Mobile Health for Implementation of Home-based TB Contact Investigation in Uganda

移动医疗在乌干达实施家庭结核病接触者调查

• 批准号: 9274904
• 负责人: John Lucian Davis
• 金额: $ 53.23万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-17 至 2019-01-10
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9274904
• 关键词: Adoption; Advocate; Affect; Area; Behavioral Sciences; Biometry; Car Phone; Caring; Clinic; Clinic Visits; Clinical Research; Collection; Communities; Country; Data; Detection; Diagnosis; Dimensions; Early identification; Early treatment; Economics; Education; Effectiveness; Ensure; Environment; Epidemic; Epidemiology; Evaluation; Evidence based practice; Future; Geography; Goals; HIV; HIV diagnosis; Health; Health Policy; Health Services Research; Health system; Home environment; Household; Human; Human immunodeficiency virus test; Incentives; Incidence; Individual; Intervention; Interview; Investigation; Knowledge; Link; Maintenance; Mathematics; Measures; Methods; Modeling; Monitor; Outcome; Patient Care; Patient risk; Patients; Population; Process; Public Health; Public Sector; Qualitative Methods; Randomized; Randomized Controlled Trials; Research; Research Personnel; Resources; Risk; Rural; Services; Severities; Site; Specific qualifier value; Sputum; Symptoms; System; Target Populations; Technology; Test Result; Testing; Time; Travel; Tuberculosis; Uganda; Visit; Work; arm; base; behavior change; case finding; contextual factors; cost; experience; follow-up; formative assessment; health economics; improved; incremental cost-effectiveness; indexing; innovation; insight; low income country; mHealth; mortality; multidisciplinary; novel; novel strategies; patient oriented; programs; public health relevance; routine practice; scale up; screening; success; theories; trial comparing; tuberculosis treatment; two-dimensional; voucher

DESCRIPTION (provided by applicant): Contact investigation is a widely advocated strategy for extending tuberculosis (TB) case detection from clinics to communities through screening of household contacts of new TB patients and referral of at-risk patients for clinic-based confirmatory testing and treatment. Unfortunately, low rates of clinic follow-up among at-risk individuals represent a major barrier to implementing contact investigation in high-burden countries. In a formative evaluation based on a WHO-endorsed conceptual model of barriers to accessing TB evaluation services, we have identified a lack of patient knowledge about TB and TB evaluation, and economic and geographic barriers as the major determinants of this quality gap. The objective of this proposal is to determine if home sputum collection, supported by targeted, mobile-phone health (mHealth) messages and incentives, is an effective and scalable solution for overcoming these barriers to implementing contact investigation. The scientific approach will be to carry-out a household-randomized, controlled trial in five rural Ugandan communities comparing two approaches to evaluation of at-risk contacts: referral to clinics for TB testing (standard approach) vs. home sputum collection supported by mHealth interventions. We will use the RE-AIM framework for intervention evaluation to assess the patient and public-health impact of these interventions, using pre-specified measures of their reach, effectiveness, adoption, implementation, and maintenance. Specifically, we will first determine if mHealth-facilitated home sputum collection increases rates of TB and HIV diagnosis and clinic follow-up (reach), TB treatment initiation (effectiveness), and completion (maintenance), as compared to standard contact investigation. Second, we will use quantitative and qualitative methods to evaluate the internal effectiveness and fidelity of the component interventions across different sites (adoption). Third, we will employ economic and epidemic modeling to estimate the costs and epidemiological impact of this intervention (implementation). The proposed research will make a significant contribution to patient care and health policy by providing comprehensive, practice-based evidence on contact investigation in a low- income country, including whether it can be implemented more widely and efficiently by decreasing unnecessary clinic referrals and increasing early identification and treatment of infectious TB patients. We have assembled a well-established team of investigators, who will take advantage of the outstanding environment for health services research with the Uganda TB Surveillance Project. Together, they will combine their expertise in innovative, multi-disciplinary methods from clinical research, behavioral science, and applied mathematics with their extensive experience in core content areas, including TB diagnosis and contact investigation; mHealth; theories of behavior change and implementation frameworks; biostatistics; and health economics to evaluate a cutting-edge, patient-centered technological intervention.

描述（由申请人提供）：接触者调查是一种广泛提倡的策略，通过筛查新结核病患者的家庭接触者和转诊高危患者进行基于诊所的确认性检测和治疗，将结核病 (TB) 病例检测从诊所扩展到社区。不幸的是，高危人群的临床随访率低，是在高负担国家实施接触者调查的主要障碍。在基于世卫组织认可的获得结核病评估服务障碍概念模型的形成性评估中，我们发现患者缺乏关于结核病和结核病评估的知识，以及经济和地理障碍是造成这种质量差距的主要因素。该提案的目的是确定在有针对性的手机健康 (mHealth) 消息和激励措施的支持下，家庭痰液采集是否是一种有效且可扩展的解决方案，可以克服实施接触者调查的这些障碍。科学方法将是在乌干达的五个农村社区进行一项家庭随机对照试验，比较两种评估高危接触者的方法：转诊至诊所进行结核病检测（标准方法）与由移动医疗干预支持的家庭痰液采集。我们将使用 RE-AIM 干预评估框架来评估这些干预措施对患者和公共卫生的影响，并使用预先指定的措施来衡量干预措施的范围、有效性、采用、实施和维护。具体来说，我们将首先确定与标准接触调查相比，移动医疗促进的家庭痰液采集是否会提高结核病和艾滋病毒诊断率、临床随访率（达到率）、结核病治疗开始率（有效性）和完成率（维持率）。其次，我们将使用定量和定性方法来评估不同地点（采用）干预措施的内部有效性和保真度。第三，我们将采用经济和流行病模型来估计这种干预（实施）的成本和流行病学影响。拟议的研究将为低收入国家的接触者调查提供全面的、基于实践的证据，包括是否可以通过减少不必要的诊所转诊和增加传染性结核病患者的早期识别和治疗来更广泛、更有效地实施，从而为患者护理和卫生政策做出重大贡献。我们组建了一支完善的研究团队，他们将利用乌干达结核病监测项目的良好环境进行卫生服务研究。他们将共同将临床研究、行为科学和应用数学等创新、多学科方法的专业知识与结核病诊断和接触者调查等核心内容领域的丰富经验结合起来；移动医疗；行为改变理论和实施框架；生物统计学；和卫生经济学来评估尖端的、以患者为中心的技术干预措施。