Feasibility and acceptability of a peer-led strategy to improve community tuberculosis case finding among non-household contacts in Zambia

项目总结/摘要 全球每年仍有300万结核病（TB）病例未被诊断，这是导致结核病的一个关键因素。 为什么结核病是艾滋病毒感染者（PWH）的主要死因， 全世界的死亡虽然世卫组织建议在高负担环境中进行全社区结核病筛查， 虽然这可能会降低社区患病率，但不太可能成为一种可扩展的结核病控制策略。利用训练有素的同行 （近期结核病患者）在非家庭接触者中进行以社区为基础的系统性结核病筛查 新诊断的结核病患者，包括在社区场所的偶然接触，可能是一种有效的， 促进结核病早期诊断和与护理联系的可持续战略;然而， 这种策略在资源匮乏、结核病负担高的环境中是可行和可接受的。 通过有针对性的培训和强大的指导，在实施科学的方法，我将开发和评估 以理论为依据的、多方面的、同行领导的战略，开展以社区为基础的、系统的结核病筛查 在卢萨卡两个公共卫生设施新诊断的结核病患者的非家庭接触者中， 赞比亚.这个建议建立在我在传染病期间开始发展的研究合作的基础上 奖学金，并利用传染病研究中心的丰富经验和基础设施 在赞比亚（CIDRZ）。在目标1中，我将在关键利益相关者中进行混合方法研究，以确定 利用同伴在非家庭接触者中进行结核病筛查的障碍。在目标2中，我将使用离散 在结核病患者、高危社区成员和社区场地所有者中进行选择实验，以确定 它们对执行战略各组成部分的交付方式的偏好。目标1的发现 和2将为非家庭成员中多成分、同伴主导的结核病接触者追踪战略的设计提供信息 在目标3中，将在为期6个月的试点期间对这些联系进行评估，以评估其可行性、可接受性和覆盖范围。 我的总体培训目标是发展实施科学专业知识;我将通过以下方式实现这一目标： 精心挑选的课程，讲习班和研讨会，并通过指导高度完成 导师谁是专家在国际实施科学研究，混合方法的研究和 多部门结核病/艾滋病毒执行战略。我的培训目标依次映射到我的研究 目的是：（1）获得应用混合方法进行实施科学研究的经验; (2)发展使用实施科学方法的专门知识，以开发多组件实施 （3）为干预性研究的研究设计和分析方法奠定坚实的基础 实施研究。我的职业目标是成为一名独立的医生科学家， 科学方法，以改善低资源环境中的结核病和艾滋病毒结果。由此产生的结果 K23奖将告知R 01提案，以进行一项适应性、集群随机试验， 赞比亚的多部门结核病病例发现战略。

PROJECT SUMMARY/ABSTRACT Three million global tuberculosis (TB) cases remain undiagnosed each year, which is a key factor underpinning why TB is the leading cause of death among people living with HIV (PWH) and the leading infectious cause of death worldwide. While community-wide screening for TB in high-burden settings is recommended by WHO and may reduce community prevalence, it is unlikely to be a scalable TB control strategy. Leveraging trained peers (recent TB patients) to undertake community-based, systematic TB screening among non-household contacts of newly diagnosed TB patients, including casual contacts at community venues, may be an efficient and sustainable strategy to facilitate early TB diagnosis and linkage to care; however, little is known about whether such a strategy is feasible and acceptable to undertake in low-resource, high TB burden settings. Through targeted training and strong mentorship in implementation science methods, I will develop and evaluate a theory-informed, multicomponent, peer-led strategy to undertake community-based, systematic TB screening among non-household contacts of newly diagnosed TB patients attending two public health facilities in Lusaka, Zambia. This proposal builds upon the research collaboration I began developing during my infectious disease fellowship and leverages the robust experience and infrastructure of the Centre for Infectious Diseases Research in Zambia (CIDRZ). In Aim 1, I will undertake mixed-methods research among key stakeholders to identify barriers to undertaking TB screening among non-household contacts using peers. In Aim 2, I will use a discrete choice experiment among TB patients, at-risk community members, and community venue owners, to determine their preferences for the mode of delivery for the implementation strategy components. Findings from Aims 1 and 2 will inform the design of a multicomponent, peer-led TB contact tracing strategy among non-household contacts that will be evaluated in Aim 3, during a 6-month pilot to assess its feasibility, acceptability and reach. My overall training objective is to develop implementation science expertise; I will accomplish this by undertaking carefully selected coursework, workshops, and seminars, and through the guidance of highly accomplished mentors who are experts in international Implementation science research, mixed-methods research and multicomponent TB/HIV implementation strategies. My training objectives sequentially map onto my research aims and are to: (1) gain experience in the application of mixed-methods for implementation science research; (2) develop expertise in using implementation science methods to develop multicomponent implementation strategies; (3) develop a strong foundation in study designs and analysis approaches for interventional implementation research. My career goal is to be an independent physician-scientist who applies implementation science methods to improve TB and HIV outcomes in low-resource settings. The findings generated from this K23 award will inform an R01 proposal to undertake an adaptive, cluster randomized trial evaluating a peer-led, multicomponent TB case finding strategy in Zambia.