Author: dcarnice
Last saved by: Ivan Valenčík
Company: aspb

Expertise of the organisation proposing a partnership:

Area of expertise: 
Tuberculosis (TB) prevention and control,  contact tracing, community intervention programmes, infectious diseases  surveillance, international health.

The Public Health Agency of Barcelona  (PHAB) is the centre for Communicable Disease Surveillance and Control in the City of Barcelona.
The PHAB is mastering the Tuberculosis Prevention and control Programme in Barcelona since 1986.
This is a Public Organisation linked to the Catalan Government (Department of Health, Generalitat de Catalunya) 
The Agency has a collaboration with the Public Health Laboratory of Barcelona for Tuberculosis tests and IGRAs studies as well as for the testing of food borne and other infectious and vaccine preventable diseases.

With special emphasis on Tuberculosis, the PHAB, has an important role in the Tuberculosis Research Unit  (UITB) that has a collaborative work among all local and some international TB related health professionals. The UITB has produced 4 relevant consensus documents on Control and Prevention of TB, organises an annual Tuberculosis conference and produces a quarterly issued Scientific Journal: “Enfermedades Emergentes”.
The PHAB has also in important role on surveillance and control of outbreak prone diseases, STIs and HIV/AIDS, as well as other blood borne diseases (hepatitis viral) and malaria in Barcelona, collaborating with other centres of excellence of the Government of Catalonia. Implementing, analysing and distributing information to all notifying centres.

Currently, the main research lines in the Tuberculosis field are:
1-	The validation and implementation of new diagnostic technologies : 
a.	The assessment of Interferon Gamma Release Assays (IGRAs) for the diagnosis of  latent Tb infection (LTBI) in a cohort of patients at risk of developing TB
2-	The participation in Clinical Trials of Tuberculosis New Treatments Research under coordination of the Centers for Disease Control of the USA. 
3-	Impact assessment of Community Health Agents on Tuberculosis contact tracing in a city with high immigration
4-	TB transmission studies through contact tracing and molecular epidemiology

The PHAB team includes medical epidemiologists, statisticians, sociologists, public health nurses, community health agents, informatics and other research support personnel.

Organisation type:
Governmental organisation
 
Possible Project proposal:
Title:
Assessment of  IGRAs for the diagnosis of latent tuberculosis infection (LTBI) in patients at risk of developing TB in European countries with high-medium TB incidence.

Thematic areas:
Health Security

Summary:
Main objective:
Contribute to improved detection of Latent Tuberculosis Infection (LTBI) and to more precise indications of treatment of LTBI in persons with high risk of developing TB 
Strategic relevance and contribution to the EU Health Programme:
The EU Framework Action Plan to fight tuberculosis is based in four principles concordant with the proposed project: ensure prompt care, strengthen capacity, develop new tools and building partnership. Identification of persons with LTBI is crucial to prevent developing active TB. IGRAs have been recommended for the diagnosis of LTBI and many treatment algorithms base now decisions for LTBI treatment on IGRA results. Many studies show better sensibility and specificity of IGRAs compared to TST.There is a high heterogeneity on contact tracing and LTBI detection policies across the EU countries, mainly depending on testing and surveillance capacity. This study will contribute to homogenize coverage of contact tracing and improve surveillance as well as will produce important findings on the role of IGRAs  among foreign born populations with high BCG vaccination coverage, to develop active TB.
Methods and means:
This is a prospective population based cohort study. The study population will be eligible individuals identified through contact tracing of pulmonary smear positive TB patients. Contacts will be recruited during the year 2010 and will be followed 3 or 6-monthly and assessed for signs of active TB during a period of 2 years. CXR at exit. The follow up will be established until TB diagnosis or the end of the study period. The comparison of discordant results between TST and IGRAs at the beginning of the study with the final evaluation after 2 years follow up, will allow conclusions on the  predictive value of a positive blood test for progression to active disease among the individuals. In order to discern between previous and new infection, all contacts should be assessed for active TB after 2 years and molecular epidemiology performed when possible. Consensus with regards to LTBI treatment -criteria and protocols needs to be established between participating centres as a first step.
Expected outcome:
This multicentric European study will provide the opportunity to strengthen capacity among the participating centers and build up partnership for the use of tools to detect LTBI and Improved and more precise indications of LTBI treatment in high risk contacts. Spared unnecessary treatments in contacts with BCG vaccination history or other confounding factors. Potential for further translational research studies on cost-effectivity of the TST vs IGRAs: direct costs of the techniques and medical interventions derived of the diagnosis.
Outputs of the project.
-	Three follow up and consensus meetings (one every year)
-	Contribution to the consensus statement 
-	A report updating the testing policies in Europe.
-	Scientific articles on LTBI  and active TB diagnosis related research questions 

Looking for potential partners
In subject area:
TB surveillance and control departments
TB clinicians
TB laboratories
Among organisations:
Governmental 
In countries:
Any country of the European Union where:
1-	TST and IGRAs testing are in place and 
2-	Have high TB incidence and /or prevalence or
3-	Have increased number of foreign born population from high TB incidence and /or prevalence countries