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

项目摘要/摘要 家庭接触调查是一种以证据为基础、世卫组织推荐的发现未确诊病例的方法 目前正在高负担、低收入国家实施这一方案。在.期间 在当前授权期内，我们确定了坎帕拉在提供结核病接触者调查方面的主要差距， 乌干达；用行为术语描述了这些差距；并设计、实施和评估了一种理论-- 针对这些差距的知情策略在家庭集群随机试验中。不幸的是，这个策略， 以家庭为基础的结核病接触调查在增加结核病评估或诊断方面并不有效， 尽管接触者和卫生工作者都更喜欢它。干预措施核心内容的保真度 家庭艾滋病毒和结核病检测以及通过短信报告结果的组件水平较低，这表明需要 完善投放模式。以人为中心的设计(HCD)提供了一种新的方法来改善 使用共同创建、快速原型制作和迭代测试对家庭成员进行干预，以确定更多 接洽交付解决方案。实践社区-由专业人员组成的紧密网络，以提供 同行支持和分享隐性知识--日益被认为是促进和维持的资源 医疗保健的质量。因此，我们建议与全球人类创新者IDEO.org合作- 中心设计，以完善家庭结核病接触者调查的交付。我们还将与外行健康合作 工作人员使用实践社区来适应和维持核心干预组件的交付。我们会 然后在六个城市进行阶梯式楔形整群随机试验，对改进的实施策略进行评估 没有参与HCD改进的乌干达社区。我们将确定HCD精炼战略是否- 通过非专业卫生工作者实践社区提供的基于家庭的结核病接触调查-改善 相对于标准策略，家庭结核病接触者调查的质量、产量和可持续性。最后， 我们将通过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，以及经济评估(包括经验性成本计算) 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 乌干达结核病执行研究联盟提供的环境。我们久负盛名的 调查人员具有相关的方法学经验(以人为本的设计、实施科学、 生物统计、混合方法、经济评估)和内容专门知识(艾滋病毒、结核病诊断和接触 调查、移动技术)。这项研究将通过以下方式为公共卫生做出重大贡献 确定是否、如何以及为什么采用以患者为中心的新颖模式在 低收入国家是有效、高效、可持续和具有成本效益的。我们还将生成可泛化的 了解以人为中心的设计和实践社区作为工具和方法的价值 改善低收入环境下实施战略的适合性和交付情况。

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.