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

确保公平接种疫苗对于保护所有儿童免受可预防的和潜在的 小儿麻痹症、白喉和麻疹等危险感染。然而，许多研究都强调了低 疫苗接种覆盖率和及时性，特别是在资源有限的环境中的儿童。例如，在 在坦桑尼亚，只有68%的儿童在出生第一年就接种了所有推荐的基本疫苗。原因 对于疫苗接种来说，不平等是多方面的；其中包括照顾者对疫苗的了解程度较低，以及挑战 医疗服务的提供和获取。全球新冠肺炎大流行期间卫生服务中断 进一步限制了照顾者教育的机会，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服务 在资源有限的环境中提供远程医疗服务的能力具有缓解童年的巨大潜力 疫苗接种不公平。我们最近完成了(1)一项由Fogarty资助的研究(R21TW010262)，证明了 基于手机提醒和有条件的财政激励改进的可行性和有效性 儿童疫苗接种的覆盖率和及时性；(2)社区卫生工作者(CHW)的干预 这被证明是可以接受的，以缓解照顾者对儿童疫苗的知识差距。在基础上建设 这项前期工作在坦桑尼亚国家免疫和疫苗发展计划的支持下，我们 建议评估以社区为基础的综合数字干预措施，以促进儿童公平 接种疫苗。外展和教育干预称为“Chanjo Kua Wakati”(“及时接种疫苗”)， 面向最近的母亲，包括CHW外展和低成本数字战略的组合 (基于自主移动电话的疫苗接种推广消息、提醒、缺货通知和 为及时接种疫苗提供奖励)。在目标1中，我们将评估Chanjo Kua Wakati在 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率和及时性 审判。该试验将涉及在40个农村集水区交错实施干预措施 坦桑尼亚两个以农村为主的地区的卫生设施，这些地区有大量未接种或接种不足的人 孩子们。将对参与试验的1200名妇女所生孩子的疫苗接种结果进行分析。在AIM 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展到其他 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的有效性 主动识别未接种或延迟接种疫苗的风险儿童，并验证预测模型 在AIM 1收集的疫苗接种数据。研究结果将为未来的实施和扩大Chanjo提供参考 夸瓦卡蒂，包括可能的干预措施，以改善农村儿童的疫苗接种公平，资源-- 有限的，或服务不足的社区在美国。

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.