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

项目摘要/摘要 每年仍有300万全球结核病(TB)病例未确诊，这是一个关键因素 为什么结核病是艾滋病毒携带者(PWH)死亡的主要原因，也是 世界范围内的死亡。虽然世卫组织建议在高负担环境下进行社区范围的结核病筛查，但 可能会降低社区流行率，但不太可能是可推广的结核病控制战略。利用训练有素的同行 (最近的结核病患者)在非家庭接触者中进行以社区为基础的系统结核病筛查 对新诊断的结核病患者，包括在社区场所进行临时接触，可能是一种有效和 促进结核病早期诊断和与护理挂钩的可持续战略；然而，关于是否 这种战略在资源少、结核病负担高的情况下是可行的，也是可以接受的。 通过有针对性的培训和强大的实施科学方法指导，我将制定和评估 一种以理论为基础、多组成部分、同行主导的战略，以开展基于社区的系统性结核病筛查 在卢萨卡两家公共卫生机构就诊的新诊断结核病患者的非家庭接触者中， 赞比亚。这项建议建立在我患传染病期间开始发展的研究合作基础上 并利用传染病研究中心的强大经验和基础设施 赞比亚(CIDRZ)。在目标1中，我将在主要利益相关者中进行混合方法研究，以确定 在使用同伴的非家庭接触者中进行结核病筛查的障碍。在目标2中，我将使用一个离散的 在结核病患者、高危社区成员和社区场馆所有者中进行选择实验，以确定 他们对实施战略组成部分的交付方式的偏好。AIMS 1的调查结果 和2将为在非家庭中设计多组成部分、同行主导的结核病接触者追踪战略提供信息 在为期6个月的试点期间，将在AIM 3中评估其可行性、可接受性和覆盖面。 我的总体培训目标是发展实现科学专业知识；我将通过以下方式实现这一目标 精心挑选的课程、工作坊和研讨会，并通过高度完成的指导 是国际实施科学研究、混合方法研究和 多组分结核病/艾滋病毒实施战略。我的培训目标依次与我的研究相对应 目的和目的是：(1)获得应用混合方法进行实施科学研究的经验； (2)培养使用实施科学方法开发多组件实施的专业知识 策略；(3)为干预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内科医生-科学家，应用 在低资源环境下改善结核病和艾滋病毒结果的科学方法。由此产生的发现 K23奖将通知R01提案，进行一项适应性、整群随机试验，评估同行领导的 赞比亚的多成分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.