Improving active case finding for tuberculosis in South Africa: informing innovative implementation approaches in the context of the Kharitode trial through formative research
Improving active case finding for tuberculosis in South Africa: informing innovative implementation approaches in the context of the Kharitode trial through formative research
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DOI：
10.1186/s12961-017-0206-8
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发表时间：
2017-05-30
影响因子：
4
通讯作者：
Dowdy, David
中科院分区：
文献类型：
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作者：
Kerrigan, Deanna;West, Nora;Dowdy, David
背景：结核病 (TB) 是全球主要的传染病杀手，2015 年约有 180 万人死亡。虽然存在有效的治疗方法，但在资源有限的环境中，实施主动病例发现 (ACF) 方法以及时且具有成本效益的方式识别活动性结核病患者仍然是一项重大挑战。为了深入了解实施障碍，我们进行了有限的定性工作。方法：进行了定性研究，为结核病的三项 ACF 策略的制定提供信息，这些策略将作为在南非农村省份进行的 Kharitode 整群随机试验的一部分进行评估。其中包括对 8 名结核病患者、7 名家庭成员和 10 名诊所卫生工作者进行 25 次半结构化深度访谈，以及 4 次焦点小组讨论（2 个农村地点和 2 个主要城镇地点），每次有 6-8 名参与者 (n = 27)。访谈和焦点小组讨论探讨了三种 ACF 方法的背景、优点和局限性以及含义。利用内容分析来记录有关其可行性、可接受性和潜在有效性的显着主题。结果：研究参与者（结核病患者和社区成员）报告称难以识别结核病症状并及时寻求护理。反过来，所有利益相关者团体都认为更积极主动的案例查找策略将是有益的。根据参与者对 ACF 策略的偏好排名，基于临床的策略（包括筛查所有患者，无论就诊目的如何）被视为最可接受的方法。然而，考虑到南非公共医疗系统的资源限制，许多参与者怀疑这是否是最有效的策略。家庭外展和基于激励的策略被认为是有希望的，但参与者报告了一些担忧（例如，基于家庭的耻辱和激励的道德问题）。参与者就如何优化每项策略、根据社区需求（结核病知识水平低）和现实（财务限制、交通、下班时间）定制实施方案提出了见解。结论：研究结果表明，不同的结核病 ACF 方法可能会吸引不同的人群，这凸显了综合方法的实用性。
Background: Tuberculosis (TB) is the leading infectious killer worldwide, with approximately 1.8 million deaths in 2015. While effective treatment exists, implementation of active case finding (ACF) methods to identify persons with active TB in a timely and cost-effective manner continues to be a major challenge in resource-constrained settings. Limited qualitative work has been conducted to gain an in-depth understanding of implementation barriers.Methods: Qualitative research was conducted to inform the development of three ACF strategies for TB to be evaluated as part of the Kharitode cluster-randomised trial being conducted in a rural province of South Africa. This included 25 semi-structured in-depth interviews among 8 TB patients, 7 of their household members and 10 clinic health workers, as well as 4 focus group discussions (2 rural and 2 main town locations) with 6-8 participants each (n = 27). Interviews and focus group discussions explored the context, advantages and limitations, as well as the implications of three ACF methods. Content analysis was utilised to document salient themes regarding their feasibility, acceptability and potential effectiveness.Results: Study participants (TB patients and community members) reported difficulty identifying TB symptoms and seeking care in a timely fashion. In turn, all stakeholder groups felt that more proactive case finding strategies would be beneficial. Clinic-based strategies (including screening all patients regardless of visit purpose) were seen as the most acceptable method based on participants' preference ranking of the ACF strategies. However, given the resource constraints experienced by the public healthcare system in South Africa, many participants doubted whether it would be the most effective strategy. Household outreach and incentive-based strategies were described as promising, but participants reported some concerns (e.g. stigma in case of household-based and ethical concerns in the case of incentives). Participants offered insights into how to optimise each strategy, tailoring implementation to community needs (low TB knowledge) and realities (financial constraints, transport, time off from work).Conclusions: Findings suggest different methods of TB ACF are likely to engage different populations, highlighting the utility of a comprehensive approach.