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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要尽管有可用的治疗方法，但结核病 (TB) 仍然是全球主要的传染病杀手之一全面的结核病规划执行不力。艾滋病毒感染仍然是南非等高负担国家结核病发病率持续居高的推动因素。南非在结核病护理级联中存在许多损失；估计有 95% 的结核病患者能够获得治疗服务；评估，但只有 82% 得到诊断，70% 开始治疗，53% 成功完成治疗。然而，还必须筛查和治疗亚临床结核感染，以减少大量结核病的储存。有发展为结核病风险的人群，尤其是近期接触过结核病患者和艾滋病毒感染者的人 (PLH)。使用实施科学方法并在艾滋病毒改进的成功基础上继续前进。护理级联“90-90-90”目标，我们的团队最近针对耐药和耐药性试行了两个结核病护理级联药物敏感结核病，并试点了结核病预防计划，包括对超过 304 个家庭进行家访，对 922 名结核病患者的家庭接触者进行了筛查。该 R01 奖项将采用系统分析和改进方法 (SAIA)，这是一种基于证据的方法实施科学战略将系统工程工具结合到结核病临床级包中（SAIA- TB），扩展了在撒哈拉以南非洲的一系列临床环境中试验的成功 SAIA 模型，以及美国，并利用 PI 在南非的初步结核病级联分析数据，SAIA-TB 将评估六项。综合结核病指标（筛查、评估、诊断、与护理、治疗和无结核病的联系）生存）帮助一线医护人员和管理人员通过使用来优化级联性能 TB 级联分析工具、工艺流程图和持续质量改进周期。我们的具体目标是： (1) 评估 SAIA-TB 对患者级联优化的有效性我们将使用阶梯楔形交叉试验来评估结核病和高风险接触者（特别是 PLH）的情况。 SAIA-TB 对 12 个农村诊所综合结核病护理的影响我们在 SAIA-TB 实施方面遇到了困难。将导致结核病筛查和结核病预防治疗或结核病治疗开始时间增加 20% (2) 确定各诊所 SAIA-TB 实施差异的驱动因素。将通过焦点小组讨论和关键知情人访谈来描述实施过程使用实施研究综合框架和附加数据对诊所工作人员进行分析从研究日志中收集来描述对 SAIA-TB 的忠诚度 (3) 评估综合结核病护理的可接受性。在结核病级联的每个步骤中，在实施 SAIA-TB 的诊所接受护理的患者中，我们将使用可接受性的理论框架和定义可接受性并进行比较的社会生态模型个人、家庭和系统层面的障碍和促进因素在患者中完成结核病级联步骤有和没有 HIV 感染。