{"doc_desc":{"title":"tmt","idno":"DDI-MWI-MEIRU-TMT-2012-v1","producers":[{"name":"Themba Chirwa","abbr":"TC","affiliation":"MEIRU","role":"Metadata Entry and Editing Officer"},{"name":"Elizabeth Nancy Munthali","abbr":"ENM","affiliation":"MEIRU","role":"Metadata Supervisor"},{"name":"Chifundo Kanjala","abbr":"CK","affiliation":"MEIRU","role":"Documentation Planning and Supervision"},{"name":"Malawi Epidemiology and Intervention Research Unit","abbr":"MEIRU","affiliation":"MEIRU","role":"Agency"},{"name":"Jacky Saul","abbr":"JS","affiliation":"LSHTM and MEIRU","role":"Production of the documentation used to create this DDI document"},{"name":"Keith Branson","abbr":"KB","affiliation":"LSHTM and MEIRU","role":"Production of the documentation used to create this DDI document"}],"prod_date":"2020-04-14","version_statement":{"version":"version 1 ( June 2019 )"}},"study_desc":{"title_statement":{"idno":"MWI-MEIRU-TMT-2012-v1","title":"TMT-Tracing Microbacteria Transimission - 2012","translated_title":"English"},"authoring_entity":[{"name":"Prof Amelia C Crampin","affiliation":"London School of Hygiene and Tropical Medicine & MEIRU"}],"oth_id":[{"name":"MEIRU Core datamanagement team","affiliation":"","email":"","role":""}],"production_statement":{"producers":[{"name":"Prof Judith Glynn","abbr":"JG","affiliation":"London School of Hygiene and Tropical Medicine","role":"Co-investigators"},{"name":"Dr Rein Houben","abbr":"RH","affiliation":"London School of Hygiene and Tropical Medicine","role":"Co-investigators"},{"name":"Prof Neil French","abbr":"NF","affiliation":"Liverpool School of Tropical Medicine","role":"Co-investigators"},{"name":"Berlings Mhango","abbr":"BM","affiliation":"Ministry of Health, National TB Programme","role":"Co-investigators"},{"name":"Sebastian Mboma","abbr":"SM","affiliation":"MEIRU\/KPS","role":"Co-investigators"},{"name":"Themba Mzembe","abbr":"TM","affiliation":"MEIRU\/KPS","role":"Co-investigators"}],"prod_date":"2017-03-02","funding_agencies":[{"name":"Wellcome Trust, UK","abbr":"WT-UK","role":""}]},"distribution_statement":{"depositor":[{"name":"","abbr":"","affiliation":"","uri":""}]},"series_statement":{"series_name":"Intervention Study"},"version_statement":{"version":"- v1:  Edited data,First version, for internal use only","version_date":"2012-06-26"},"study_info":{"abstract":"1 The HIV epidemic continues to present a major challenge to TB control. ART reduces TB risk at the individual level, but the risk remains well above that of HIV-negative individuals, even at high CD4 counts.1 With growing numbers of people on ART, with long survival and increased risk of smear-positive pulmonary disease, the expected population impacts are unclear. In Malawi TB notifications have stopped declining for the last two years. \nThe newly launched Stop TB 2011-2015 plan acknowledges that as well as stepping-up current control measures, more fundamental research is needed if  the WHO target of \u201celimination of TB by 2050\u201d is to be met.2 One area of research is to understand where transmission is occurring. \nKPS has previously shown that recent infection is the predominant cause of TB in HIV-infected individuals,3-4 that HIV-infected cases play an important role in transmission,5 and that ART may be increasing TB rates at the population level in Karonga district. Interrupting ongoing transmission is key to control and will have more immediate impact than those interventions addressing latent infection which are required for long term control.\nWe know that most M.tb infection is due to casual contacts. Based on DNA fingerprinting, we have shown that about two thirds of the TB in adults is due to recent transmission, 6 but only about 12% of TB in the population is attributable to identifiable contacts, and even those with known household or close family contact with smear positive TB were likely to have acquired their TB elsewhere.7 This shows that contact tracing is unlikely to contribute much to TB control, with the exception is spouses of TB patients, about 40% of whom are HIV positive, have a high risk of TB, and can be easily identified.\nOngoing transmission in the population is measured by the rate of M.tb infection, most easily determined through age-specific skin test positivity in children. Since Mtb infection is a relatively rare event, if a child is infected with Mtb, the infection event should have happened recently. Considering the relative reduced mobility of children, the source of infection will also probably be local. \nWe intend to monitor children in our demographic surveillance area in the south of the District (total population ~35,000) to investigate the overall prevalence and distribution of skin test positivity, and the relationship to known smear positive cases of tuberculosis (62 smear positive cases in the past five years in the area), aiming to identify clusters of transmission events. We have previously found that although skin test positivity in the under fives is higher in those living in the household of a smear positive TB case, (34%, compared to 8% with no known household contact), 93% of infections occur in households without known cases.\n\n2, Interrupting ongoing transmission of Mycobacterium tuberculosis is key to control and will have more immediate impact than those interventions addressing latent infection which are required for long term control.\nIn high burden countries, M.tuberculosis infection is due to casual contacts and only a small proportion of TB cases are attributable to identifiable contacts. Even in children under five years old, the majority of infections occur in households without known cases. \nIn the Karonga demographic survey area we propose to assess tuberculin skin test (TST) sensitivity in children and identify new infections to track transmission. Young children spend more time near their home and close family than do adults, and are less likely to be already infected, so increasing the chance of being able to pinpoint the source of infection. Staff will conduct TST on children <5 years, with follow-up a year. Prevalent TST \u201cpositivity\u201d will be mapped to establish linkage to known cases within the last five years. All children <5 with evidence of incident infection will be investigated with a commercial interferon gamma release assay (IGRA). All household, neighbourhood and regular visitor contacts of these newly-infected children (~20 contacts\/child) will be screened at the household. This will establish the contribution of known symptomatic cases, \u201csilent\u201d but detectable excretors, and unknown sources, to transmission of infection in the population. Children <5 with incident infection will be offered isoniazid preventive therapy.","coll_dates":[{"start":"2012-07-17","end":"2015-07-28","cycle":""}],"nation":[{"name":"Malawi","abbreviation":"MWI"}],"geog_coverage":"MEIRU, Chilumba DSS","analysis_unit":"Individual","universe":"1, For the Tuberculin Skin Test screening we will include all children under 5 years old living in the Demographic Surveillance Area. We will seek written consent from the guardian for each child. \n2, all children <5 years old resident in the demographic surveillance area suspected sources of M.tb infection (household, neighbourhood and regular visitor contacts of children with a positive TST) resident in the demographic surveillance area","data_kind":"Biomeasures data","notes":"TMT1 - INFECTION FOLLOW UP FORM - KPS - Households visited in the last year, MAin Carrier\/s of Child if under 1 year old, GATHERINGS, Education, PREVIOUS TB TREATMENT, CONTACT WITH OTHER TB PATIENTS IN THE LAST YEAR, HOUSEHOLD CONTACTS OR MEMBERS OF THE FAMILY WHO HAVE HAD TB IN THE LAST YEAR, OTHER PEOPLE CHILD KNOWS WHO HAVE HAD TB IN THE LAST YEAR, PRE-ISONIAZID PREVENTIVE THERAPY SCREEN, ANTHROPOMETRIC MEASUREMENTS, BCG scar survey\n\nTMTc questionnaire- KPS - Households visited in the last year, MAin Carrier\/s of Child if under 1 year old, GATHERINGS, Education, CONTACT WITH OTHER TB PATIENTS IN THE LAST YEAR."},"method":{"data_collection":{"data_collectors":[{"name":"Malawi Epidemiology and Intervention Research Unit","abbr":"MEIRU","role":"","affiliation":""}],"coll_mode":["Face-to-face [f2f]"],"research_instrument":"attached here as external resources","sources":[{"name":"","origin":"","characteristics":""}]}},"data_access":{"dataset_availability":{"original_archive":"Chilumba"},"dataset_use":{"contact":[{"name":"Malawi Epidemiology and Intervention Research Unit","affiliation":"","email":"","uri":""}],"conditions":"This data is made available for licensed access under the following conditions:\n\n1. Data and other material provided by MEIRU will not be redistributed or sold to other individuals, institutions or organisations without MEIRU's written agreement.\n\n2. In the case of multi-centre datasets, data originating from a single contributing member centre of the collaboration may not be analysed or reported on in isolation without the express permission of the member centre concerned.\n\n3. No attempt will be made to re-identify respondents, and there will be no use of the identity of any person or establishment discovered inadvertently. Any such discovery will be reported immediately to MEIRU.\n\n4. No attempt will be made to produce links between datasets provided by MEIRU or between MEIRU data and other datasets that could identify individuals.\n\n5. Any books, articles, conference papers, theses, dissertations, reports or other publications employing data obtained from MEIRU will cite the source, in line with the citation requirement provided with the dataset.\n\n6. An electronic copy of all publications based on the requested data will be sent to MEIRU."}}},"schematype":"survey"}