Addressing the Social Determinants and Consequences of Tuberculosis (ASCOT): a pilot randomised controlled trial and process evaluation in Nepal

解决结核病的社会决定因素和后果（ASCOT）：尼泊尔的一项试点随机对照试验和过程评估

• 批准号: MR/V004832/1
• 负责人: Thomas Wingfield
• 金额: $ 25.68万
• 依托单位: Liverpool School of Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FV004832%2F1
• 关键词: Addressing; Social; Determinants; Consequences; Tuberculosis

BACKGROUND. Tuberculosis (TB) kills more people than any infection. Poorer people in low income countries (LICs) are disproportionately affected by TB. Once ill, people with TB face severe psychological, social, and economic (socioeconomic) challenges, including mental illness, discrimination, income loss, and catastrophic costs of accessing TB care. These challenges reduce patients' chances of cure, push households deeper into poverty, and impede global TB control efforts. To combat this, the World Health Organization (WHO) advocates socioeconomic support for TB-affected households. RELATED WORK. In Peru, a middle-income country, members of our team previously showed that socioeconomic support for TB-affected households increases TB cure rates and reduces catastrophic costs. However, no related evidence exists in LICs with significant TB burden, like Nepal. Over the past two years funded by a Wellcome Trust Seed Award, our team worked with communities, people with TB, and the National TB Program (NTP) of Nepal to address this knowledge gap. We identified barriers to accessing TB services in Nepal including low TB knowledge, perceived stigma, isolation, and high travel costs to receive care. We then suggested feasible and locally-appropriate socioeconomic support packages to overcome these barriers, including cash transfers and peer support. We are ready to field-test these packages and select the most promising for large-scale trial evaluation.OBJECTIVES1. Field-test socioeconomic support packages for TB-affected households to identify which is most feasible and acceptable in Nepal;2. Inform design and delivery of a definitive, large-scale trial to evaluate the impact of the selected support package on health, finances, and stigma of TB-affected households in Nepal; and3. Consolidate partnerships with communities, the Nepal NTP, and WHO, to ensure the future trial is achievable, act as a model for other LICs, and informs TB policy and practice.SETTING. Four districts of Nepal with high TB and poverty: Chitwan, Mahottari, Morang, and Pyuthan.DESIGN. A randomised-controlled pilot trial of socioeconomic support packages for TB-affected households. POPULATION. 100 people with TB diagnosed in NTP clinics in the study sites (25 consecutively diagnosed participants per site). INTERVENTIONS. Computer software will randomly allocate participants to receive:i) Control standard of care with no additional socioeconomic support; ii) Social support through home-based peer-led mutual support groups to reduce stigma; iii) Economic support with monthly cash transfers to mitigate costs and enable treatment adherence ; oriv) Socioeconomic support integrating social and economic support. Interventions will be delivered by Birat Nepal Medical Trust (BNMT), a well-established, Nepalese non-governmental organisation. Interventions will be flexible to refine size or frequency of cash or support groups where needed.STUDY ACTIVITIES. Participants will be surveyed on TB knowledge, stigma, mental health, quality of life, poverty level, costs of TB, and satisfaction with interventions received. Focus groups and interviews with selected participants, project and BNMT team members, and NTP staff will be combined with project costs data to evaluate the feasibility of the interventions. PRIMARY OUTCOME. To evaluate the feasibility and acceptability of the interventions in order to select the most promising intervention for large-scale trial evaluation.SECONDARY OUTCOMES. To explore the impact of interventions on TB cure and catastrophic costs of TB-affected households.Benefits and applications. This research will ensure the most fundable, achievable, and impactful design of a definitive, large-scale trial of socioeconomic support for TB-affected households in Nepal, the findings of which will be the first of their kind in a LIC and will inform regional and international TB policy and practice.

背景资料。结核病(TB)导致的死亡人数超过任何感染。低收入国家(LIC)的较贫穷人口受结核病的影响不成比例。一旦患病，结核病患者将面临严峻的心理、社会和经济(社会经济)挑战，包括精神疾病、歧视、收入损失和获得结核病护理的灾难性成本。这些挑战降低了患者治愈的机会，将家庭推向更深的贫困，并阻碍了全球结核病控制努力。为了应对这一问题，世界卫生组织(WHO)倡导为受结核病影响的家庭提供社会经济支持。相关工作。在秘鲁这个中等收入国家，我们小组的成员以前曾表明，对受结核病影响的家庭提供社会经济支持可以提高结核病治愈率并降低灾难性成本。然而，在像尼泊尔这样结核病负担显著的地方，没有相关证据存在。在过去的两年里，在惠康信托种子奖的资助下，我们的团队与社区、结核病患者和尼泊尔国家结核病计划(NTP)合作，以解决这一知识差距。我们确定了在尼泊尔获得结核病服务的障碍，包括低结核病知识、被认为是耻辱、与世隔绝和接受护理的高昂旅行费用。然后，我们建议了可行的、适合当地情况的社会经济支持方案，以克服这些障碍，包括现金转移和同行支持。我们准备对这些包进行现场测试，并选择最有希望进行大规模试验评估的包。实地测试对受结核病影响的家庭的社会经济支助方案，以确定在尼泊尔最可行和最可接受的方案；2.为设计和交付一项最终的大规模试验提供信息，以评估选定的一揽子支助方案对尼泊尔受结核病影响的家庭的健康、财务和耻辱的影响；以及3.巩固与社区、尼泊尔NTP和世卫组织的伙伴关系，以确保未来的试验可以实现，作为其他LIC的典范，并为结核病政策和实践提供信息。集合。尼泊尔四个结核病和贫困地区：奇特万、Mahottari、Morang和Pyuthan。设计。为受结核病影响的家庭提供社会经济支持方案的随机对照试点试验。人口。在研究地点的NTP诊所诊断出100名结核病患者(每个地点连续诊断25名参与者)。干预措施。计算机软件将随机分配参与者接受：i)控制护理标准，无需额外的社会经济支持；ii)通过以家庭为基础的同行领导的相互支持小组提供社会支持，以减少耻辱；iii)经济支持，每月现金转移，以降低费用，使治疗得以坚持；orv)整合社会和经济支持。干预措施将由比拉特尼泊尔医疗信托基金(BNMT)提供，这是一个久负盛名的尼泊尔非政府组织。干预措施将根据需要灵活调整现金或支持团体的规模或频率。参与者将接受关于结核病知识、污名、心理健康、生活质量、贫困水平、结核病费用以及对接受干预的满意度的调查。重点小组和对选定参与者、项目和BNMT团队成员以及NTP工作人员的访谈将与项目成本数据结合起来，以评估干预措施的可行性。主要结果。评价干预措施的可行性和可接受性，以选择最有希望的干预措施进行大规模试验评价。[目的]探讨干预措施对结核病防治效果的影响，并探讨干预措施在结核病防治中的应用。这项研究将确保为尼泊尔受结核病影响的家庭提供社会经济支助的最终、大规模试验的设计是最有资金、可实现和最有影响力的，其结果将是LIC中的第一个此类试验，并将为区域和国际结核病政策和实践提供信息。

项目成果

Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention.

• DOI: 10.1136/bmjopen-2021-049900
• 发表时间: 2021-10-01
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Dixit K;Biermann O;Rai B;Aryal TP;Mishra G;Teixeira de Siqueira-Filha N;Paudel PR;Pandit RN;Sah MK;Majhi G;Levy J;Rest JV;Gurung SC;Dhital R;Lönnroth K;Squire SB;Caws M;Sidney K;Wingfield T
• 通讯作者: Wingfield T

Clinical features and management of human monkeypox: a retrospective observational study in the UK.

• DOI: 10.1016/s1473-3099(22)00228-6
• 发表时间: 2022-08
• 期刊: LANCET INFECTIOUS DISEASES
• 影响因子: 56.3
• 作者: Adler, Hugh;Gould, Susan;Hine, Paul;Snell, Luke B.;Wong, Waison;Houlihan, Catherine F.;Osborne, Jane C.;Rampling, Tommy;Beadsworth, Mike Bj;Duncan, Christopher Ja;Dunning, Jake;Fletcher, Tom E.;Hunter, Ewan R.;Jacobs, Michael;Khoo, Saye H.;Newsholme, William;Porter, David;Porter, Robert J.;Ratcliffe, Libuse;Schmid, Matthias L.;Semple, Malcolm G.;Tunbridge, Anne J.;Wingfield, Tom;Price, Nicholas M.
• 通讯作者: Price, Nicholas M.

A patient satisfaction survey and educational package to improve the care of people hospitalised with COVID-19: a quality improvement project, Liverpool, UK.

• DOI: 10.12688/wellcomeopenres.17163.2
• 发表时间: 2021
• 期刊: Wellcome open research
• 作者: Ahmad MS;Hicks SR;Watson R;Ahmed RA;Jones L;Vaselli M;Wu MS;Hayat F;Ratcliffe L;McKenna M;Hine P;Defres S;Wingfield T
• 通讯作者: Wingfield T

The socioeconomic impact of tuberculosis on children and adolescents: a scoping review and conceptual framework.

• DOI: 10.1186/s12889-022-14579-7
• 发表时间: 2022-11-23
• 期刊: BMC public health
• 影响因子: 4.5

Expanding molecular diagnostic coverage for tuberculosis by combining computer-aided chest radiography and sputum specimen pooling: a modeling study from four high burden countries

通过结合计算机辅助胸片和痰标本汇集扩大结核病分子诊断覆盖范围：来自四个高负担国家的模型研究

• DOI: 10.21203/rs.3.rs-3813705/v1
• 发表时间: 2024
• 作者: Codlin A