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Optimal targeting for individual and population-level TB prevention

Award Number: R01AI146555
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 12/05/2019
PERIOD OF PERFORMANCE END DATE: 11/30/2025

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Optimal targeting for individual and population-level TB prevention - PROJECT SUMMARY/ABSTRACT Within the same community, TB risks can differ by several orders of magnitude due to differences in infectious exposure and immune competence, and TB control depends heavily on targeting services to those most at risk. Priority groups described by the CDC and other agencies capture major TB risk factors, but these broad categories include many individuals with low TB risk, and exclude others who would benefit from screening. Our long-term objective is to provide individually- and locally-tailored evidence on TB risks and intervention effects, to optimize TB prevention services. In prior work we have demonstrated the feasibility of estimating TB risks for small population groups, and in Aim 1 we will create granular estimates of TB risk for the US population, via a Bayesian evidence synthesis combining time series data on TB cases and population size, prevalence of latent infection (LTBI), and the fraction of cases due to recent infection. This analysis will allow us to produce individually-tailored risk predictions to better target preventive services, and provide patients with quantitative information on the risks they face. The number of patients to whom this applies is substantial—approximately half of all US residents have been tested for LTBI, and of those testing positive only half initiate treatment. This represents a large number of people facing decisions about LTBI testing and treatment. Aim 2 will directly address these questions, creating highly-disaggregated estimates of the costs, harms, and benefits of LTBI testing and treatment. To do so we will construct a Markov microsimulation model of LTBI screening and treatment. Using this model we will estimate long-term patient-level outcomes, including changes in TB risk, survival, costs, and adverse events. Based on these analyses we will develop a user-friendly web tool to provide patients and clinicians prompt, validated, and individually-tailored information on possible treatment outcomes. We will also conduct analyses and develop a companion tool that will report the impact and cost-effectiveness of LTBI screening for user-defined target groups for the purpose of guiding program decision-making. To increase the reach and impact of these tools we will adapt them for other countries with TB incidence below 20 per 100,000. In Aim 3 we will develop a transmission-dynamic simulation model to predict long-term outcomes for a broad set of TB control options (including but not limited to LTBI treatment) and risk factor trends. The model will be calibrated for multiple jurisdictions, and a web-based interface will allow users to specify scenarios and visualize outcomes. By identifying how current and novel interventions can be most effectively deployed to improve health, this research addresses the NIH’s highest priority area of health economics research, and responds directly to the need for computational tools and models to better understand and respond to infectious disease risks. 1


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = -$263 )
2026	2024	PRESIDENT AND FELLOWS OF HARVARD COLLEGE	1033 MASSACHUSETTS AVE STE 3	CAMBRIDGE	MA	02138	MIDDLESEX	USA	Allergy and Infectious Diseases Research	000	5	4/20/2026	NON-COMPETING CONTINUATION	-$263
														Subtotal = -$263

Issue Date FY: 2024 ( Subtotal = $491,559 )
2024	2024	HARVARD COLLEGE PRESIDENT & FELLOWS OF	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Allergy and Infectious Diseases Research	001	5	5/15/2024	NON-COMPETING CONTINUATION	$49,156
2024	2024	HARVARD COLLEGE PRESIDENT & FELLOWS OF	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	5	11/13/2023	NON-COMPETING CONTINUATION	$442,403
														Subtotal = $491,559

Issue Date FY: 2023 ( Subtotal = $499,215 )
2023	2023	HARVARD COLLEGE PRESIDENT & FELLOWS OF	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	4	11/8/2022	NON-COMPETING CONTINUATION	$499,215
														Subtotal = $499,215

Issue Date FY: 2022 ( Subtotal = $499,215 )
2022	2022	PRESIDENT AND FELLOWS OF HARVARD COLLEGE	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	3	12/8/2021	NON-COMPETING CONTINUATION	$499,215
														Subtotal = $499,215

Issue Date FY: 2021 ( Subtotal = $496,208 )
2021	2021	PRESIDENT AND FELLOWS OF HARVARD COLLEGE	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	2	11/30/2020	NON-COMPETING CONTINUATION	$496,208
														Subtotal = $496,208

Issue Date FY: 2020 ( Subtotal = $529,009 )
2020	2020	PRESIDENT AND FELLOWS OF HARVARD COLLEGE	677 HUNTINGTON AVE	BOSTON	MA	02115	SUFFOLK	USA	Allergy and Infectious Diseases Research	000	1	12/5/2019	NEW	$529,009
														Subtotal = $529,009

Grand Total All Awards = $2,514,943

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Optimal targeting for individual and population-level TB prevention

Award Number: R01AI146555

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 12/05/2019

PERIOD OF PERFORMANCE END DATE: 11/30/2025

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