Feasibility and acceptability of a peer-led strategy to improve community tuberculosis case finding among non-household contacts in Zambia

同行主导战略的可行性和可接受性，以改善赞比亚非家庭接触者中的社区结核病病例发现

• 批准号: 10448468
• 负责人: Andrew Kerkhoff
• 金额: $ 19.98万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448468
• 关键词: Adult; Africa South of the Sahara; Caring; Cause of Death; Clinic; Cluster randomized trial; Collaborations; Communicable Diseases; Communities; Consolidated Framework for Implementation Research; Contact Tracing; Detection; Diagnosis; Education; Educational workshop; Effectiveness; Enrollment; Face; Fellowship; Foundations; Gender Role; Goals; HIV; HIV Seronegativity; HIV Seropositivity; HIV/TB; Health; Health care facility; Household; Individual; Infectious Diseases Research; Infrastructure; International; Intervention; Interview; Knowledge; Location; Maps; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Newly Diagnosed; Outcome; Patients; Persons; Physicians; Pilot Projects; Prevalence; Provider; Public Health; Research; Research Design; Research Methodology; Research Personnel; Resource-limited setting; Resources; Risk; Scientist; Social support; South Africa; Surveys; Theory of Change; Time; Tracer; Training; Travel; Tuberculosis; Tuberculosis diagnosis; Work; World Health Organization; Zambia; acceptability and feasibility; base; behavior change; career; case finding; clinical epidemiology; design; diagnostic tool; epidemiology study; experience; experimental study; high risk population; implementation intervention; implementation research; implementation science; implementation strategy; improved; improved outcome; indexing; member; novel diagnostics; outreach; peer; preference; screening; social stigma; theories; transmission process

PROJECT SUMMARY/ABSTRACT Three million global tuberculosis (TB) cases remain undiagnosed each year, which is a key factor underpinning why TB is the leading cause of death among people living with HIV (PWH) and the leading infectious cause of death worldwide. While community-wide screening for TB in high-burden settings is recommended by WHO and may reduce community prevalence, it is unlikely to be a scalable TB control strategy. Leveraging trained peers (recent TB patients) to undertake community-based, systematic TB screening among non-household contacts of newly diagnosed TB patients, including casual contacts at community venues, may be an efficient and sustainable strategy to facilitate early TB diagnosis and linkage to care; however, little is known about whether such a strategy is feasible and acceptable to undertake in low-resource, high TB burden settings. Through targeted training and strong mentorship in implementation science methods, I will develop and evaluate a theory-informed, multicomponent, peer-led strategy to undertake community-based, systematic TB screening among non-household contacts of newly diagnosed TB patients attending two public health facilities in Lusaka, Zambia. This proposal builds upon the research collaboration I began developing during my infectious disease fellowship and leverages the robust experience and infrastructure of the Centre for Infectious Diseases Research in Zambia (CIDRZ). In Aim 1, I will undertake mixed-methods research among key stakeholders to identify barriers to undertaking TB screening among non-household contacts using peers. In Aim 2, I will use a discrete choice experiment among TB patients, at-risk community members, and community venue owners, to determine their preferences for the mode of delivery for the implementation strategy components. Findings from Aims 1 and 2 will inform the design of a multicomponent, peer-led TB contact tracing strategy among non-household contacts that will be evaluated in Aim 3, during a 6-month pilot to assess its feasibility, acceptability and reach. My overall training objective is to develop implementation science expertise; I will accomplish this by undertaking carefully selected coursework, workshops, and seminars, and through the guidance of highly accomplished mentors who are experts in international Implementation science research, mixed-methods research and multicomponent TB/HIV implementation strategies. My training objectives sequentially map onto my research aims and are to: (1) gain experience in the application of mixed-methods for implementation science research; (2) develop expertise in using implementation science methods to develop multicomponent implementation strategies; (3) develop a strong foundation in study designs and analysis approaches for interventional implementation research. My career goal is to be an independent physician-scientist who applies implementation science methods to improve TB and HIV outcomes in low-resource settings. The findings generated from this K23 award will inform an R01 proposal to undertake an adaptive, cluster randomized trial evaluating a peer-led, multicomponent TB case finding strategy in Zambia.

项目摘要/摘要 每年仍未诊断出300万个全球结核病（TB）病例，这是支撑的关键因素 为什么结核病是艾滋病毒（PWH）患者中死亡的主要原因，也是主要的传染病。 全球死亡。尽管谁和 可能会降低社区的流行，这不太可能是可扩展的结核病控制策略。利用训练有素的同行 （最近的结核病患者）进行基于社区的非房屋联系人的系统性结核病筛查 在新诊断的结核病患者中，包括在社区场所进行的偶然接触，可能是一个有效的 可持续的战略，以促进早期结核病诊断和与护理联系；但是，关于是否知道是否 这种策略是可行的，可以在低资源，高的结核病负担中进行。 通过有针对性的培训和实施科学方法的强大指导，我将开发和评估 理论知情的，多组分的，同行领导的策略，以进行社区，系统的结核病筛查 在卢萨卡两家公共卫生机构的新诊断出的结核病患者的非房屋联系中， 赞比亚。这项建议是基于我在传染病期间开始发展的研究合作 奖学金和利用感染性疾病中心研究中心的强大经验和基础设施 在赞比亚（Cidrz）。在AIM 1中，我将在主要利益相关者之间进行混合方法研究以确定 使用同行对非房屋联络进行结核病筛查的障碍。在AIM 2中，我将使用离散 结核病患者，高危社区成员和社区场所的选择实验，以确定 他们对实施策略组件交付方式的偏好。目标1的发现 2将告知非屋顶的多组分，同行指定的结核病联系策略 在6个月的飞行员期间，将在AIM 3中评估的联系人评估其可行性，可接受性和覆盖范围。 我的整体培训目标是发展实施科学专业知识；我将通过承诺来实现这一目标 精心挑选的课程工作，讲习班和研讨会，并通过高度成就的指导 是国际实施科学研究，混合方法研究专家的导师 多组分结核病/HIV实施策略。我的培训目标依次映射到我的研究 目的并应：（1）获得混合方法用于实施科学研究的经验； （2）开发使用实施科学方法来开发多组件实施方面的专业知识 策略； （3）在研究设计和分析方法中为介入而奠定了坚实的基础 实施研究。我的职业目标是成为应用实施的独立医师科学家 在低资源环境中改善结核病和艾滋病毒结果的科学方法。从此产生的发现 K23 Award将告知R01提案，以进行自适应，群集随机试验，以评估同行指导， 赞比亚多组分结核病案例查找策略。