IMPLEMENTATION OF A CULTURALLY TAILORED DECENTRALIZATION PROGRAMME FOR SNAKEBITE TREATMENT IN INDIGENOUS COMMUNITIES IN THE BRAZILIAN AMAZONIA

实施针对巴西亚马逊土著社区蛇咬伤治疗的文化定制分散化计划

• 批准号: MR/Y019709/1
• 负责人: Wuelton Marcelo Monteiro
• 金额: $ 143.7万
• 依托单位: Tropical Medicine Foundation (FMT-HVD)
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY019709%2F1
• 关键词: IMPLEMENTATION; CULTURALLY; TAILORED; DECENTRALIZATION; PROGRAMME

Snakebite envenomations (SBE) is an emergency health condition with freely available efficacious treatment. This disease burden on the indigenous population is entirely preventable. As described, the central obstacles to overcome in improving SBE patient outcomes are the patient's need to seek higher-level care and, thus, leave the indigenous village, alongside the lack of resources that strangle indigenous health care as a whole. Current community health centres (CHC) care in the Brazilian Amazon region lacks the training and capacity to offer specialized care for SBE. Though systemic challenges are complex and multifaceted, decentralizing antivenom from hospitals to the local CHC is feasible, likely cost-effective, and addresses these central obstacles. Indigenous peoples in the Brazilian Amazon are caught between an undervalued and disintegrating traditional culture and an inaccessible western system. In Brazil, antivenom is produced by public manufacturers and provided to patients free of charge but is only available at limited hospitals in the urban areas. Absence of antivenom in indigenous CHCs limits timely access to SBE care for patients in the villages. Our preliminary work with indigenous populations has shown a resistance to leaving the community to receive care contributing to the delays, exacerbated by cultural and geographical barriers in the region. A short-term, safe and efficacious solution is to decentralize SBE treatment with antivenoms to the level of indigenous CHCs. The AJURI intervention assists a historically oppressed and underserved population to develop, implement, and evaluate an integrative model of care that delivers quality, patient-centered treatment to their peoples. If successful, this intervention could drastically reduce the burden of SBE and prevent a significant population health and economic burden among the indigenous population. This implementation study will provide evidence-based knowledge to develop a novel strategy for antivenom delivery that could be implemented for other vulnerable populations. This proposal will provide conditions for the necessary work leading to a proposal to the UKRI Medical Research Council (MRC) to (a) evaluate the most cost-effective scenario to optimize distribution of antivenom, (b) analyze the feasibility, barriers and facilitators of implementing this strategy, and (c) evaluate the cost-effectiveness of this SBE care delivery strategy. This proposal specifically responds to UK Research and Innovation-Applied global health research, calling for studies on Implementation Science, aimed to ensure that evidence-based SBE treatment is implemented in an accessible and fair way for indigenous population in the Brazilian Amazonia, a vulnerable population with great difficulty in accessing the health system. We propose the development and pilot implementation of an innovative multi-modal intervention to improve SBE treatment in the Brazilian Amazonia. This intervention model will be potentially generalizable to other indigenous areas and to other diseases. This proposal responds also to the WHO strategic aims, which advocates that the numbers of deaths and cases of disability from SBEs be reduced by 50% before 2030 through initiatives that "empower and engage communities, ensure safe and effective treatment, strengthen health systems, and increase partnerships, coordination and resources".

蛇咬伤 (SBE) 是一种紧急健康状况，可免费获得有效的治疗方法。这种对土著居民造成的疾病负担是完全可以预防的。如上所述，改善 SBE 患者治疗效果需要克服的主要障碍是患者需要寻求更高级别的护理，从而离开原住村落，同时资源的缺乏阻碍了原住民医疗保健的整体发展。巴西亚马逊地区目前的社区卫生中心 (CHC) 缺乏为 SBE 提供专门护理的培训和能力。尽管系统性挑战是复杂且多方面的，但将抗蛇毒血清从医院分散到当地 CHC 是可行的，可能具有成本效益，并且可以解决这些主要障碍。巴西亚马逊地区的原住民陷入了被低估和瓦解的传统文化与难以接近的西方体系之间。在巴西，抗蛇毒血清由公共制造商生产并免费提供给患者，但仅在城市地区的有限医院提供。当地社区卫生中心缺乏抗蛇毒血清，限制了村庄患者及时获得 SBE 护理。我们与土著居民的初步工作表明，他们不愿意离开社区接受护理，这导致了延误，而该地区的文化和地理障碍又加剧了延误。短期、安全且有效的解决方案是将抗蛇毒血清的 SBE 治疗分散到当地 CHC 的水平。 AJURI 干预措施帮助历史上受压迫和服务不足的人群开发、实施和评估综合护理模式，为他们的人民提供优质、以患者为中心的治疗。如果成功，这种干预措施可以大大减轻 SBE 的负担，并防止土著居民承受重大的健康和经济负担。这项实施研究将提供基于证据的知识，以制定一种可用于其他弱势群体的新的抗蛇毒血清输送策略。该提案将为必要的工作提供条件，从而向 UKRI 医学研究委员会 (MRC) 提出提案，以 (a) 评估最具成本效益的方案以优化抗蛇毒血清的分配，(b) 分析以下方案的可行性、障碍和促进因素：实施该战略，以及 (c) 评估该 SBE 护理服务战略的成本效益。该提案专门响应英国研究与创新应用全球健康研究，呼吁开展实施科学研究，旨在确保以证据为基础的 SBE 治疗以一种可及且公平的方式为巴西亚马逊流域的土著居民（弱势群体）实施很难进入卫生系统。我们建议开发并试点实施创新的多模式干预措施，以改善巴西亚马逊流域的 SBE 治疗。这种干预模式有可能推广到其他土著地区和其他疾病。该提案还响应了世界卫生组织的战略目标，该目标主张通过“赋权和参与社区、确保安全有效的治疗、加强卫生系统和加强伙伴关系、协调和资源”。