Simplified Isoniazid Preventive Therapy (SPIRIT) Strategy to Reduce TB Burden

减少结核病负担的简化异烟肼预防治疗 (SPIRIT) 策略

基本信息

项目摘要

ABSTRACT The failure to use isoniazid (INH) preventative therapy (IPT) in persons living with HIV (PLHIV) in Sub-Saharan Africa represents one of the single biggest implementation gaps between evidence and practice in today's response to the HIV epidemic. In PLHIV, TB is a lead cause of death, and IPT reduces TB incidence by 40%. Yet in Africa, less than 2% of eligible individuals receive IPT. Given the existence of both country guidelines recommending IPT, as well as simple clinical algorithms to identify IPT eligible persons, a remaining critical requirement for scale-up is strengthening the link - mediated by middle management in most health systems - between health ministry policy and clinics. In Uganda, District Health Officers (DHOs) serve as key middle managers working at the nexus between policy and implementation. We propose to test a countrywide multi- component “SPIRIT” (Simplified INH Preventive Therapy) intervention targeting DHOs – whom we view as critical dissemination agents. SPIRIT is based on the PRECEDE model of behavioral change that deploys predisposing (teaching collaborative); enabling (INH/B6/septrin single pill combination and SMS from DHO to provider); and reinforcing (reporting collaborative) components. For this resubmission, we provide data to show feasibility of SPIRT through a pilot study of 5 DHOs and their clinics. The DHOs engaged in the mini- collaborative and implemented key components of SPIRIT including bidirectional text messaging to front line providers. The number of HIV+ adults prescribed IPT increased from zero at baseline to 300 at 8 weeks. Aim 1: Determine if the SPIRIT intervention increases IPT initiation. We will form 20 groups of 5 District Health Officers and randomize 10 to the SPIRIT intervention and 10 to control (country standard) in a cluster- randomized trial. The primary outcome is proportion of IPT-eligible adults initiating IPT. For secondary outcomes, we will measure changes in knowledge, attitudes and practices regarding IPT among DHOs and front line health workers to assess mechanisms through which the intervention achieves outcomes. Aim 2: Evaluate the effect of the SPIRIT intervention on IPT completion and TB incidence. Even if the intervention increases IPT use, quantifying actual use of IPT by patients and effects on population health status (e.g. reduction in TB), provides an important impact measure that can enable policy makers to prioritize this intervention more widely. A two-stage survey sampling approach will be used to identify a probability sample of patients eligible for IPT in which to measure adherence through hair levels of INH (direct measure of pill consumption/adherence) and TB incidence (population health measure) Aim 3: Assess the cost and cost-effectiveness of SPIRIT. Using effectiveness measures obtained in Aims 1 and 2, standard time and motion and costing methods, we will estimate the cost and cost-effectiveness of SPIRIT vs standard of care in our sampled population from Aim 2. Outcomes of interest will include program costs per: a) IPT initiation; b) IPT completion; and c) TB case averted.
摘要

项目成果

期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)

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Diane V Havlir其他文献

Dynamic choice HIV prevention with cabotegravir long-acting injectable in rural Uganda and Kenya: a randomised trial extension
乌干达和肯尼亚农村地区使用卡博特韦长效注射剂进行动态选择的艾滋病毒预防:一项随机试验扩展
  • DOI:
    10.1016/s2352-3018(24)00235-2
  • 发表时间:
    2024-11-01
  • 期刊:
  • 影响因子:
    13.000
  • 作者:
    Moses R Kamya;Laura B Balzer;James Ayieko;Jane Kabami;Elijah Kakande;Gabriel Chamie;Nicole Sutter;Helen Sunday;Janice Litunya;Joshua Schwab;John Schrom;Melanie Bacon;Catherine A Koss;Alex R Rinehart;Maya Petersen;Diane V Havlir;SEARCH Consortium
  • 通讯作者:
    SEARCH Consortium

Diane V Havlir的其他文献

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{{ truncateString('Diane V Havlir', 18)}}的其他基金

A Multisectoral Strategy to Address Persistent Drivers of the HIV Epidemic in East Africa
解决东非艾滋病毒流行的持续驱动因素的多部门战略
  • 批准号:
    10267216
  • 财政年份:
    2020
  • 资助金额:
    --
  • 项目类别:
A Multisectoral Strategy to Address Persistent Drivers of the HIV Epidemic in East Africa
解决东非艾滋病毒流行的持续驱动因素的多部门战略
  • 批准号:
    10085144
  • 财政年份:
    2020
  • 资助金额:
    --
  • 项目类别:
A Multisectoral Strategy to Address Persistent Drivers of the HIV Epidemic in East Africa
解决东非艾滋病毒流行的持续驱动因素的多部门战略
  • 批准号:
    10438844
  • 财政年份:
    2020
  • 资助金额:
    --
  • 项目类别:
Strategic antiretroviral therapy and HIV testing for youth in rural Africa
为非洲农村青年提供战略性抗逆转录病毒治疗和艾滋病毒检测
  • 批准号:
    10216460
  • 财政年份:
    2018
  • 资助金额:
    --
  • 项目类别:
Strategic antiretroviral therapy and HIV testing for youth in rural Africa
为非洲农村青年提供战略性抗逆转录病毒治疗和艾滋病毒检测
  • 批准号:
    10252946
  • 财政年份:
    2018
  • 资助金额:
    --
  • 项目类别:
Strategic antiretroviral therapy and HIV testing for youth in rural Africa
为非洲农村青年提供战略性抗逆转录病毒治疗和艾滋病毒检测
  • 批准号:
    10469425
  • 财政年份:
    2018
  • 资助金额:
    --
  • 项目类别:
Simplified Isoniazid Preventive Therapy (SPIRIT) Strategy to Reduce TB Burden
减少结核病负担的简化异烟肼预防治疗 (SPIRIT) 策略
  • 批准号:
    10343685
  • 财政年份:
    2016
  • 资助金额:
    --
  • 项目类别:
Reducing Failure-to-Initiate ART: Streamlined ART Start Strategy (START)
减少 ART 启动失败的情况:简化的 ART 启动策略 (START)
  • 批准号:
    8705385
  • 财政年份:
    2012
  • 资助金额:
    --
  • 项目类别:
Reducing Failure-to-Initiate ART: Streamlined ART Start Strategy (START)
减少 ART 启动失败的情况:简化的 ART 启动策略 (START)
  • 批准号:
    8295938
  • 财政年份:
    2012
  • 资助金额:
    --
  • 项目类别:
Reducing Failure-to-Initiate ART: Streamlined ART Start Strategy (START)
减少 ART 启动失败的情况:简化的 ART 启动策略 (START)
  • 批准号:
    8613427
  • 财政年份:
    2012
  • 资助金额:
    --
  • 项目类别:

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Structural Racism, Pharmacy Closures and Disparities in Medication Adherence Among Older Adult Medicare Part-D Beneficiaries
结构性种族主义、药房关闭以及老年人医疗保险 D 部分受益人的药物依从性差异
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Medication Adherence and Cardio-Metabolic Control Indicators among Adult American Indians Receiving Tribal Health Services
接受部落卫生服务的成年美洲印第安人的药物依从性和心脏代谢控制指标
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    2022
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利用技术提高青少年和年轻肾移植或肝移植受者的药物依从性
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    10369750
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Leveraging Technology to Improve Medication Adherence in Adolescent and Young Adult Kidney or Liver Transplant Recipients
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  • 批准号:
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Leveraging Technology to Improve Medication Adherence in Adolescent and Young Adult Kidney or Liver Transplant Recipients
利用技术提高青少年和年轻肾移植或肝移植受者的药物依从性
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Mindfulness training with HIV-positive youth and adult family members to improve treatment adherence
对艾滋病毒呈阳性的青少年和成年家庭成员进行正念训练,以提高治疗依从性
  • 批准号:
    9906853
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