Understanding and addressing geographic barriers to accessing TB services in a high-burden urban setting

了解并解决在高负担城市环境中获得结核病服务的地理障碍

• 批准号: 10657154
• 负责人: Helen E. Jenkins
• 金额: $ 60.34万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10657154
• 关键词: Address; Affect; Area; Award; Catchment Area; Cause of Death; Censuses; Characteristics; Cities; Communicable Diseases; Communities; Country; Data; Diagnosis; Diagnostic; Diagnostic Services; Disease; Employment Status; Equation; Evidence based treatment; Face; Geography; Goals; Health; Health Services Accessibility; Health care facility; Incidence; Income; Individual; Intervention; Knowledge; Measures; Methods; Modeling; Morbidity - disease rate; National Institute of Allergy and Infectious Disease; Network-based; Outcome; Participant; Patients; Persons; Peru; Research; Research Priority; Risk; Sampling; Services; Surveys; Symptoms; Time; Travel; Treatment outcome; Tuberculosis; Tuberculosis diagnosis; United States National Institutes of Health; Visit; design; economic disparity; economic indicator; effective therapy; experimental study; geographic barrier; health care availability; high risk; improved; innovation; models and simulation; mortality; poor health outcome; preference; prevent; programs; research study; sex; simulation; social disparities; socioeconomics; surveillance data; therapy design; tool; transmission process; tuberculosis diagnostics; tuberculosis treatment; urban setting

SUMMARY Each year, over 10 million people become sick with tuberculosis (TB), and around 1.4 million die from the disease. Around 86% of people with TB live in middle-income countries, with a large proportion living in cities. To substantially decrease the global burden of TB, it is necessary to ensure that people are diagnosed quickly and treated successfully. Geographic barriers to accessing health services – such as living far from a health center – can lead to poor health outcomes. However, there is limited knowledge about how geographic access barriers impact TB diagnosis and treatment outcomes in middle-income country urban settings. Health facilities are generally present in these settings, but people with TB, who are often socially and economically disadvantaged, face barriers in accessing them. We also lack tools for designing and targeting interventions that address access barriers and thus improve TB diagnosis and treatment. This proposal seeks to address these knowledge gaps using the “5 A’s” conceptual framework, which describes five domains that drive health care access: availability, accessibility, accommodation, affordability, acceptability. To help understand how geographic accessibility barriers and other types of access barriers contribute to delayed TB diagnosis, we will apply structural equation modeling and simulation methods to data from TB patient surveys based on the 5 A’s framework. To help programs target interventions to communities that are most at risk for delayed TB diagnosis and incomplete TB treatment, we will create community-level risk scores that incorporate measures of geographic accessibility as well as socioeconomic and demographic census data. To help programs develop effective treatment support interventions, we will conduct a discrete choice experiment to identify optimal packages of interventions aimed at addressing different types of access barriers during treatment, assessing how preferences differ among different demographic groups. This proposal is significant because the results will help TB programs to identify interventions that would be most effective for improving TB diagnosis and treatment, and target these interventions to the individuals and communities that need them most. This proposal is innovative because prior quantitative TB research studies have not used a health care access conceptual framework, structural equation modeling or conjoint analysis to understand how to address access barriers, or community risk scores to target interventions. In the long term, this research will help TB programs reduce delays to diagnosis and incomplete treatment rates, thus reducing the global burden of TB morbidity and mortality.

概括 每年，超过 1000 万人罹患结核病 (TB)，约 140 万人死于结核病 疾病。大约 86% 的结核病患者生活在中等收入国家，其中很大一部分生活在城市。 为了大幅减轻全球结核病负担，必须确保人们得到快速诊断 并治疗成功。获得医疗服务的地理障碍——例如居住地远离医疗机构 中心——可能导致不良的健康结果。然而，对于地理访问如何进行了解有限。 障碍影响中等收入国家城市环境中的结核病诊断和治疗结果。卫生设施 通常存在于这些环境中，但结核病患者通常在社会和经济方面受到影响 弱势群体在获取这些资源时面临障碍。我们还缺乏设计和瞄准干预措施的工具 解决获取障碍，从而改善结核病诊断和治疗。该提案旨在解决 使用“5A”概念框架来弥补这些知识差距，该框架描述了推动健康的五个领域 护理获取：可用性、可及性、住宿、负担能力、可接受性。帮助理解如何 地理可达性障碍和其他类型的可达性障碍会导致结核病诊断延迟，我们将 将结构方程建模和模拟方法应用于基于 5A 的结核病患者调查数据 框架。帮助项目针对迟发性结核病风险最高的社区进行干预 诊断和不完整的结核病治疗，我们将创建包含措施的社区级风险评分 地理可达性以及社会经济和人口普查数据。帮助程序开发 有效的治疗支持干预措施，我们将进行离散选择实验以确定最佳 旨在解决治疗期间不同类型的准入障碍的一揽子干预措施、评估 不同人口群体之间的偏好有何不同。这项建议意义重大，因为结果 将帮助结核病规划确定最有效改善结核病诊断和治疗的干预措施 治疗，并将这些干预措施针对最需要的个人和社区。这 该提案具有创新性，因为之前的定量结核病研究并未使用医疗保健服务 概念框架、结构方程建模或联合分析，以了解如何解决访问问题 目标干预措施的障碍或社区风险评分。从长远来看，这项研究将有助于结核病项目 减少诊断延误和治疗不彻底率，从而减轻全球结核病发病率负担 和死亡率。