Household contact tuberculosis preventive therapy program in rural Eastern Cape, South Africa

南非东开普省农村家庭接触性结核病预防治疗计划

• 批准号: 10531661
• 负责人: Brittney Jayne van de Water
• 金额: $ 13.32万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-11 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10531661
• 关键词: Household; contact; tuberculosis; preventive; therapy

PROJECT SUMMARY This mentored patient-oriented research career development award will prepare the candidate, a pediatric nurse practitioner with doctoral training in tuberculosis (TB) research, to become an independent nurse-scientist with expertise in implementation science. The candidate's long-term goal is to lead interdisciplinary global health research to improve patient and population TB and TB/HIV health outcomes. TB is the leading cause of death in South Africa, where 63% of individuals with TB are co-infected with HIV. As in most high TB burden countries, South Africa has historically focused TB efforts on treating those already sick with TB, while the use of highly effective TB preventive therapy (TPT) has not been widely deployed. Zithulele District Hospital in the Eastern Cape Province is incorporating TPT into its practice through a household- delivered TPT program (King Sabata Dalindyebo district (KSD) Without TB, aka KWIT-TB). This study will provide evidence regarding household-delivered TPT in a rural setting with a high burden of TB. We will measure the reach, implementation, and effectiveness of nurses and community health workers providing screening in households, tests to rule out TB disease, and initiation and completion of TPT. Aim 1 will assess a cascade of care to understand risk factors for failing to screen for TB disease, initiate TPT, and complete TPT. Aim 1 will examine the reach of the KWIT-TB program through the multiple steps of the care cascade. This will provide evidence of what steps to target to optimize TPT programs in the future. Aim 2 will assess the effectiveness of this KWIT-TB program among individuals who complete the full TPT course (six months of daily isoniazid), and examine the role of HIV and anti-retroviral therapy as modifiers of effectiveness. Finally, aim 3 will qualitatively characterize perceptions of eligible TB household contacts on factors influencing initiation and completion of TPT. This aim will provide rich data regarding barriers and facilitators to consider when scaling up TPT efforts in similar settings. The candidate has carefully developed a career trajectory for patient-oriented implementation science, meeting NINR's programmatic priorities to promote health and prevent disease, and to advance nursing science to improve the health and well-being of the world's citizens. This career development plan integrates coursework with practical mentored research to achieve three training goals: (1) develop skills in implementation science, (2) develop expertise in the application of quantitative and qualitative methods in nursing and public health research, and (3) build nursing leadership and managerial skills to lead well- organized, scaled research and clinical trials.

项目摘要 这个受到指导的以患者为导向的研究职业发展奖将为候选人做好准备 肺结核研究博士培训（TB）研究的儿科护士从业人员成为独立 具有实施科学专业知识的护士科学家。候选人的长期目标是领导 跨学科的全球健康研究，以改善患者和人口结核病和结核病/HIV健康结果。 TB 是南非死亡的主要原因，其中有63％的结核病患者与艾滋病毒共同感染。如 大多数高结核病负担国家，南非历史上一直以结核病为治疗那些已经生病的人的努力 使用结核病，虽然使用高效的TB预防疗法（TPT）尚未广泛部署。 Zithulele 东开普省的地区医院正在通过家庭将TPT纳入其实践中 - 交付的TPT计划（国王Sabata Dalindyebo District（KSD），没有结核病，又称KWIT-TB）。这项研究会 提供有关在农村地区较高负担结核病的乡村环境中提供家庭服务的证据。我们将 衡量护士和社区卫生工作者提供的覆盖范围，实施和有效性 在家庭中进行筛查，排除结核病疾病的测试以及TPT的启动和完成。 AIM 1将评估一系列护理，以了解未能筛查结核病疾病的危险因素， 启动TPT，并完成TPT。 AIM 1将通过多个检查KWIT-TB程序的范围 护理级别的步骤。这将提供有关针对哪些步骤优化TPT程序的证据 未来。 AIM 2将评估完成完整的个人中该KWIT-TB计划的有效性 TPT课程（每天六个月的异烟肼），并检查HIV和抗逆转录病毒疗法作为修饰剂的作用 有效性。最后，AIM 3将定性地表征对合格结核病家庭联系的看法 影响TPT启动和完成的因素。这个目标将提供有关障碍和的丰富数据 在类似的环境中扩大TPT努力时要考虑的促进者。 候选人已经仔细地开发了用于以患者为导向的实施科学的职业轨迹， 满足忍者的计划优先事项，以促进健康和预防疾病，并提高护理 改善世界公民健康和福祉的科学。该职业发展计划整合了 通过实践指导的研究工作以实现三个培训目标：（1）发展技能 实施科学，（2）在应用定量和定性方法的应用方面发展专业知识 护理和公共卫生研究，以及（3）建立护理领导和管理技能，以领导良好 有组织的，扩展的研究和临床试验。