Patient-centered intervention to prevent tuberculosis among children < 5 years old

摘要 异烟肼预防治疗(IPT)可降低60%以上的结核病风险。年幼的孩子在 罹患严重形式结核病的风险更高，尽管这可以通过全程IPT预防。 来自研究区的初步数据显示，70%的合格儿童开始了IPT，30%的儿童完成了IPT。 对照顾者的咨询以完成IPT取决于研究的知识、动机和时间 工作人员。护理员对IPT的重要性和年轻人患结核病的风险认识有限 孩子。很少有干预措施对改善儿童完成IPT的战略进行评估。这份职业 发展奖寻求1)设计和验证三种工具：面向照顾者的教育小册子、短信 在24周的IPT课程中每周发送提醒，每周提供一本儿童故事书 在24周的IPT课程中分期进行，并2)测试将这三项结合起来的干预效果 为提高IPT完成率提供工具，并确定其可接受性和可行性。设计和验证将 使用定性方法和迭代方法，并由目标受众直接参与 (照顾者和儿童)和卫生保健工作者。一项试点随机对照试验将确定 联合干预的效果。我将招募60名护理员和儿童，并将他们(1：1)随机分配到 干预组(接受三种工具)和对照组(标准护理)。我会在接下来的时间里跟踪他们 六个月课程的持续时间。中间结果将是尿液中存在异烟肼，而 干预措施实施的可达性和忠诚度。该结果将为设计一种随机化的集群提供参考 研究预防儿童结核病联合干预效果的试验，并提交给R01 资金问题。如果成功，它将提供一种可扩展的方法来减少儿科结核病。 我将得到一个多学科指导团队的支持，他们的专业知识涵盖了相关学科 我的职业生涯规划：结核病治疗和预防试验及干预措施评估(斯特林博士) 儿科学研究(奥乔亚博士)、定性方法和健康促进(拜尔博士)、实施科学、 (赞特博士)，秘鲁的结核病预防和控制(西斯博士)，干预措施评估和量化数据 分析(范德斯图夫特博士)。与他们一起，我设计了一个培训计划，以填补知识和技能方面的空白 我需要实现我的目标。我将在健康促进、移动健康、健康 传播、干预措施评估和实施科学。我还将获得撰写助学金的技能 我将继续接受负责任的研究行为方面的培训。这次指导性的研究培训 支持将使我实现我的目标，成为一名领先的大学全球卫生研究人员 Peruana Cayetano Heredia，积极与顶级国际机构合作，促进卫生政策 有确凿的证据。

Summary Isoniazid preventive therapy (IPT) reduces the risk of tuberculosis in over 60%. Young children are at higher risk of developing severe forms of TB, though this can be prevented with a full course of IPT. Preliminary data from the study districts indicate that 70% of eligible children start IPT, and 30% complete it. Counseling to caretakers to complete IPT depends on the knowledge, motivation and time of the research staff. Caretakers have a limited understanding of the importance of IPT and the higher risk of TB in the young child. Very few interventions have evaluated strategies to improve IPT completion among children. This career development award seeks 1) to design and validate three tools: an educational booklet for caretakers, SMS reminders to be sent weekly throughout the 24 week IPT course, a children storybook to be given in weekly installments throughout the 24 week IPT course and 2) test the efficacy of an intervention combining the three tools in increasing IPT completion and determine its acceptability and feasibility. The design and validation will be done using qualitative methods and an iterative approach with direct participation of the intended audience (caretakers and children) and the health care workers. A pilot randomized control trial will determine the efficacy of the combined intervention. I will recruit 60 caretakers and children and randomize them (1:1) to an intervention (receives the three tools) and control (standard of care) group. I will follow them up throughout the duration of the six months course. Intermediate outcomes will be the presence of isoniazid in urine, and the reach and fidelity in the delivery of the intervention. The results will inform the design of a cluster-randomized trial to study the effectiveness of the combined intervention to prevent pediatric TB, and submit it for R01 funding. If successful, it would deliver a scalable approach to reduce pediatric TB. I will be supported by a multi-disciplinary mentoring team whose expertise span the disciplines related to my career plan: Tuberculosis treatment and prevention trials and evaluation of interventions (Dr. Sterling), pediatrics studies (Dr. Ochoa), qualitative methods and health promotion (Dr. Bayer), implementation science, (Dr. Zunt), TB prevention and control in Peru (Dr. Seas), evaluation of interventions and quantitative data analysis (Dr. Van der Stuyft). With them, I have designed a training plan to fill the gaps in knowledge and skills I need to succeed in my goals. I will get additional training in health promotion, mobile health, health communication, evaluation of interventions and implementation science. I will also acquire skills in grant writing and I will pursue continuous training in responsible conduct of research. This mentored research training support will enable me to achieve my goal of becoming a leading global health researcher at Universidad Peruana Cayetano Heredia, actively collaborating with top international institutions and fostering health policies with rigorous evidence.