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.

项目概要/摘要 全球每年有 300 万结核病病例未确诊，这是支撑结核病的关键因素 为什么结核病是艾滋病毒感染者 (PWH) 死亡的主要原因，也是艾滋病毒感染者的主要传染原因 全世界的死亡。虽然世卫组织建议在高负担环境中进行社区范围内的结核病筛查， 可能会降低社区患病率，但不太可能成为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）对非家庭接触者进行基于社区的系统性结核病筛查 新诊断的结核病患者，包括社区场所的偶然接触，可能是一种有效且有效的方法。 促进结核病早期诊断和护理联系的可持续战略；然而，人们对是否 在资源匮乏、结核病负担高的环境中，这一战略是可行且可接受的。 通过实施科学方法方面的有针对性的培训和强有力的指导，我将开发和评估 一项基于理论、多组成部分、同行主导的策略，以进行基于社区的系统性结核病筛查 在卢萨卡两个公共卫生机构就诊的新诊断结核病患者的非家庭接触者中， 赞比亚。该提案建立在我在传染病期间开始开展的研究合作的基础上 奖学金并利用传染病研究中心的丰富经验和基础设施 赞比亚 (CIDRZ)。在目标 1 中，我将在主要利益相关者中进行混合方法研究，以确定 使用同伴对非家庭接触者进行结核病筛查的障碍。在目标 2 中，我将使用离散 在结核病患者、高危社区成员和社区场所所有者之间进行选择实验，以确定 他们对实施战略组成部分的交付方式的偏好。目标 1 的发现 2 将为非家庭成员中多组成部分、同伴主导的结核病接触者追踪策略的设计提供信息 将在为期 6 个月的试点期间对目标 3 中的联系人进行评估，以评估其可行性、可接受性和影响范围。 我的总体培训目标是培养实施科学专业知识；我将通过承诺来实现这一目标 精心挑选的课程、讲习班和研讨会，并通过卓有成效的指导 导师是国际实施科学研究、混合方法研究和 多组成部分的结核病/艾滋病毒实施战略。我的培训目标依次映射到我的研究 目标是：（1）获得应用混合方法进行科学研究的经验； (2) 发展使用实施科学方法开发多组件实施的专业知识 策略； (3) 为干预研究设计和分析方法奠定坚实的基础 实施研究。我的职业目标是成为一名应用实施的独立医师科学家 改善资源匮乏地区结核病和艾滋病毒治疗结果的科学方法。由此产生的调查结果 K23 奖项将通知 R01 提案，以进行一项自适应、整群随机试验，评估同行主导的、 赞比亚多成分结核病病例发现策略。