TB Guidline Observation and Adherence in Low Income Countries (TB GOAL)

低收入国家结核病指导方针的观察和遵守（结核病目标）

• 批准号: 8286148
• 负责人: Adithya Cattamanchi
• 金额: $ 20.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8286148
• 关键词: Address; Adherence; Africa South of the Sahara; Attitude; Behavior; Caring; Categories; Cause of Death; Characteristics; Collection; Communicable Diseases; Country; Data; Data Analyses; Deltastab; Detection; Development; Diagnosis; Diagnostic tests; Elements; Enabling Factors; Ensure; Environment; Evaluation; Feedback; Funding; Future; Goals; Government; Guidelines; Health; Health Personnel; Health Promotion; Health system; Incidence; Individual; International; Intervention; Knowledge; Laboratory Technicians; Lead; Low income; Measures; Microscopy; Mission; Modeling; Morbidity - disease rate; Nurses; Patients; Performance; Pilot Projects; Planning Theory; Positive Test Result; Predisposing Factor; Provider; Reinforcing Factor; Reporting; Research; Research Subjects; Resources; Risk; Series; Site; Solid; Specimen; Sputum; Study models; System; Testing; Time; Training; Tuberculosis; Uganda; United States National Institutes of Health; Work; World Health Organization; base; behavior change; cost effective; design; effective intervention; evidence based guidelines; improved; mortality; multi-component intervention; novel diagnostics; prevent; randomized trial; surveillance network; trend; tuberculosis treatment; uptake

DESCRIPTION (provided by applicant): The World Health Organization estimates that tuberculosis (TB) elimination can be achieved by 2050 if 70% of estimated sputum smear-positive TB cases are identified and 85% are treated successfully.1-3 Unfortunately, smear-positive TB case detection rates are far below the 70% target in most high burden countries.1 To improve case detection and management, the Tuberculosis Coalition for Technical Assistance developed evidence-based guidelines called the International Standards for TB Care (ISTC).6 Adherence to ISTC-recommended practices for TB suspect evaluation is poor in low-income countries.5,7 Thus, improving ISTC implementation offers a tremendous opportunity to reduce the global burden of TB. Our long-term objective is to determine whether a multi-faceted intervention to improve ISTC implementation reduces TB-related morbidity and mortality in low-income countries. The proposed multi-faceted intervention addresses three categories of factors that are critical for changing behavior: (1) predisposing factors - knowledge or attitudes that either support or inhibit the desired behavior; (2) enabling factors - characteristics of an individual or environment that facilitate the desired behavior; and (3) reinforcing factors -anticipated consequences of following the desired behavior.9,10 Thus, the multi-faceted intervention includes (1) ISTC training modules to improve provider knowledge and attitudes toward ISTC; (2) single-specimen microcopy (a more efficient smear microscopy strategy) to enable ISTC adherence; and (3) a performance feedback system to reinforce ISTC adherence. The pilot studies proposed in this R21 application are designed to evaluate the feasibility and impact of each of these intervention components. The data will inform a future R01 application to assess whether a multi-faceted intervention to improve ISTC adherence actually increases TB case detection. For the pilot studies, our hypothesis is that each component will improve provider adherence to ISTC-recommended TB suspect evaluation practices. The pilot studies will take place within the Uganda Infectious Disease Surveillance Network (UIDSN), which collects data on TB care at 6 government health centers (>100,000 annual patient encounters) that are typical of those seen throughout sub-Saharan Africa. The research subjects are the approximately 50 providers (3- 4 clinicians, 1-2 laboratory technicians, and 2-3 nurses per health center) working at the 6 UIDSN health centers. To test our hypothesis, each intervention component will be introduced at the 6 UIDSN health centers in a sequential fashion. Data from approximately 2500 TB suspects will be used to objectively measure provider adherence to ISTC before and after introduction of each intervention component. If successful, the proposed studies could help reverse the current trend of rising global TB incidence and are consistent with NIAID's mission to prevent infectious diseases that threaten millions of lives. In addition, this research will lead to a better understanding of the factors and types of interventions associated with successful evidence-based guideline implementation and strengthened health systems in resource-limited settings.

描述（由申请人提供）：世界卫生组织估计，如果确定了70％的估计痰液涂片阳性的结核病病例，可以在2050年实现结核病（TB）消除，并成功治疗了85％，而1-3不幸的是，涂片阳性的TB案例检测率在大多数高率的情况下都远低于70％的助手。基于证据的指南称为国际结核病护理标准（ISTC）。6在低收入国家中，遵守ISTC强制性的TB嫌疑犯评估的做法很差。5,7因此，改善ISTC实施提供了巨大的机会，可以减轻全球TB负担。 我们的长期目标是确定以改善ISTC实施的多方面干预措施是否会降低低收入国家中与TB相关的发病率和死亡率。提出的多面干预措施解决了对改变行为至关重要的三类因素：（1）诱发因素 - 知识或支持或抑制所需行为的知识或态度； （2）启用因素 - 促进所需行为的个体或环境的特征； （3）加强因素遵循所需行为的后果。9,10因此，多方面的干预措施包括（1）ISTC培训模块，以提高提供者知识和对ISTC的态度； （2）单特异性微拷贝（一种更有效的涂片显微镜策略），以实现ISTC依从性； （3）绩效反馈系统以增强ISTC依从性。 R21应用程序中提出的试点研究旨在评估这些干预组件中每一个的可行性和影响。这些数据将为未来的R01应用程序提供信息，以评估多方面的干预措施是否提高ISTC依从性实际上会增加TB病例检测。 对于试点研究，我们的假设是，每个组件都将提高提供者遵守ISTC征求的TB可疑评估实践。试点研究将在乌干达传染病监视网络（UIDSN）中进行，该网络收集了6个政府卫生中心（> 100,000例年度患者遇到的TB护理数据，这些数据是整个撒哈拉以南非洲地区的典型患者。研究对象是在UIDSN健康中心工作的大约50个提供者（3-4名临床医生，1-2个实验室技术人员和2-3名护士）。 为了检验我们的假设，每个干预组件将以连续的方式在6个UIDSN健康中心引入。来自大约2500个TB嫌疑人的数据将用于在引入每个干预组件之前和之后客观地测量提供商遵守ISTC。如果成功的话，拟议的研究可能有助于扭转全球结核病发生率上升的当前趋势，并与Niaid的使命一致，那就是防止威胁着数百万生命的传染病。此外，这项研究将更好地理解与成功的基于证据的指南实施相关的干预措施的因素和类型，并在资源有限的环境中加强了卫生系统。

项目成果

Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda.

• DOI: 10.5588/ijtld.14.0166
• 发表时间: 2015-08
• 期刊: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
• 作者: Shete PB;Haguma P;Miller CR;Ochom E;Ayakaka I;Davis JL;Dowdy DW;Hopewell P;Katamba A;Cattamanchi A
• 通讯作者: Cattamanchi A