SAIA-TB: Using the Systems Analysis and Improvement Approach (SAIA) to prevent TB in rural South Africa

SAIA-TB：使用系统分析和改进方法 (SAIA) 预防南非农村地区的结核病

• 批准号: 10699071
• 负责人: Brittney Jayne van de Water
• 金额: $ 65.54万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-12 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10699071
• 关键词: Affect; Africa South of the Sahara; Area; Attitude; Award; Belief; Caring; Clinic; Clinical; Cluster randomized trial; Collaborations; Communicable Diseases; Consolidated Framework for Implementation Research; Country; Cross-Over Trials; Data; Data Analyses; Development; Diagnosis; Diagnostic; Disease; Drug resistance; Effectiveness; Eligibility Determination; Engineering; Evaluation; Family; Focus Groups; HIV; HIV Infections; HIV/TB; Health; Health Personnel; Health Services Accessibility; Home; Home visitation; Household; Immunocompromised Host; Individual; Infection; Intervention; Interview; Knowledge; Literature; Maps; Mentored Patient-Oriented Research Career Development Award; Methods; Modeling; Patient-Focused Outcomes; Patients; Performance; Persons; Policies; Population; Populations at Risk; Positioning Attribute; Prevention; Prevention program; Preventive therapy; Process; Reporting; Research; Resource-limited setting; Rural; Site; South Africa; South African; System; Systems Analysis; Thoracic Radiography; Translating; Tuberculosis; Update; Viral; Visit; Work; acceptability and feasibility; clinical care; cost; design; drug-sensitive; effectiveness evaluation; evidence base; evidence based guidelines; follow-up; global health; high risk; implementation process; implementation science; implementation strategy; improved; informant; innovation; insight; patient engagement; prevent; programs; progression risk; rural South Africa; rural area; rural health clinic; scale up; screening; success; system-level barriers; testing access; tool; treatment guidelines; tuberculosis treatment; uptake

Project Summary Tuberculosis (TB) remains one of the leading infectious disease killers globally despite the availability of robust diagnostics, effective prevention, and treatment. Poor implementation of comprehensive TB programs and HIV infection remain drivers of ongoing high TB rates in high burden countries such as South Africa. In South Africa there are many losses in the TB care cascade; an estimated 95% of individuals with TB access evaluation, yet only 82% are diagnosed, 70% initiate treatment, and 53% successfully complete treatment. However, it is also imperative to also screen and treat subclinical TB infection to lessen the vast reservoir of people at risk of progressing to TB disease, especially recent contacts of TB patients and people living with HIV (PLH). Using implementation science methods and building on the success of the improvements in the HIV care cascade “90-90-90” targets, our team has recently piloted two TB care cascades for drug-resistant and drug-sensitive TB as well as piloted a TB prevention program including home visits to over 304 families, screening 922 household contacts of patients with TB. This R01 award will adapt the Systems Analysis and Improvement Approach (SAIA), an evidence-based implementation science strategy combining systems engineering tools into a clinic-level package for TB (SAIA- TB), expanding upon successful SAIA models trialed across a range of clinical settings in sub-Saharan Africa and the USA, and leveraging the PI’s preliminary TB cascade analysis data in South Africa. SAIA-TB will evaluate six comprehensive TB indicators (screening, evaluation, diagnosis, linkage to care, treatment, and TB-free survival) to aid frontline healthcare workers and managers to optimize cascade performance through the use of a TB cascade analysis tool, process flow mapping, and continuous quality improvement cycles. Our specific aims are to: (1) Evaluate the effectiveness of SAIA-TB on cascade optimization for patients with TB and high-risk contacts (specifically PLH). We will use a stepped-wedge crossover trial to evaluate the impact of SAIA-TB on comprehensive TB care in 12 rural clinics. We hypothesize that SAIA-TB implementation will lead to a 20% increase in TB screening and TB preventive therapy or TB disease treatment initiation during the 2-year intervention period. (2) Determine the drivers of SAIA-TB implementation variability across clinics. The implementation process will be described using focus group discussions and key informant interviews with clinic staff, analyzed using the consolidated framework for implementation research, with additional data gathered from study logs to describe fidelity to SAIA-TB. (3) Assess the acceptability of comprehensive TB care among patients accessing care at clinics implementing SAIA-TB at each step of the TB cascade. We will use the theoretical framework for acceptability and the socioecological model to define acceptability and compare individual-, family- and system-level barriers and facilitators to completing TB cascade steps among patients with and without HIV infection.

项目摘要 结核病（TB）仍然是全球领先的传染病杀手之一 强大的诊断，有效的预防和治疗。全面结核病计划的实施不力 艾滋病毒感染仍然是南非等高负担国家中持续高的结核病率的驱动因素。在 南非在结核病护理级联中遭受了许多损失。估计有95％的结核病患者 评估，但只有82％的诊断，70％开始治疗，而53％的人成功完成治疗。 但是，也必须筛查和治疗亚临床结核病感染以减少大量储备 有可能发展为结核病疾病的人，尤其是结核病患者和艾滋病毒患者的最近接触 （PLH）。使用实施科学方法并建立艾滋病毒改善的成功 Care Cascade“ 90-90-90”目标，我们的团队最近试行了两个TB护理级联，以进行抗药性和 对药物敏感的结核病以及试点预防结核病计划，包括304多个家庭的家庭访问， 筛查结核病患者的922个家庭接触。 该R01奖将适应系统分析和改进方法（SAIA），这是基于证据的 实施科学策略将系统工具工具结合到结核病的诊所级别（SAIA-） TB），扩展在撒哈拉以南非洲和 美国，利用PI在南非的初步结核病级联分析数据。 Saia-TB将评估六个 全面的结核病指标（筛查，评估，诊断，与护理和无结核病的联系 生存）帮助一线医疗保健工作者和经理通过使用来优化级联绩效 结核级联分析工具，过程流量映射和持续质量改进周期的元素。 我们的具体目的是：（1）评估SAIA-TB对患者级联优化的有效性 具有结核病和高风险触点（特别是PLH）。我们将使用阶梯向外的跨界试验来评估 SAIA-TB对12个农村诊所的全面结核病护理的影响。我们假设SAIA-TB实施 在TB筛查和结核病预防疗法或结核病疾病治疗计划中，将导致20％的增长 两年干预期。 （2）确定诊所之间SAIA-TB实施变异性的驱动因素。 实施过程将使用焦点小组讨论和关键的线人访谈来描述 诊所工作人员，使用合并框架进行实施研究进行分析，并提供其他数据 从学习日志中聚集，描述对Saia-TB的保真度。 （3）评估全面结核病护理的可接受性 在TB Cascade的每个步骤中实施SAIA-TB的诊所的患者中。我们将使用 可接受性和社会生态模型的理论框架，以定义可接受性并进行比较 个人，家庭和系统级别的障碍以及促进者，以完成患者结核级联步骤 有和没有艾滋病毒感染。