Post-Tuberculosis Lung Disease in Youth with and without HIV Globally

Indiana University Indianapolis, Indianapolis IN

Investigators

Abstract

PROJECT ABSTRACT Post-tuberculosis lung disease (PTLD) is a major cause of chronic disease globally. Data are lacking, however, on the prevalence of PTLD and targets for its prevention in youth (ages 15-24), who are vulnerable to care engagement challenges and social determinants that may increase risk for PTLD. Tuberculosis (TB) has tremendous health burdens for youth and is a leading cause of death in this age group. Our long-term goal is to implement youth-focused TB services that target the drivers of PTLD, optimize care engagement, and promote long-term lung health and well-being. Our objective is to establish the prevalence of PTLD in youth, identify modifiable patient-level and environmental risk factors, and assess the effect of PTLD on youth quality of life. Our central hypothesis is that PTLD is prevalent in youth and has associated modifiable risk factors and quality of life impacts that can be targeted with tailored interventions and novel care models. The project will leverage the Tuberculosis Sentinel Research Network (TB-SRN) of the International epidemiology Databases to Evaluate AIDS (IeDEA). TB-SRN is enrolling 2,600 people aged ≥15 with pulmonary TB, with or without HIV, in 11 countries, and following them from TB treatment initiation to 12 months post-treatment. Assessments span clinical, adherence, lung health, mental health, substance use and social determinant domains. We will enhance existing procedures at 7 Youth TB-SRN sites in 6 African countries. Activities at Youth TB-SRN sites will ensure robust analyses of PTLD in youth, through: 1) enhanced data collection on lung health, air pollution, quality of life and well-being; 2) additional enrollment of youth with and without TB, to target 600 total; and 3) youth-friendly supports for study retention. In Aim 1, we will identify PTLD prevalence and risk factors among youth. Persistent pulmonary function impairment at 12-months post-TB treatment (and at 24-months in secondary analyses) will be tested for association with clinical, care engagement, and substance use factors. Pulmonary function will be compared in youth with and without TB. In Aim 2, we will assess air pollution as a risk factor for PTLD in youth. We will add actionable air pollution data to TB-SRN procedures. In 180 youth with TB, 72-hour personal fine particulate matter (PM2.5) exposure will be measured at month 2 of TB treatment, at end of treatment, and 6- and 12-months post-TB treatment. Among 180 youth without TB, PM2.5 exposure will be measured at two timepoints, to enable analyses of TB and air pollution as drivers of lung health. In Aim 3, we will evaluate the impact of PTLD on youth quality of life. Data on health-related quality of life and mental and social well-being will inform the development of care models and interventions to mitigate and manage PTLD. We evaluate persistent pulmonary function impairment for association with health-related quality of life (by EQ-5D-5L) at 12-months post-treatment. Quality of life will be compared in youth with and without TB. Study findings will address a critical knowledge gap about PTLD prevalence in youth and identify key targets for interventions to prevent or mitigate PTLD, as well as foci for strategies to alleviate the detrimental impacts of PTLD on youth quality of life and well-being.