Human-centered Design and Communities of Practice to Improve Delivery of Home-based TB Contact Investigation in Uganda

项目总结/摘要 家庭接触调查是世卫组织推荐的一种循证方法， 目前正在高负担、低收入国家实施的结核病（TB）患者的预防和治疗方案。期间 在当前的奖励期内，我们已经确定了在坎帕拉开展结核病接触者调查方面的主要差距， 乌干达;在行为方面的特点，这些差距;并设计，实施，并评估了一个理论- 在一项家庭聚集的随机试验中针对这些差距的知情策略。不幸的是，这个策略， “以家庭为基础的”结核病接触者调查，在增加结核病评估或诊断方面无效， 尽管接触者和卫生工作者都更喜欢它。 家庭艾滋病毒和结核病检测以及通过短信报告结果的比例很低，这表明需要 来完善交付模式。以人为本的设计（HCD）提供了一种新的方法来改善适合的 通过共同创造、快速原型设计和迭代测试对家庭成员进行干预， 参与交付解决方案。实践社区-专业人士组成的紧密网络， 同侪支持和分享隐性知识-越来越被认为是促进和维持 保健质量。因此，我们建议与IDEO.org合作，这是一个全球性的人类创新者， 中心化设计，完善以家庭为基础的结核病接触者调查。我们也会让非专业的医疗人员 工作人员利用实践社区来调整和维持核心干预措施的交付。我们将 然后在六个城市的一个阶梯楔形随机分组试验中评估改进的实施策略， 乌干达社区没有参与HCD改进。我们将确定经过HCD改进的策略是否- 通过非专业卫生工作者实践社区开展的以家庭为基础的结核病接触者调查-提高了 与标准策略相比，家庭结核病接触者调查的质量、产量和可持续性。最后， 我们将使用嵌套混合方法研究进行详细的过程评估，以评估保真度/适应性， 可持续性及其决定因素，以及经济评价（包括经验成本计算）， 确定成本和成本效益。我们将与现实世界中的方案合作伙伴一起开展这项工作 乌干达结核病实施研究联合会提供的环境。我们完善的团队 研究人员具有相关的方法论经验（以人为本的设计，实施科学， 生物统计学、混合方法、经济评估）和内容专业知识（艾滋病毒、结核病诊断和接触 调查、移动的技术）。这项研究将为公共卫生做出重大贡献， 确定是否，如何以及为什么要采用以患者为中心的新型模式进行家庭接触调查， 低收入国家是有效的、高效的、可持续的和具有成本效益的。我们还将产生可推广的 了解以人为本的设计和实践社区作为工具和方法的价值， 在低收入环境中改进实施战略的适应性和交付。

PROJECT SUMMARY/ABSTRACT Household contact investigation is an evidence-based, WHO-recommended approach to finding undiagnosed patients with tuberculosis (TB) that is now being implemented in high-burden, low-income countries. During the current award period, we have identified major gaps in the delivery of TB contact investigation in Kampala, Uganda; characterized these gaps in behavioral terms; and designed, implemented, and evaluated a theory- informed strategy targeting these gaps in a household-clustered, randomized trial. Unfortunately, the strategy, “home-based” TB contact investigation, was not effective in increasing either TB evaluation or diagnosis, although contacts and health workers both preferred it. Fidelity of delivery of the intervention's core components – home HIV and TB testing and results reporting via text messaging – was low, suggesting a need to refine the models of delivery. Human-Centered Design (HCD) offers a novel approach to improving the fit of interventions to household members using co-creation, rapid prototyping, and iterative testing to identify more engaging delivery solutions. Communities of Practice – close networks of professionals that form to provide peer support and share tacit knowledge – are increasingly recognized as resources to promote and sustain quality in health care. Therefore, we propose to collaborate with IDEO.org, a global innovator in Human- Centered Design, to refine the delivery of home-based TB contact investigation. We will also engage lay health workers using Communities of Practice to adapt and sustain delivery of core intervention components. We will then evaluate the refined implementation strategy in a stepped-wedge, cluster-randomized trial in six urban Ugandan communities not involved in the HCD refinements. We will determine if the HCD-refined strategy – home-based TB contact investigation delivered via lay health worker communities of practice – improves the quality, yield, and sustainability of household TB contact investigation relative to a standard strategy. Finally, we will carry out a detailed process evaluation with nested mixed-methods studies to assess fidelity/adaptation, sustainability, and their determinants, as well as an economic evaluation (including empirical costing) to determine cost and cost-effectiveness. We will carry out this work with programmatic partners in the real-world environment provided by the Uganda TB Implementation Research Consortium. Our well-established team of investigators has relevant methodological experience (Human-Centered Design, implementation science, biostatistics, mixed-methods, economic evaluation) and content expertise (HIV, TB diagnostics and contact investigation, mobile technology). This research will make a significant contribution to public health by determining if, how, and why novel, patient-centered models for delivering household contact investigation in low-income countries are effective, efficient, sustainable, and cost-effective. We will also produce generalizable knowledge about the value of Human-Centered Design and Communities of Practice as tools and methods for improving fit and delivery of implementation strategies in low-income settings.