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 70% 的估计痰涂片阳性结核病病例得到识别并且 85% 得到成功治疗，则到 2050 年即可实现结核病 (TB) 消除。1-3在大多数高负担国家，结核病病例阳性检出率远低于 70% 的目标。1 为了改善病例检出和管理，结核病技术援助联盟制定了基于证据的指南，称为国际结核病护理标准 (ISTC)。6 低收入国家很少遵守 ISTC 建议的结核病疑似评估做法。5,7 因此，改进 ISTC 实施为减轻全球结核病负担提供了巨大的机会。 我们的长期目标是确定改善 ISTC 实施的多方面干预措施是否可以降低低收入国家与结核病相关的发病率和死亡率。所提出的多方面干预措施涉及对改变行为至关重要的三类因素：（1）诱发因素——支持或抑制期望行为的知识或态度； (2) 促成因素——促进期望行为的个人或环境的特征； (3) 强化因素 - 遵循期望行为的预期后果。9,10 因此，多方面干预包括 (1) ISTC 培训模块，以提高提供者对 ISTC 的了解和态度； (2) 单样本显微镜检查（一种更有效的涂片显微镜检查策略），以实现 ISTC 的遵守； (3) 绩效反馈系统，以加强对 ISTC 的遵守。 R21 申请中提出的试点研究旨在评估每个干预措施的可行性和影响。这些数据将为未来的 R01 应用程序提供信息，以评估提高 ISTC 依从性的多方面干预措施是否真正提高了结核病病例的检出率。 对于试点研究，我们的假设是每个组成部分都将提高提供者对 ISTC 推荐的结核病疑似评估实践的遵守程度。试点研究将在乌干达传染病监测网络 (UIDSN) 内进行，该网络收集 6 个政府卫生中心的结核病护理数据（每年接触超过 100,000 名患者），这些中心在整个撒哈拉以南非洲地区都是典型的。研究对象是在 6 个 UIDSN 卫生中心工作的大约 50 名提供者（每个卫生中心 3-4 名临床医生、1-2 名实验室技术人员和 2-3 名护士）。 为了检验我们的假设，每个干预措施都将在 6 个 UIDSN 卫生中心按顺序引入。来自大约 2500 TB 嫌疑人的数据将用于客观衡量提供者在引入每个干预组件之前和之后对 ISTC 的遵守情况。如果成功，拟议的研究将有助于扭转当前全球结核病发病率上升的趋势，并符合 NIAID 预防威胁数百万人生命的传染病的使命。此外，这项研究将有助于更好地了解与成功实施循证指南和在资源有限的环境中加强卫生系统相关的干预措施的因素和类型。

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