TB-CAPS: a mixed methods study to implement a peer-led, community-based psychosocial support package for Indonesians affected by tuberculosis stigma

TB-CAPS：一项混合方法研究，旨在为受结核病耻辱影响的印度尼西亚人实施由同伴主导、以社区为基础的社会心理支持方案

基本信息

批准号：
MR/Y503216/1
负责人：
Thomas Wingfield
金额：
$ 19.21万
依托单位：
Liverpool School of Tropical Medicine
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2023
资助国家：
英国
起止时间：
2023 至无数据
项目状态：
未结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FY503216%2F1
关键词：
TB CAPS mixed methods study

项目摘要

Tuberculosis (TB) is a leading infectious disease killer, and ending TB is a key strategic priority in global public health. However, achieving the World Health Organization's (WHO) goal of ending TB by 2050 is challenging. One of the critical barriers is the stigma towards people with TB (TB-Stigma). In some cultures, TB is considered a 'curse' on family and is associated with poverty, HIV/AIDS, or other misconduct behaviour. These often lead to social discrediting, isolation, and feelings of "shame, self-rejection, and self-loathing". When people with symptoms of TB anticipate or experience such stigmatising behaviour, they may avoid seeking care. It results in delayed diagnosis and treatment, making them seriously ill and infecting others in the family and neighbourhood. TB-stigma also can negatively impact their treatment compliance and mental health, such as depression because of discriminating behaviour and feeling guilty. It also has socioeconomic consequences, such as income and job loss, which can increase the risk of mental illness. Despite the consequences of stigma, we have lacked evidence on the optimal strategies to address TB-stigma effectively. TB-CAPS study aims to design, implement, and evaluate psychosocial support interventions to reduce TB-stigma. The support will be co-designed and provided through a peer-led, community-based intervention package. In TB-CAPS, the intervention will be developed in several steps. First, we will review the literature to identify community-based psychosocial support interventions designed to reduce disease-related stigma in various countries. We will synthesise the scoping review findings to create a long list of potential community-based psychosocial support packages, including counselling, mutual support groups, TB education, drama/storytelling, home visits, and smartphone-based applications. The list will be iteratively shaped to a shortlist through a Delphi study and a participatory workshop, in which we invite people with TB, their households, and community health volunteers to co-design the intervention, together with stakeholders and experts. We will also produce the training module and learning materials for community healthcare volunteers to ensure a standardised intervention. During TB-CAPS, people with TB, their households, and community health volunteers within the study sites will not only co-design a TB-stigma reduction intervention but be the target recipient population. We will implement the intervention in two provinces of Indonesia. The intervention will be evaluated through two main mechanisms. First, we will invite people receiving the interventions and critical stakeholders into focus group discussions and key informant interviews to assess the intervention's feasibility, acceptability, equity, and scalability. Second, we will determine the reduction of TB-stigma and depression symptoms after the intervention. At the closing participatory workshop, we will invite all stakeholders to reach a collective decision on intervention refinement and the progression of the large-scale intervention. All evaluations will be reported as a policy brief for a nationwide implementation program, open access training manual and protocol for wider replication and implementation, and international scientific publications. This study and its findings will align with the efforts to achieve SDGs 3/10 target and consolidated partnerships with the Indonesian, UK, and WHO's TB Civil Society Task Force.

结核病（TB）是主要的传染病杀手，消灭结核病是全球公共卫生的重要战略重点。然而，实现世界卫生组织 (WHO) 到 2050 年消灭结核病的目标具有挑战性。关键障碍之一是对结核病患者的耻辱（TB-Stigma）。在某些文化中，结核病被认为是对家庭的“诅咒”，并与贫困、艾滋病毒/艾滋病或其他不当行为有关。这些往往会导致社会耻辱、孤立和“羞耻、自我拒绝和自我厌恶”的感觉。当有结核病症状的人预期或经历这种耻辱行为时，他们可能会避免寻求治疗。这导致延误诊断和治疗，使他们病情严重，并传染给家人和邻居中的其他人。结核病耻辱感还会对他们的治疗依从性和心理健康产生负面影响，例如由于歧视行为和感到内疚而导致抑郁。它还具有社会经济后果，例如收入和失业，这可能会增加患精神疾病的风险。尽管存在耻辱感的后果，但我们仍缺乏有效解决结核病耻辱感的最佳策略的证据。 TB-CAPS 研究旨在设计、实施和评估社会心理支持干预措施，以减少结核病耻辱感。该支持将通过同行主导、基于社区的干预方案共同设计和提供。在 TB-CAPS 中，干预措施将分几个步骤进行。首先，我们将回顾文献，以确定旨在减少各国与疾病相关的耻辱的基于社区的社会心理支持干预措施。我们将综合范围界定审查结果，创建一长串潜在的基于社区的社会心理支持方案，包括咨询、互助小组、结核病教育、戏剧/讲故事、家访和基于智能手机的应用程序。该名单将通过德尔菲研究和参与式研讨会迭代形成入围名单，其中我们邀请结核病患者、他们的家庭和社区卫生志愿者与利益相关者和专家一起共同设计干预措施。我们还将为社区医疗志愿者制作培训模块和学习材料，以确保干预的标准化。在 TB-CAPS 期间，研究地点内的结核病患者、其家庭和社区卫生志愿者不仅将共同设计减少结核病耻辱感的干预措施，而且将成为目标接受人群。我们将在印度尼西亚的两个省份实施干预。干预措施将通过两种主要机制进行评估。首先，我们将邀请接受干预措施的人和关键利益相关者参加焦点小组讨论和关键知情人访谈，以评估干预措施的可行性、可接受性、公平性和可扩展性。其次，我们将确定干预后结核病耻辱感和抑郁症状的减少情况。在闭幕式参与式研讨会上，我们将邀请所有利益相关者就干预措施的细化和大规模干预的进展达成集体决定。所有评估都将作为全国实施计划的政策简介、开放获取培训手册和更广泛复制和实施的协议以及国际科学出版物进行报告。这项研究及其结果将与实现可持续发展目标 3/10 的目标以及与印度尼西亚、英国和世卫组织结核病民间社会工作组的巩固伙伴关系相一致。