PDF(Pubmed)
Abstract：
BACKGROUND: Namibia is a high tuberculosis (TB)-burden country with an estimated incidence of 460/100 000 (around 12 000 cases) per year. Approximately 4.5% of new cases and 7.9% of previously treated TB cases are multidrug resistant (MDR) and 47% of patients with MDR-TB are HIV coinfected. Published data suggest a clustering of MDR-TB transmission in specific areas. Identifying transmission clusters is key to implementing high-yield and cost-effective interventions. This includes knowing the yield of finding TB cases in high-transmission zones (eg, community hotspots, hospitals or households) to deliver community-based interventions. We aim to identify such transmission zones for enhanced case finding and evaluate the effectiveness of this approach.
METHODS: H3TB is an observational cross-sectional study evaluating MDR-TB active case finding strategies. Sputum samples from MDR-TB cases in three regions of Namibia will be evaluated by whole genome sequencing (WGS) in addition to routine sputum investigations (Xpert MTB/RIF, culture and drug susceptibility testing). We will collect information on household contacts, use of community spaces and geographical map intersections between participants, synthesising these data to identify transmission hotspots. We will look at the feasibility, acceptability, yield and cost of case finding strategies in these hotspots, and in households of patients with MDR-TB and visitors of hospitalised patients with MDR-TB. A compartmental transmission dynamic model will be constructed to evaluate the impact and cost-effectiveness of the strategies if scaled.
BACKGROUND: Ethics approval was obtained. Participants will give informed consent. H3TB will capitalise on a partnership with the Ministry of Health and Social Services to follow up individuals diagnosed with MDR-TB and integrate WGS data with innovative contact network mapping, to allow enhanced case finding. Study data will contribute towards a systems approach to TB control. Equally important, it will serve as a role model for similar studies in other high-incidence settings.
METHODS: H3TB is an observational cross-sectional study evaluating MDR-TB active case finding strategies. Sputum samples from MDR-TB cases in three regions of Namibia will be evaluated by whole genome sequencing (WGS) in addition to routine sputum investigations (Xpert MTB/RIF, culture and drug susceptibility testing). We will collect information on household contacts, use of community spaces and geographical map intersections between participants, synthesising these data to identify transmission hotspots. We will look at the feasibility, acceptability, yield and cost of case finding strategies in these hotspots, and in households of patients with MDR-TB and visitors of hospitalised patients with MDR-TB. A compartmental transmission dynamic model will be constructed to evaluate the impact and cost-effectiveness of the strategies if scaled.
BACKGROUND: Ethics approval was obtained. Participants will give informed consent. H3TB will capitalise on a partnership with the Ministry of Health and Social Services to follow up individuals diagnosed with MDR-TB and integrate WGS data with innovative contact network mapping, to allow enhanced case finding. Study data will contribute towards a systems approach to TB control. Equally important, it will serve as a role model for similar studies in other high-incidence settings.
摘要：
背景：纳米比亚是一个结核病（TB）负担很高的国家，每年估计发病率为460/10万（约12000例）。大约4.5%的新病例和7.9%以前治疗过的结核病病例是多重耐药(MDR)的，47%的耐多药结核病患者是艾滋病毒合并感染的。已发布的数据表明，特定地区的耐多药结核病传播呈集群状态。识别传播集群是实施高收益和具有成本效益的干预措施的关键。这包括了解在高传播区发现结核病例的产量(例如，社区热点,医院或家庭)提供基于社区的干预措施。我们的目标是确定这样的传播区域，以增强病例发现并评估这种方法的有效性。
方法：H3TB是一项观察性横断面研究，评估MDR-TB主动病例发现策略。除常规痰液调查外，还将通过全基因组测序（WGS）评估纳米比亚三个地区耐多药结核病病例的痰液样本（XpertMTB/RIF，培养和药敏试验)。我们会收集家庭联系人的资料,参与者之间使用社区空间和地理地图交叉点，合成这些数据以识别传输热点。我们将看看可行性，可接受性,在这些热点中寻找案例的策略的收益和成本，以及耐多药结核病患者的家庭和住院耐多药结核病患者的访客。如果按比例缩放，将构建一个隔室传输动态模型来评估策略的影响和成本效益。
背景：获得了伦理批准。参与者将给予知情同意。H3TB将利用与卫生和社会服务部的合作关系，对被诊断为耐多药结核病的个人进行随访，并将WGS数据与创新的联系网络映射相结合。以允许增强的病例查找。研究数据将有助于结核病控制的系统方法。同样重要的是,它将成为其他高发病率环境中类似研究的榜样.
方法：H3TB是一项观察性横断面研究，评估MDR-TB主动病例发现策略。除常规痰液调查外，还将通过全基因组测序（WGS）评估纳米比亚三个地区耐多药结核病病例的痰液样本（XpertMTB/RIF，培养和药敏试验)。我们会收集家庭联系人的资料,参与者之间使用社区空间和地理地图交叉点，合成这些数据以识别传输热点。我们将看看可行性，可接受性,在这些热点中寻找案例的策略的收益和成本，以及耐多药结核病患者的家庭和住院耐多药结核病患者的访客。如果按比例缩放，将构建一个隔室传输动态模型来评估策略的影响和成本效益。
背景：获得了伦理批准。参与者将给予知情同意。H3TB将利用与卫生和社会服务部的合作关系，对被诊断为耐多药结核病的个人进行随访，并将WGS数据与创新的联系网络映射相结合。以允许增强的病例查找。研究数据将有助于结核病控制的系统方法。同样重要的是,它将成为其他高发病率环境中类似研究的榜样.
