Mobile Health and Oral Testing to Optimize Tuberculosis Contact Tracing in Colombia

移动健康和口腔测试可优化哥伦比亚的结核病接触者追踪

• 批准号: 10667885
• 负责人: John Lucian Davis
• 金额: $ 21.53万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-02 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667885
• 关键词: Adult; Affect; Age; Algorithms; COVID-19 pandemic; Caring; Cellular Phone; Cessation of life; Child; Client; Clinic; Collection; Colombia; Communicable Diseases; Communities; Contact Tracing; Coughing; Country; Cross-Sectional Studies; Data Collection; Diagnostic; Diagnostic tests; Education; Educational Materials; Ensure; Environment; Epidemic; Evaluation; Evidence based practice; Evolution; Focus Groups; Friends; Future; Goals; Health system; Home; Household; Incidence; Individual; Instruction; International; Intervention; Interview; Knowledge; Liquid substance; Maps; Methodology; Methods; Microscopy; Modification; Molecular; Molecular Diagnosis; Motivation; Mycobacterium tuberculosis; Newly Diagnosed; Oral; Outcome; Pan American Health Organization; Patients; Performance; Persons; Prevention; Privatization; Procedures; Public Health; Pulmonary Tuberculosis; Qualitative Methods; Qualitative Research; Randomized; Recommendation; Research; Research Design; Research Methodology; Resources; Saliva; Sampling; Services; Specificity; Specimen; Sputum; Surveys; Swab; Symptoms; Techniques; Testing; Time; Tuberculosis; Tuberculosis diagnosis; United States Public Health Service; Visit; Work; analytical method; arm; behavior change wheel; case finding; chatbot; clinical care; clinical diagnostics; design; diagnostic accuracy; digital health; evidence base; expectation; implementation evaluation; implementation science; implementation strategy; implementation trial; improved; informant; innovation; mHealth; member; next generation; novel; poor communities; prevent; recruit; retention rate; sample collection; screening; secondary outcome; sex; support tools; telehealth; theories; tool; trial enrollment; tuberculosis diagnostics; uptake; usability; user centered design; video chat; vulnerable community

PROJECT SUMMARY Nearly one-third of the 10 million annual tuberculosis (TB) cases worldwide are missed each year. TB contact tracing is an evidence-based practice that is internationally recommended for finding, treating, and preventing TB among close contacts of TB patients. Contact tracing is also considered a highly significant strategy for advancing the WHO and PAHO goal of eliminating TB in moderate-incidence countries like Colombia by 2050. Unfortunately, large implementation gaps persist. Specifically there is need for 1) better TB screening and testing tools to overcome the low sensitivity of symptom screening and the difficulty of collecting sputum in those without cough, and 2) more client-centered implementation strategies to improve case-finding and linkage to care. In prior work with the Secretariat of Public Health (SPH) in Cali, Colombia, we introduced client-friendly education materials, home sputum collection and transport, and molecular testing for TB. The COVID-19 pandemic has led to further evolution of this service to accommodate telehealth visits, and there is need to further adapt these tools to client expectations and the new digital health landscape. Two of the most promising innovations for achieving these goals are pairing next-generation molecular testing with non-sputum samples like saliva and oral swabs to simplify and improve screening and testing algorithms; and incorporating chat apps (e.g., WhatsApp) and automated customer support tools (i.e., chatbots) as mobile health (mHealth) tools to engage, support, and retain household members. Our scientific approach will be to carry out two cross-sectional studies with nested mixed-methods and design research to refine and adapt these tools for contact tracing. Our overall objectives are to enhance the sensitivity, feasibility, acceptability, and appropriateness of contact tracing, and to prepare for a future household-randomized implementation trial. We propose two specific aims: 1) To determine the diagnostic performance of oral samples for TB molecular testing in possible TB patients in clinic and household settings; and 2) To design and iteratively refine an mHealth strategy for implementing contact tracing optimized for feasibility, acceptability, usability, and appropriateness. The investigative team has expertise in TB diagnostics and clinical care, contact tracing, user-centered design, qualitative methods, and implementation science, and a well-established partnership with the SPH that will ensure an outstanding environment for the proposed research. These studies will determine if oral samples are viable for molecular diagnosis of TB and refine an mHealth strategy for household TB contact tracing, using an innovative design approach that is both theory-informed and community-engaged. This study will ultimately deliver client-centered implementation components for an mHealth contact tracing strategy for future evaluation in a randomized, controlled implementation trial.

项目摘要 每年在全球范围内遗漏了每年1000万例结核病（TB）病例中的三分之一。 TB 接触跟踪是一种基于循证的实践，在国际上建议查找，治疗， 并防止结核病患者密切接触中结核病。接触跟踪也被认为是高度 推进WHO和PAHO目标的重要策略 到2050年，像哥伦比亚这样的国家。不幸的是，较大的实施差距持续存在。特别是 需要1）更好的结核病筛查和测试工具来克服症状筛查的低灵敏度 以及在没有咳嗽的人中收集痰的困难，以及2）以客户为中心的 实施策略，以改善案件调查和关怀联系。在与秘书处的先前工作 哥伦比亚卡利的公共卫生（SPH），我们介绍了客户友好的教育材料，家庭 痰收集和运输，以及结核病的分子测试。共同的19个大流行已导致 这项服务的进一步发展以适应远程医疗访问，需要进一步适应 这些工具可用于客户期望和新的数字健康格局。最有前途的两个 实现这些目标的创新是将下一代分子测试与非输入配对 唾液和口服拭子等样品，以简化和改善筛查和测试算法；和 合并聊天应用程序（例如WhatsApp）和自动化客户支持工具（即聊天机器人） 移动健康（MHealth）工具可参与，支持和保留家庭成员。我们的科学 方法将是通过嵌套混合方法和设计进行两项横断面研究 研究以完善和调整这些工具以进行接触跟踪。我们的总体目标是增强 接触追踪的敏感性，可行性，可接受性和适当性，并为未来做准备 家庭随机实施试验。我们提出了两个具体目标：1）确定 在诊所可能的结核病患者和 家庭环境； 2）设计和迭代地完善实施的MHealth策略 与可行性，可接受性，可用性和适当性进行优化的接触跟踪。调查 团队在结核病诊断和临床护理，联系跟踪，以用户为中心的设计，定性方面具有专业知识 方法和实施科学，以及与SPH建立良好的合作伙伴关系，以确保 拟议研究的杰出环境。这些研究将确定是否口服样本 对于TB的分子诊断和完善家庭结核病的MHealth策略是可行的 追踪，使用一种创新的设计方法，既是理论知觉又具有社区参与的方式。 这项研究最终将提供以客户为中心的MHealth联系的实施组件 在一项随机，受控的实施试验中追踪未来评估的策略。