Using an implementation science approach to refine, implement and evaluate pilot strategies for tuberculosis contact tracing in South Africa

项目摘要 结核病（TB）仍然是全球卫生紧急情况，造成1000万新病例和150万 2018年死亡。控制结核伙伴关系制定了雄心勃勃的目标，其中包括将结核病减少50 从2015年到2025年。在病程早期发现活动性结核病患者的策略必须 因此，如果要实现2025年的结核病控制目标，就必须迅速扩大规模。然而，活跃的案件 发现结核病是昂贵的，而且在实践中难以实施，特别是追踪新感染者的密切接触者。 确诊的肺结核病例。追踪接触者的一种创新方法是放弃家庭访问，而选择小规模的 鼓励结核病患者及其接触者到诊所进行结核病筛查。这 所提出的研究是一项新颖的研究，着眼于实施基于激励的接触追踪的障碍， 完善战略，以改变这些障碍，并在南非农村的高负担环境中进行试点测试。 我们将衡量可接受性、可行性、覆盖范围、实施情况，并生成试点有效性数据， 可用于规划规模扩大。拟议的研究将在南非Vhembe的农村地区进行， 结核病发病率为350/100，000/年。我们将使用以下方法评估实施障碍： 对接受干预的结核病例及其接触者进行定量调查和定性访谈 在随机分组对照试验的背景下，以及医护人员。我们将优先考虑障碍 与利益攸关方合作，制定一个完善的基于奖励的追查执行战略。我们将对此进行试点测试 在Vhembe内的6个公共初级保健诊所实施了这一战略，并审查了执行情况和初步 有效性本研究的具体目标是：（1）识别个体和系统层面的障碍， 在高负担环境中实施基于激励的接触者追踪的促进者;（2）制定 并对改进的接触者追踪战略进行试点测试。这项多学科研究代表了一种创新的 在关键的流行病学环境中实现中期结核病控制目标的途径， 一个方法论的例子，说明如何在广泛的其他领域改善现实世界的决策， 在紧迫和雄心勃勃的人口健康优先事项的背景下。

PROJECT SUMMARY Tuberculosis (TB) remains a global health emergency, responsible for 10 million new cases and 1.5 million deaths in 2018. The Stop TB Partnership has set very ambitious targets that include a 50% reduction in TB incidence from 2015 to 2025. Strategies to find people with active TB earlier in their disease course must therefore be rapidly scaled up if TB control targets for 2025 are to be approached. However, active case finding or TB is expensive and difficult to implement in practice, particularly tracing close contacts of newly diagnosed TB cases. One innovative approach to contact tracing is to forego household visits in favor of small incentives to the TB case and their contact for the contacts to present to the clinic for TB screening. This proposed research is a novel study looking at barriers to implementation of incentive-based contact tracing, refining the strategy to modify these barriers and pilot testing it in the high burden setting of rural South Africa. We will measure acceptability, feasibility, reach, implementation and generate pilot effectiveness data which can be used to plan for scale-up. The proposed study will be in the rural district of Vhembe, South Africa – a district with a TB incidence of 350 per 100,000/year. We will assess barriers to implementation using quantitative surveys and qualitative interviews with TB cases and their contacts who received the intervention in the context of a cluster-randomized controlled trial, as well as healthcare workers. We will prioritize barriers with stakeholders and devise a refined incentive-based tracing implementation strategy. We will pilot test this strategy in 6 public primary health clinics within Vhembe, and examine implementation and preliminary effectiveness. The specific aims of this research are: (1) To identify individual and systems-level barriers and facilitators to the implementation of incentive-based contact tracing in a high burden setting; (2) To develop and pilot test an improved contact tracing strategy. This multidisciplinary research represents an innovative path toward achieving medium-term TB control targets in a key epidemiological setting, and can also serve as a methodological example of how to improve real-world decision-making across a broad array of other fields in the context of urgent and ambitious population health priorities.