Using an implementation science approach to refine, implement and evaluate pilot strategies for tuberculosis contact tracing in South Africa

项目总结 结核病(TB)仍然是一个全球卫生紧急情况，导致1000万新病例和150万 2018年的死亡人数。遏制结核病伙伴关系制定了非常雄心勃勃的目标，包括将结核病减少50% 2015年至2025年的发病率。在患者病程早期发现活动性结核病患者的策略必须 因此，如果要实现2025年的结核病控制目标，就必须迅速扩大规模。然而，正在处理的案例 发现或发现结核病的成本很高，在实践中很难实施，特别是追踪新病例的密切接触者 确诊的结核病病例。追踪接触者的一种创新方法是放弃家访，转而进行小规模的 鼓励结核病病例及其接触者到诊所进行结核病筛查。这 拟议的研究是一项新的研究，着眼于实施基于激励的接触者追踪的障碍， 完善修改这些障碍的战略，并在南非农村的高负担环境中进行试点测试。 我们将衡量可接受性、可行性、覆盖面、实施情况，并生成试点成效数据 可用于规划扩容。拟议的研究将在南非温贝的农村地区进行--a 结核病发病率为350/10万/年的地区。我们将使用以下工具评估实施障碍 对接受干预的结核病病例及其接触者进行定量调查和定性访谈 在整群随机对照试验的背景下，以及医护人员。我们将对障碍进行优先排序 与利益攸关方合作，并制定完善的以激励为基础的跟踪实施战略。我们将对此进行试运行 在Vhembe的6个公立初级卫生诊所实施战略，并审查执行情况和初步情况 有效性。这项研究的具体目标是：(1)确定个人和系统层面的障碍和 促进在高负担环境下实施以激励为基础的接触者追踪；(2)发展 并对改进的接触者追踪策略进行试点测试。这项多学科的研究代表了一种创新的 在关键的流行病学背景下实现中期结核病控制目标的途径，并可作为 中的其他领域如何改进现实世界决策的方法论示例 紧急和雄心勃勃的人口健康优先事项的背景下。

PROJECT SUMMARY Tuberculosis (TB) remains a global health emergency, responsible for 10 million new cases and 1.5 million deaths in 2018. The Stop TB Partnership has set very ambitious targets that include a 50% reduction in TB incidence from 2015 to 2025. Strategies to find people with active TB earlier in their disease course must therefore be rapidly scaled up if TB control targets for 2025 are to be approached. However, active case finding or TB is expensive and difficult to implement in practice, particularly tracing close contacts of newly diagnosed TB cases. One innovative approach to contact tracing is to forego household visits in favor of small incentives to the TB case and their contact for the contacts to present to the clinic for TB screening. This proposed research is a novel study looking at barriers to implementation of incentive-based contact tracing, refining the strategy to modify these barriers and pilot testing it in the high burden setting of rural South Africa. We will measure acceptability, feasibility, reach, implementation and generate pilot effectiveness data which can be used to plan for scale-up. The proposed study will be in the rural district of Vhembe, South Africa – a district with a TB incidence of 350 per 100,000/year. We will assess barriers to implementation using quantitative surveys and qualitative interviews with TB cases and their contacts who received the intervention in the context of a cluster-randomized controlled trial, as well as healthcare workers. We will prioritize barriers with stakeholders and devise a refined incentive-based tracing implementation strategy. We will pilot test this strategy in 6 public primary health clinics within Vhembe, and examine implementation and preliminary effectiveness. The specific aims of this research are: (1) To identify individual and systems-level barriers and facilitators to the implementation of incentive-based contact tracing in a high burden setting; (2) To develop and pilot test an improved contact tracing strategy. This multidisciplinary research represents an innovative path toward achieving medium-term TB control targets in a key epidemiological setting, and can also serve as a methodological example of how to improve real-world decision-making across a broad array of other fields in the context of urgent and ambitious population health priorities.