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.

项目概要 全球每年 1000 万例结核病 (TB) 病例中，有近三分之一被漏诊。结核病 接触者追踪是一种基于证据的做法，国际上建议用于发现、治疗、 在结核病患者的密切接触者中预防结核病。接触者追踪也被认为是一项高度 推进世界卫生组织和泛美卫生组织消除中等发病率结核病目标的重要战略 到 2050 年，哥伦比亚等国家将实现这一目标。不幸的是，巨大的实施差距仍然存在。具体有 1) 需要更好的结核病筛查和检测工具，以克服症状筛查的低敏感性 以及无咳嗽者采集痰液的困难，以及 2）更加以客户为中心 改善病例发现和护理联系的实施战略。在之前与秘书处的合作中 哥伦比亚卡利公共卫生 (SPH) 部门，我们推出了客户友好型教育材料、家庭 痰液采集和运输以及结核病分子检测。 COVID-19 大流行导致 该服务的进一步发展以适应远程医疗就诊，并且需要进一步适应 这些工具满足客户的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检测与非痰检测相结合 唾液和口腔拭子等样本，用于简化和改进筛查和测试算法；和 将聊天应用程序（例如 WhatsApp）和自动化客户支持工具（即聊天机器人）合并为 用于吸引、支持和留住家庭成员的移动医疗 (mHealth) 工具。我们的科学 方法将采用嵌套混合方法和设计进行两项横断面研究 研究改进和调整这些接触者追踪工具。我们的总体目标是增强 接触者追踪的敏感性、可行性、可接受性和适当性，并为未来做好准备 住户随机实施试验。我们提出两个具体目标：1）确定 口腔样本对临床和可能的结核病患者进行结核分子检测的诊断性能 家庭环境； 2) 设计并迭代完善移动医疗战略以实施 针对可行性、可接受性、可用性和适当性优化了接触者追踪。调查的 团队在结核病诊断和临床护理、接触者追踪、以用户为中心的设计、定性 方法、实施科学以及与 SPH 建立的良好伙伴关系将确保 为拟议的研究提供了良好的环境。这些研究将确定口腔样本是否 可用于结核病的分子诊断，并完善家庭结核病接触的移动医疗策略 使用既以理论为基础又以社区参与的创新设计方法进行追踪。 这项研究最终将为移动医疗联系人提供以客户为中心的实施组件 在随机对照实施试验中跟踪未来评估的策略。