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.

项目概要 这个以患者为导向的研究职业发展奖将为候选人做好准备， 接受过结核病 (TB) 研究博士培训的儿科执业护士，成为一名独立的护士 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 跨学科的全球卫生研究，以改善患者和人群的结核病和结核病/艾滋病毒健康结果。结核病 结核病是南非的主要原因，该国 63% 的结核病患者同时感染艾滋病毒。如在 作为结核病高负担国家，南非历来将结核病工作重点放在治疗已经患病的人上 结核病，而高效的结核病预防疗法（TPT）尚未得到广泛应用。齐图勒勒 东开普省的地区医院正在通过家庭将 TPT 纳入其实践中。 实施 TPT 计划（King Sabata Dalindyebo 区 (KSD) 无结核病，又名 KWIT-TB）。这项研究将 提供有关在结核病负担高的农村地区家庭进行 TPT 的证据。我们将 衡量护士和社区卫生工作者提供服务的范围、实施情况和有效性 家庭筛查、排除结核病的检测以及 TPT 的开始和完成。 目标 1 将评估一系列护理，以了解未能筛查结核病的风险因素， 启动TPT，完成TPT。目标 1 将通过多种方式检查 KWIT-TB 计划的影响范围 护理级联的步骤。这将为优化 TPT 计划的目标步骤提供证据。 未来。目标 2 将评估该 KWIT-TB 计划在完成全部课程的个人中的有效性 TPT 课程（六个月每日异烟肼），并检查 HIV 和抗逆转录病毒治疗作为调节剂的作用 的有效性。最后，目标 3 将定性描述合格结核病家庭接触者对以下方面的看法： 影响TPT开始和完成的因素。这一目标将提供有关障碍和问题的丰富数据 协调员在类似环境中扩大 TPT 工作时应考虑的因素。 候选人精心制定了以患者为导向的实施科学的职业轨迹， 满足 NINR 的计划重点，以促进健康和预防疾病，并推进护理 科学改善世界公民的健康和福祉。该职业发展计划整合了 课程作业与实践指导研究相结合，以实现三个培训目标：(1) 培养以下方面的技能： 实施科学，(2) 发展定量和定性方法应用方面的专业知识 护理和公共卫生研究，以及（3）培养护理领导力和管理技能，以领导良好的 有组织的、规模化的研究和临床试验。