of deaths among persons with HIV are due to TB. Undernutrition is the leading risk factor for TB in India. TB transmission from HIV-negative persons likely fuels the TB epidemic among Indian persons with HIV. I hypothesize that population-scale nutritional interventions would reduce TB incidence and mortality among persons with and without HIV. I also hypothesize that, in an Indian context, in-kind nutritional supplementation would be more cost-effective than cash transfers. Models allow us to generate representations of real-world problems in mathematical language which can be used to gain insights and to make projections. The proposed Nutritional Interventions to End Tuberculosis among persons with HIV in India (NUTRIENT-India) study will have the following aims: 1. Quantify the long-term impact of population-scale nutritional interventions on TB incidence and mortality among persons with and without HIV in the Indian state of Tamil Nadu using a microsimulation model 2. Estimate the impact and cost-effectiveness of a variety of nutritional interventions to decrease TB incidence & mortality among persons with and without HIV For aim 1, we will develop the microsimulation model and validate it. We will then calibrate the model using data from national health surveys and primary data from the ongoing TB Learning the Impact of Nutrition (LION) study of nutritional interventions. For aim 2, we will synthesize evidence on the impact of cash transfers and in-kind transfers on nutritional status of recipients. Next, we will adapt an existing Markov model to simulate three different nutritional interventions: 1) 2600 Kilocalories (Kcal)/d of food, 750 Kcal/d of food, and Rs 500/month cash transfer. We will obtain cost estimates from the TB-LION study and NTEP programmatic costs. After calibrating the model using data from TB-LION and the Regional Prospective Observational Research on Tuberculosis (RePORT)- India consortium, we will conduct cost-effectiveness analysis of the three different nutritional interventions. The NUTRIENT-India study will help quantify the long-term impact of nutritional interventions on TB incidence and mortality among persons with and without TB in India, The study will also define the most cost- effective nutritional interventions in the Indian context. Thus, it will inform policymakers on why they must address this critical TB risk factor that keeps TB entrenched in India and how they can intervene while making maximal use of available resources.