Communities of Practice for lay health worker-delivered contact investigation for TB: Mechanisms and context

项目概要/摘要 结核病（TB）仍然是全球十大死亡原因之一，不成比例地影响着低收入人群， 收入国家。世卫组织建议对结核病进行接触者调查，以发现和预防其他结核病。 例接触调查通常由接受过在职培训的非专业卫生工作者进行; 然而，缺乏相关的在职培训是他们提供高质量保健服务的主要障碍。 促进非专业卫生工作者培训的一种方法是实施实践社区。警察 是由专业人士组成的团体，他们定期聚会，互相支持，分享知识，以提高他们的 朝着一个共同的目标努力。CoP已用于卫生领域，以改善高质量的 中等收入和高收入国家的医生和护士的护理。然而，还需要更多的研究。 确定了如何使用CoP来促进低收入国家非专业卫生工作者的绩效。 我的培训建议解决了在理解低收入国家的CoP如何运作方面的差距 通过两个科学目标和四个培训目标，利用Luke Davis博士（申办者）的实施试验 CoP（5R01 AI104824-08，2021-2023）。戴维斯博士的试验旨在解决结核病实施中的差距 在乌干达的接触者调查中，我们的研究小组发现，只有20%的高风险接触者完成了结核病治疗 这一比例远低于世卫组织≥ 90%的目标。与受资助的试验分开，我将测试我的概念 如何以及在什么情况下，警察可以改善接触调查的交付模式。在目标1中，我将测试我的 假设非专业卫生工作者自我效能，或他们提供高质量卫生服务信心， 介导的接触调查的CoP的影响。我将寻求调查方法方面的培训和指导 和心理测量学，以验证在乌干达广泛使用的自我效能测量。我也会接受培训 中介分析中的指导指导，以评估非专业卫生工作者自我效能是否介导 缔约方会议进行接触调查。在目标2中，我将寻求高级定性方法的培训和指导， 确定影响COP有效性的背景因素。通过评估作用机制， 与CoP相关的背景因素，我们的研究结果可以解释为什么父母试验改善或失败， 改善，成果。我们的研究结果也将产生如何设计和实施外行卫生工作者的见解， 改进提供高质量卫生服务的合作伙伴关系，可适用于其他低收入环境。 我的培训计划以及耶鲁大学和乌干达结核病实施研究中心的合作环境 联盟将使我能够发展研究，临床和研究职业生涯所需的专业技能， 一位使用实施科学来减轻低收入人群健康差距的流行病学医生。 国家我的培训计划概述了课程作业，指导研究和临床经验，以提高我的 实施试验，先进的生物统计学，定性方法和传染病医学的技能。

Project Summary/Abstract Tuberculosis (TB) remains among the top 10 causes of death worldwide, disproportionately impacting low- income countries. Contact investigation for TB is recommended by the WHO to find and prevent additional cases. Contact investigation is often carried out by lay health workers who receive on-the-job training; however, lack of relevant in-service training is a major barrier to their delivery of high-quality health services. One approach to facilitating lay health worker training is to implement Communities of Practice (CoPs). CoPs are groups of professionals who meet regularly to support each other and share knowledge to advance their practice toward a common goal. CoPs have been used in the health field to improve the delivery of high-quality care by physicians and nurses in middle- and high-income countries. However, additional studies are needed that identify how CoPs can be used to facilitate the performance of lay health workers in low-income countries. My training proposal addresses the gaps in understanding how CoPs function in low-income countries through two scientific aims and four training aims that leverage Dr. Luke Davis’ (Sponsor) implementation trial of CoPs (5R01 AI104824-08, 2021-2023). Dr. Davis’ trial aims to address gaps in the implementation of TB contact investigation in Uganda; our research team found that only 20% of high-risk contacts completed TB evaluation in full, far below the WHO target of ≥90%. Separate from the funded trial, I will test my conceptual model of how and in what contexts CoPs can improve delivery of contact investigation. In Aim 1, I will test my hypothesis that lay health worker self-efficacy, or their confidence delivering high-quality health services, mediates the effects of CoPs on contact investigation. I will seek training and mentorship in survey methods and psychometrics to validate a widely used self-efficacy measure for use in Uganda. I will also receive training and guided mentorship in mediation analysis to assess if lay health worker self-efficacy mediates the effects of CoPs on contact investigation. In Aim 2, I will seek training and mentorship in advanced qualitative methods to identify contextual factors that impact the effectiveness of CoPs. By evaluating mechanisms of action and contextual factors pertinent to CoPs, our findings can explain why the parent trial improved, or failed to improve, outcomes. Our findings will also yield insights on how to design and implement lay health worker CoPs to improve delivery of high-quality health services, which can be applied to other low-income settings. My training plan and the collaborative environments at Yale and the Uganda TB Implementation Research Consortium will allow me to develop research, clinical, and professional skills needed for a research career as a physician-epidemiologist who uses implementation science to mitigate health disparities in low-income countries. My training plan outlines coursework, mentored research, and clinical experiences to enhance my skills in implementation trials, advanced biostatistics, qualitative methods, and infectious diseases medicine.