"Chanjo Kwa Wakati" - Leveraging community health workers and a responsive digital health system to improve vaccination coverage and timeliness in rural settings

确保公平的疫苗接种对于保护所有儿童免受可预防和潜在的疾病至关重要。 小儿麻痹症、白喉和麻疹等危险传染病。然而，许多研究表明， 疫苗接种的覆盖面和及时性，特别是在资源有限环境中的儿童中。例如在 在坦桑尼亚，只有68%的儿童在出生后第一年接受了所有建议的基本疫苗。原因 疫苗接种不公平是多方面的;它们包括护理人员对疫苗的知识不足， 与医疗服务的提供和获取。在全球COVID-19大流行期间， 进一步限制了护理人员的教育机会，影响了疫苗的获得，并加剧了疫苗接种 不平等以最佳方式利用有限的卫生人力资源和快速发展的数字卫生 在资源有限的环境中提供远程医疗保健的能力在减轻儿童疾病方面具有巨大潜力 疫苗接种不公平我们最近完成了（1）一项Fogarty资助的研究（R21TW010262），证明 基于移动的电话提醒和有条件的财务激励措施的可行性和有效性， 儿童疫苗接种的覆盖面和及时性，以及（2）社区卫生工作者（CHW）干预 这被证明是可以接受的，以减少照顾者对儿童疫苗的知识差距。基础上 在坦桑尼亚国家免疫和疫苗开发计划的支持下， 建议评估一项综合的、以社区为基础的数字干预措施，以促进儿童平等 接种疫苗这项名为"及时接种疫苗"的宣传和教育干预措施， 针对新近的母亲，包括CHW外展和低成本数字战略的组合 （基于自主移动的电话的疫苗接种推广信息、提醒、缺货通知，以及 及时接种疫苗的奖励措施）。在目标1中，我们将评估Chanjo Kwa Wakati的有效性， 在第一类有效性实施混合方案中促进儿童疫苗接种的覆盖面和及时性 审判该试验将涉及在40个农村地区的集水区交错实施干预措施。 坦桑尼亚两个主要农村地区的卫生设施，有大量未接种或接种不足的人， 孩子将分析1200名参与试验的妇女所生儿童的疫苗接种结果。在aim中 2、我们将评估与干预效果变化相关的实施因素，分析 干预措施的成本效益，并制定实施蓝图，以指导扩大到其他 设置.在目标3中，我们将评估机器学习方法的可行性和潜在功效， 主动识别有未接种疫苗或延迟接种疫苗风险的儿童，并使用 目标1中收集的疫苗接种数据。研究结果将为Chanjo的未来实施和规模扩大提供信息 Kwa Wakati，包括可能采取的干预措施，以改善生活在农村的儿童的疫苗接种公平性， 有限的，或服务不足的社区。

Ensuring equitable vaccinations is critical for protecting all children against preventable and potentially dangerous infections such as polio, diphtheria, and measles. Yet, numerous studies have highlighted low vaccination coverage and timeliness, particularly among children from resource-limited settings. For example, in Tanzania, only 68% of children receive all basic vaccines that are recommended in the first year of life. Reasons for vaccination inequities are multifaceted; they include low caregiver knowledge about vaccines, and challenges with health service delivery and access. Health service interruptions during the global COVID-19 pandemic have further restricted opportunities for caregiver education, impacted vaccine access, and exacerbated vaccination inequities. Approaches that optimally utilize limited health workforce capacity and rapidly evolving digital health capacity for remote healthcare in resource-limited settings hold great potential for mitigating childhood vaccination inequities. We recently completed (1) a Fogarty-funded study (R21TW010262) that demonstrated the feasibility and efficacy of mobile phone-based reminders and conditional financial incentives for improving the coverage and timeliness of childhood vaccinations, and (2) a community health worker (CHW) intervention that was shown to be acceptable for mitigating caregiver knowledge gaps about childhood vaccines. Building on this prior work and with support from Tanzania’s National Immunization and Vaccine Development program, we propose to evaluate an integrated, community-based, digital intervention for promoting equity in childhood vaccinations. The outreach and educational intervention, called ”Chanjo Kwa Wakati” (“timely vaccination”), is targeted toward recent mothers and comprises a combination of CHW outreach and low-cost digital strategies (autonomous mobile phone-based vaccination promotion messages, reminders, stockout notifications, and incentive offers for timely vaccinations). In Aim 1, we will evaluate the effectiveness of Chanjo Kwa Wakati in promoting the coverage and timeliness of childhood vaccinations in a Type I effectiveness implementation hybrid trial. The trial will involve the staggered implementation of the intervention across catchment areas of 40 rural health facilities in two predominantly rural regions of Tanzania with large numbers of un- or under-vaccinated children. Vaccination outcomes will be analyzed for children born to 1200 women participating in the trial. In Aim 2, we will evaluate implementation factors associated with variations in intervention effectiveness, analyze the cost effectiveness of the intervention, and develop an implementation blueprint to guide scale-up to other settings. In Aim 3, we will evaluate the feasibility and potential efficacy of a machine learning approach for proactively identifying children at risk of non- or delayed vaccinations and validate predictive models using vaccination data gathered in Aim 1. Study findings will inform future implementations and scale up of Chanjo Kwa Wakati, including potential interventions to improve vaccination equity for children living in rural, resource- limited, or underserved communities in the United States.