Using an implementation science approach to refine, implement and evaluate pilot strategies for tuberculosis contact tracing in South Africa

使用实施科学方法完善、实施和评估南非结核病接触者追踪试点策略

• 批准号: 10428463
• 负责人: Colleen Hanrahan
• 金额: $ 16.22万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10428463
• 关键词: Adopted; Behavior; Behavioral; Caring; Cessation of life; Clinic; Contact Tracing; Country; Data; Decision Making; Detection; Diagnosis; Disease; Effectiveness; Elements; Enrollment; Epidemiology; Evaluation; Failure; Focus Groups; Future; Goals; Health; Health Personnel; Health Priorities; Health system; Healthcare; Household; Incentives; Incidence; Individual; Infrastructure; Interdisciplinary Study; Intervention; Interview; Investigation; Maps; Measures; Mentorship; Methodology; Methods; Modeling; Motivation; Newly Diagnosed; Persons; Primary Health Care; Process; Program Sustainability; Province; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Recommendation; Research; Research Personnel; Resources; Rural; South Africa; Surveys; Testing; Training; Tuberculosis; Tuberculosis diagnosis; Visit; World Health Organization; base; behavior change; behavior change wheel; career; case finding; comparative effectiveness trial; design; effectiveness measure; experience; experimental study; financial incentive; global health; global health emergency; implementation barriers; implementation design; implementation facilitators; implementation measures; implementation science; implementation strategy; improved; indexing; innovation; intervention mapping; meetings; multidisciplinary; novel; pilot test; population health; primary care setting; programs; rural South Africa; rural setting; scale up; screening; skills; success; system-level barriers

PROJECT SUMMARY Tuberculosis (TB) remains a global health emergency, responsible for 10 million new cases and 1.5 million deaths in 2018. The Stop TB Partnership has set very ambitious targets that include a 50% reduction in TB incidence from 2015 to 2025. Strategies to find people with active TB earlier in their disease course must therefore be rapidly scaled up if TB control targets for 2025 are to be approached. However, active case finding or TB is expensive and difficult to implement in practice, particularly tracing close contacts of newly diagnosed TB cases. One innovative approach to contact tracing is to forego household visits in favor of small incentives to the TB case and their contact for the contacts to present to the clinic for TB screening. This proposed research is a novel study looking at barriers to implementation of incentive-based contact tracing, refining the strategy to modify these barriers and pilot testing it in the high burden setting of rural South Africa. We will measure acceptability, feasibility, reach, implementation and generate pilot effectiveness data which can be used to plan for scale-up. The proposed study will be in the rural district of Vhembe, South Africa – a district with a TB incidence of 350 per 100,000/year. We will assess barriers to implementation using quantitative surveys and qualitative interviews with TB cases and their contacts who received the intervention in the context of a cluster-randomized controlled trial, as well as healthcare workers. We will prioritize barriers with stakeholders and devise a refined incentive-based tracing implementation strategy. We will pilot test this strategy in 6 public primary health clinics within Vhembe, and examine implementation and preliminary effectiveness. The specific aims of this research are: (1) To identify individual and systems-level barriers and facilitators to the implementation of incentive-based contact tracing in a high burden setting; (2) To develop and pilot test an improved contact tracing strategy. This multidisciplinary research represents an innovative path toward achieving medium-term TB control targets in a key epidemiological setting, and can also serve as a methodological example of how to improve real-world decision-making across a broad array of other fields in the context of urgent and ambitious population health priorities.

项目摘要 结核病（TB）仍然是全球卫生紧急情况，负责1000万例新病例和150万例 2018年的死亡。停止结核病合作伙伴关系设定了非常雄心勃勃的目标，其中包括TB的50％ 从2015年到2025年。 因此，如果要接近2025的结核病控制目标，请迅速缩放。但是，有效案例 在实践中寻找或结核病很昂贵且难以实施，尤其是追踪新近的紧密联系 诊断为结核病病例。接触追踪的一种创新方法是放弃家庭访问以支持小型 对结核病案例的激励措施及其接触接触的接触，以便向诊所提供结核病筛查。这 拟议的研究是一项新的研究，研究了实施基于激励的接触追踪的障碍， 完善了修改这些障碍并在南非农村地区高伯恩环境中对其进行测试的策略。 我们将衡量可接受性，可行性，触及，实施并生成飞行员有效性数据 可用于计划扩展。拟议的研究将在南非Vhembe的粗糙地区 - 区域的结核病事件为每100,000/年350。我们将评估使用的障碍 接受干预的TB案件及其联系人的定量调查和定性访谈 在集群随机对照试验以及医护人员的背景下。我们将优先考虑障碍 利益相关者并制定了基于激励的追踪实施策略。我们将进行试验测试 Vhembe的6家公共卫生诊所的战略，以及检查和初步 效力。这项研究的具体目的是：（1）确定个人和系统级别的障碍以及 促进在高燃烧环境中实施基于激励的接触跟踪； （2）发展 并试点测试改进的接触跟踪策略。这项多学科研究代表了创新的 在关键流行病学环境中实现中期结核病控制靶标的道路，也可以作为 一个方法论示例，说明如何在其他广泛领域中改善现实世界的决策 紧急和雄心勃勃的人口健康重点的背景。