Ricerca rapida nello sviluppo della diagnostica per la rete TB (R2D2TB Network)
Ricerca rapida nello sviluppo della diagnostica per lo studio della rete TB (rete R2D2 TB).
To reduce the burden of TB worldwide through more accurate, faster, simpler, and less expensive diagnosis of TB Every year, more than 3 million people with TB remain undiagnosed and 1 million die. Better diagnostics are essential to reducing the enormous burden of TB worldwide. The Rapid Research in Diagnostics Development for TB Network (R2D2 TB Network) brings together experts in TB care, technology assessment, diagnostics development, laboratory medicine, epidemiology, health economics and mathematical modeling with highly experienced clinical study sites in 10 countries.
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
- Test diagnostico: Novel mycobacterial culture techniques
- Test diagnostico: Novel sputum smear microscopy techniques
- Test diagnostico: Sputum-based molecular assays
- Test diagnostico: Tongue swab-based molecular assays
- Test diagnostico: Urine LAM assays
- Test diagnostico: Blood-based host immune response assays
- Test diagnostico: Breath-based assays
- Test diagnostico: Artificial intelligence-based digital health tools
- Test diagnostico: Phage-based assays
- Test diagnostico: Cartridge-based molecular assays for detecting drug resistance
- Test diagnostico: Sequencing-based assays for detecting drug resistance
Descrizione dettagliata
The Rapid Research in Diagnostics Development for TB Network (R2D2 TB Network) study seeks to identify and rigorously assess promising early stage tuberculosis (TB) triage, diagnostic and drug resistance tests (hereafter referred to as "novel tests") in clinical studies conducted in settings of intended use. Rapid diagnosis, identification of drug resistance and effective treatment are critical for improving patient outcomes and reducing TB transmission. However, analysis of care cascades and prevalence surveys indicate that 40-60% of patients with TB are not initiated on effective treatment.1,2 The different types of tests required to reduce this "diagnostic gap" have been described in the form of target product profiles (TPPs). The highest- priority TPPs are for: 1) a point-of-care, non-sputum biomarker-based test to facilitate rapid TB diagnosis using easily accessible samples (a biomarker-based diagnostic test) and 2) a simple, low-cost test that can be used by front-line health workers to rule-out TB (a triage test). The R2D2 TB Network study will evaluate the sensitivity and specificity of novel triage and diagnostic tests against a reference standard including sputum Xpert® MTB/RIF (Mycobacterium tuberculosis/Rifampin) Ultra and sputum mycobacterial culture. The sensitivity and specificity of rapid drug susceptibility tests (rDST) will be compared against a reference standard including culture-based phenotypic DST and whole genome sequencing (WGS) of mycobacterial DNA. In addition, the usability of novel tests will be assessed through direct observations and surveys of routine health workers.
Tipo di studio
Iscrizione (Stimato)
Fase
- Non applicabile
Contatti e Sedi
Contatto studio
- Nome: Adithya Cattamanchi, MD
- Numero di telefono: +1-415-206-5489
- Email: adithya.cattamanchi@ucsf.edu
Backup dei contatti dello studio
- Nome: Catherine Cook, MPH
- Numero di telefono: 603-988-9940
- Email: catherine.cook@ucsf.edu
Luoghi di studio
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Dasmariñas, Filippine
- Reclutamento
- De La Salle Medical and Health Sciences Institute
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Contatto:
- Charles Yu
- Email: chrlsyu@yahoo.com
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Tbilisi, Georgia
- Reclutamento
- National Center for Tuberculosis and Lung Diseases
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Contatto:
- Nestani Tukvadze
- Email: Nestan Tukvadze <marikushane@yahoo.com>
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Vellore, India
- Reclutamento
- Chitoor (Christian Medical College satellite campus)
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Contatto:
- DJ Christopher
- Email: djchris@cmcvellore.ac.in
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Vellore, India
- Reclutamento
- Christian Medical College CMC Pulmonary Outpatient Department
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Contatto:
- DJ Christopher
- Email: djchris@cmcvellore.ac.in
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Vellore, India
- Reclutamento
- Primary care clinics (Shalom/LCC, CHAD)
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Contatto:
- DJ Christopher
- Email: djchris@cmcvellore.ac.in
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Abuja, Nigeria
- Reclutamento
- Zankli Research Center
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Contatto:
- John Bimba, MD
- Email: john.bimba@binghamuni.edu.ng
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Cape Town, Sud Africa
- Reclutamento
- Brooklyn Chest Hospital
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Contatto:
- Grant Theron
- Email: gtheron@sun.ac.za
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Cape Town, Sud Africa
- Reclutamento
- Khayelitsha District Health Center
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Contatto:
- Grant Theron
- Email: gtheron@sun.ac.za
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Cape Town, Sud Africa
- Reclutamento
- Scottsdene primary care clinic
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Contatto:
- Grant Theron
- Email: gtheron@sun.ac.za
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Cape Town, Sud Africa
- Reclutamento
- Wallacedene primary care clinic
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Contatto:
- Grant Theron
- Email: gtheron@sun.ac.za
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Cape Town, Sud Africa
- Reclutamento
- Kraaifontein Community Health Clinic
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Contatto:
- Grant Theron
- Email: gtheron@sun.ac.za
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Kampala, Uganda
- Reclutamento
- Kisenyi Health Center
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Contatto:
- William Worodria
- Email: worodria@yahoo.com
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Kampala, Uganda
- Reclutamento
- Mulago Outpatient Department
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Contatto:
- William Worodria
- Email: worodria@yahoo.com
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Hanoi, Vietnam
- Reclutamento
- Hanoi Lung Hospital, Outpatient departments
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Contatto:
- Nhung Nguyen
- Email: vietnhung@yahoo.com
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Hanoi, Vietnam
- Reclutamento
- National Lung Hospital, Outpatient departments
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Contatto:
- Nhung Nguyen
- Email: vietnhung@yahoo.com
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Lusaka, Zambia
- Reclutamento
- Centre for Infectious Disease Research in Zambia
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Contatto:
- Monde Muyoyeta, Bsc, MBChB, PhD
- Email: monde.muyoyeta@cidrz.org
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Novel TB triage and diagnostic tests:
We will include non-hospitalized adults (age ≥ 12 years) with either 1) cough ≥2 weeks' duration, a commonly accepted criterion for identifying people with presumed pulmonary TB (to facilitate standardization across sites and comparison of test performance across sub-groups or 2) risk factors for which TB screening is recommended (HIV infection, self-reported close contact, history of mining work). People with risk factors will be included if they screen positive for TB based on WHO-recommended screening tools as specified below:
Positive TB screening definitions by risk factor:
- PLHIV (Risk Factor), CRP >5 mg/dL OR abnormal CXR (Positive TB screening definition)
- Self-reported Close Contact (Risk Factor), abnormal CXR (Positive TB screening definition)
- History of mining work (Risk Factor), abnormal CXR (Positive TB screening definition)
We will exclude people who:
- completed latent or active TB treatment within the past 12 months (to increase TB prevalence and reduce false-positive results, respectively);
- have taken any medication with anti-mycobacterial activity (including fluoroquinolones) for any reason, within 2 weeks of study entry (to reduce false-negatives);
- reside >20km from the study site or are unwilling to return for follow-up visits; or
- are unwilling to provide informed consent
Novel TB rDST assays:
We will include adults (age ≥12 years) who are positive for TB and RIF resistance according to routine diagnostic testing (based typically on Xpert MTB/RIF, Xpert MTB/RIF Ultra, or Hain MTBDRplus). We will exclude people who:
- have negative or contaminated results on all baseline (i.e., enrollment) sputum cultures
- are unable to provide at least two sputum specimens of 3 mL each within one day of enrollment
- are unable or unwilling to provide informed consent
Assessment of the usability of novel TB tests:
We will include health workers at each clinical site who are 1) aged ≥18 years and 2) involved in routine TB testing (collecting specimens for or performing TB tests). We will exclude staff who are unwilling to provide informed consent.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Diagnostico
- Assegnazione: Non randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
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Sperimentale: Evaluation of various novel TB triage and diagnostic tests.
For the novel TB triage and diagnostic tests, the investigators will conduct large-scale evaluation of design-locked tests in a cohort of adults with presumed TB, with nested feasibility/pilot studies of early and late prototype tests. The investigators aim to enroll 300-450 participants per year at each of five enrollment sites for evaluation of various novel TB triage and diagnostic tests and 50 health workers to assess test usability. |
We will evaluate tests intended to make culture more sensitive, faster, and have less contamination. We will evaluate new staining techniques or visualization methods to increase the sensitivity of smear microscopy. We will evaluate semi-automated or automated molecular assays intended for use at near point of care or point of care. We will evaluate semi-automated or automated molecular assays intended for use at near point of care or point of care. We will evaluate urine LAM assays incorporating techniques such as analyte concentration, higher sensitivity or specificity antibodies, or enhanced visualization to improve LAM detection. We will evaluate assays measuring host immune response parameters intended for use at near point of care or point of care. We will evaluate assays assessing volatile organic compounds or exhaled breath condensate for near point of care of point of care detection of TB. We will evaluate AI-based algorithms evaluating images (chest x-ray, ultrasound) or sounds (cough sounds, lung sounds) including an Infrasound-to-ultrasound e-stethoscope (Level 42 AI, USA). We will evaluate assays using phages to lyse mycobacterial cells for detection of DNA or antigens. |
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Sperimentale: Evaluation of novel rDST assays
Clinicians at participating sites will be asked to refer adult patients with rifampin-resistance identified by routine molecular testing. The investigators aim to enroll 100-200 patients per year at each of three enrollment sites for evaluation of novel rDST assays. |
We will evaluate semi-automated or automated molecular assays intended for use at near point of care or point of care. We will evaluate targeted and whole genome sequencing assays. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Sensitivity
Lasso di tempo: 7 months
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Number of positive results for a given index test/(Total positive + negative results for a given index test) among patients with TB using the microbiological reference standard |
7 months
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Specificity
Lasso di tempo: 7 months
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Number of negative results for a given index test/(Total positive + negative results for a given index test) among patients without TB using the microbiological reference standard |
7 months
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Collaboratori e investigatori
Collaboratori
Investigatori
- Investigatore principale: Adithya Cattamanchi, MD, University of California, San Francisco
Pubblicazioni e link utili
Pubblicazioni generali
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- Walker TM, Kohl TA, Omar SV, Hedge J, Del Ojo Elias C, Bradley P, Iqbal Z, Feuerriegel S, Niehaus KE, Wilson DJ, Clifton DA, Kapatai G, Ip CLC, Bowden R, Drobniewski FA, Allix-Beguec C, Gaudin C, Parkhill J, Diel R, Supply P, Crook DW, Smith EG, Walker AS, Ismail N, Niemann S, Peto TEA; Modernizing Medical Microbiology (MMM) Informatics Group. Whole-genome sequencing for prediction of Mycobacterium tuberculosis drug susceptibility and resistance: a retrospective cohort study. Lancet Infect Dis. 2015 Oct;15(10):1193-1202. doi: 10.1016/S1473-3099(15)00062-6. Epub 2015 Jun 23.
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- Crowder R, Thangakunam B, Andama A, Christopher DJ, Dalay V, Dube-Nwamba W, Kik SV, Nguyen DV, Nhung NV, Phillips PP, Ruhwald M, Theron G, Worodria W, Yu C, Nahid P, Cattamanchi A, Gupta-Wright A, Denkinger CM; R2D2 TB Network. Head-to-head comparison of diagnostic accuracy of TB screening tests: Chest-X-ray, Xpert TB host response, and C-reactive protein. medRxiv [Preprint]. 2024 Jun 21:2024.06.20.24308402. doi: 10.1101/2024.06.20.24308402.
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- Yerlikaya S, Chirwa M, Ajide B, Castro MDM, Ha H, Kato-Maeda M, Kisakye E, Marcelo D, Mochizuki T, Rockman L, Steadman A, Thangakunam B, Bimba JS, Christopher DJ, Muyoyeta M, Phan H, Theron G, Yu C, Kremer K, Phillips PPJ, Nahid P, Denkinger CM, Cattamanchi A, Andama A; R2D2 TB Network and SMART4TB Consortia. Pulmonary Tuberculosis Detection with MiniDock MTB Using Swab Samples. N Engl J Med. 2026 Apr 30;394(17):1710-1722. doi: 10.1056/NEJMoa2509761.
- Crowder R, Thangakunam B, Andama A, Christopher DJ, Dalay V, Nwamba W, Kik SV, Van Nguyen D, Viet Nhung N, Phillips PPJ, Ruhwald M, Theron G, Worodria W, Yu C, Nahid P, Cattamanchi A, Gupta-Wright A, Denkinger CM; R2D2 TB Network. Diagnostic Accuracy of Tuberculosis Screening Tests in a Prospective Multinational Cohort: Chest Radiography With Computer-Aided Detection, Xpert Tuberculosis Host Response, and C-Reactive Protein. Clin Infect Dis. 2026 Feb 25;82(2):e239-e247. doi: 10.1093/cid/ciae549.
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- U01AI152087 (Sovvenzione/contratto NIH degli Stati Uniti)
- R01AI190419 (Sovvenzione/contratto NIH degli Stati Uniti)
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Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
prodotto fabbricato ed esportato dagli Stati Uniti
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