Enhanced TB Screening to Determine the Prevalence and Incidence of TB in Patients With HIV
2017年9月13日 更新者：University of North Carolina, Chapel Hill
Enhanced TB Screening to Determine the Prevalence and Incidence of TB in a Cohort of HIV Clinic Patients in Lusaka, Zambia
This study will examine an enhanced protocol to systematically screen a cohort of 400 new HIV clinic enrollees for prevalence and 1-year incidence of tuberculosis (TB).
調査の概要
詳細な説明
Zambia is a high burden country for both HIV and TB infection and HIV clinic enrollees are a high-risk group for active TB.
Current Zambian Ministry of Health screening protocols are symptom-based even though active case-finding studies in HIV-infected populations have shown that symptoms are not always predictive of active TB.
As a result, there may be a significant amount of un-diagnosed TB among HIV-infected Zambians even in the context of accessing HIV care.
This study will examine an enhanced protocol to systematically screen a cohort of 400 new HIV clinic enrollees for prevalence and 1-year incidence of TB using symptoms, light and fluorescence microscopy, chest radiography and TB culture of sputum and extra-pulmonary fluids (when indicated).
In addition, the sensitivity, specificity and cost-effectiveness of each diagnostic tool will be evaluated.
研究の種類
観察的
入学 (実際)
400
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
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Lusaka、ザンビア
- Kalingalinga HIV Care and Treatment Clinic
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参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
16年～99年 (子、大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
全て
サンプリング方法
確率サンプル
調査対象母集団
Four hundred new enrollees at the Kalingalinga HIV Care and Treatment Clinic who are not currently being treated for TB.
説明
Inclusion Criteria:
- Persons with HIV/AIDS, 16 years of age or older, who are enrolling at the Kalingalinga ART clinic and are able and willing to provide informed consent
- Antiretroviral therapy-naïve except for short-course therapy through prevention of mother-to-child-transmission programs
- Not have taken any TB treatment in the past 3 months
- Willing to provide locator information and allow study staff to contact by phone or visit them at home if required
Exclusion Criteria:
- Any condition, including active drug or alcohol use, which in the opinion of the investigators, would interfere with adherence to study requirements
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
コホートと介入
グループ/コホート |
介入・治療 |
|---|---|
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new HIV clinic enrollees
All new enrollees to a Lusaka HIV clinic will receive a full TB work-up.
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All enrollees will receive a comprehensive TB screening regardless of symptom presentation.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Prevalence of undiagnosed TB in those with HIV.
時間枠：Enrollment screening visit
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Among the cohort of 400 new enrollees at the clinic, all will be tested for TB at the specified time points using enhanced TB screening.
Initial diagnosis will use smear microscopy and culture.
Chest X-ray will be performed on the second day of enrollment.
Presumptive Diagnosis: As culture results will take several days or weeks to become available, a presumptive diagnosis will be made based on history and physical exam, symptoms, smear microscopy and chest radiography results.
All patients who are smear-positive by at least one sample will be diagnosed with TB per national guidelines.
Patients who are smear-negative or suspected of extra-pulmonary TB based on clinical or radiographic findings may be treated empirically for TB at the discretion of a clinical or medical officer.
Sputum samples will also be sent for testing at the end of the study with the Xpert MTB/RIF assay.
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Enrollment screening visit
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Incidence of TB in a cohort of HIV clinic patients screened as 'TB negative'.
時間枠：enrollment, 3, 6, 9 and 12 month visits.
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To account for patients who are censored prior to 12 months of follow-up, the incidence of TB will be calculated as a rate.
Each patient will contribute follow-up time until they are censored, are diagnosed with TB, or have been in the study for 12 months.
Patients who were diagnosed with TB at enrollment will not be included.
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enrollment, 3, 6, 9 and 12 month visits.
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その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Performance of diagnostic measures
時間枠：Days 1, 2, 3; Months 3, 6 9 and 12
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The performance of symptom screening, light microscopy, fluorescence microscopy, chest x-ray, and Xpert MTB/RIF assay compared to culture of sputum and other fluids in HIV-infected patients will be evaluated using data analysis methods.
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Days 1, 2, 3; Months 3, 6 9 and 12
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Cost-effectiveness of each screening/diagnostic tool.
時間枠：Days 1, 2, 3 and months 3, 6, 9 and 12
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The primary outcomes of each diagnostic tool (or combination of diagnostic tools) that will be assessed are: cost per case diagnosed/detected, cost per patient cured, cost per case averted.
For instance, the cost per case of active TB detected using the "null" or gold standard screening option will be calculated and compared to the cost per case of active TB detected using each of the other screening options.
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Days 1, 2, 3 and months 3, 6, 9 and 12
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Clinical outcomes
時間枠：up to 12 months post-enrollment
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Clinical outcomes will be measured in a cohort of HIV-infected patients and TB/HIV co-infected patients during the first 12 months of HIV care including but not limited to mortality, immune recovery and development of other opportunistic infections.
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up to 12 months post-enrollment
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協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
捜査官
- 主任研究者：Stewart Reid, MD、CIDRZ; University of North Carolina at Chapel Hill
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
一般刊行物
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研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2011年10月1日
一次修了 (実際)
2012年9月1日
研究の完了 (実際)
2013年5月1日
試験登録日
最初に提出
2014年1月16日
QC基準を満たした最初の提出物
2014年1月20日
最初の投稿 (見積もり)
2014年1月23日
学習記録の更新
投稿された最後の更新 (実際)
2017年9月15日
QC基準を満たした最後の更新が送信されました
2017年9月13日
最終確認日
2014年12月1日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- CIDRZ 1226/IRB12-0416
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