Household contact tuberculosis preventive therapy program in rural Eastern Cape, South Africa

项目摘要 这个指导以病人为导向的研究职业发展奖将准备候选人， 儿科护士执业与结核病（TB）研究博士培训，成为一个独立的 在实施科学方面有专长的护士科学家。候选人的长期目标是领导 跨学科全球卫生研究，以改善患者和人口结核病和结核病/艾滋病毒的健康结果。TB 结核病是南非的主要死因，63%的结核病患者同时感染艾滋病毒。如在 在大多数结核病高负担国家，南非历来将结核病工作重点放在治疗已患病者上， 结核病的发病率很高，而高效的结核病预防性治疗（TPT）尚未得到广泛应用。齐图莱莱 东开普省的地区医院正在通过一个家庭- 提供了TPT方案（King Sabata Dalindyebo区（KSD）无结核病，又名KWIT-TB）。本研究将 提供关于结核病高负担农村地区家庭TPT的证据。我们将 衡量护士和社区卫生工作者提供的服务范围、实施情况和有效性 家庭筛查、排除结核病的测试以及TPT的开始和完成。 目标1将评估一系列护理，以了解未能筛查结核病的风险因素， 启动TPT，并完成TPT。目标1将通过多种途径审查KWIT-TB计划的覆盖范围。 护理级联的步骤。这将提供证据，说明应采取哪些步骤来优化TPT计划， 未来目标2将评估KWIT-TB计划在完成全部培训的个人中的效果。 TPT课程（每天服用异烟肼六个月），并检查HIV和抗逆转录病毒疗法作为修饰剂的作用 效率。最后，目标3将定性描述符合条件的结核病家庭接触者对以下问题的看法： 影响TPT开始和完成的因素。这一目标将提供有关障碍的丰富数据， 当在类似的环境中扩大TPT工作时，促进者需要考虑。 候选人精心制定了以患者为导向的实施科学的职业轨迹， 满足NINR的计划优先事项，以促进健康和预防疾病，并促进护理 科学，以改善世界公民的健康和福祉。该职业发展计划整合了 课程与实际指导研究，以实现三个培训目标：（1）发展技能， 实施科学，（2）发展应用定量和定性方法的专门知识， 护理和公共卫生研究，和（3）建立护理领导和管理技能，以领导良好- 有组织、有规模的研究和临床试验。

PROJECT SUMMARY This mentored patient-oriented research career development award will prepare the candidate, a pediatric nurse practitioner with doctoral training in tuberculosis (TB) research, to become an independent nurse-scientist with expertise in implementation science. The candidate's long-term goal is to lead interdisciplinary global health research to improve patient and population TB and TB/HIV health outcomes. TB is the leading cause of death in South Africa, where 63% of individuals with TB are co-infected with HIV. As in most high TB burden countries, South Africa has historically focused TB efforts on treating those already sick with TB, while the use of highly effective TB preventive therapy (TPT) has not been widely deployed. Zithulele District Hospital in the Eastern Cape Province is incorporating TPT into its practice through a household- delivered TPT program (King Sabata Dalindyebo district (KSD) Without TB, aka KWIT-TB). This study will provide evidence regarding household-delivered TPT in a rural setting with a high burden of TB. We will measure the reach, implementation, and effectiveness of nurses and community health workers providing screening in households, tests to rule out TB disease, and initiation and completion of TPT. Aim 1 will assess a cascade of care to understand risk factors for failing to screen for TB disease, initiate TPT, and complete TPT. Aim 1 will examine the reach of the KWIT-TB program through the multiple steps of the care cascade. This will provide evidence of what steps to target to optimize TPT programs in the future. Aim 2 will assess the effectiveness of this KWIT-TB program among individuals who complete the full TPT course (six months of daily isoniazid), and examine the role of HIV and anti-retroviral therapy as modifiers of effectiveness. Finally, aim 3 will qualitatively characterize perceptions of eligible TB household contacts on factors influencing initiation and completion of TPT. This aim will provide rich data regarding barriers and facilitators to consider when scaling up TPT efforts in similar settings. The candidate has carefully developed a career trajectory for patient-oriented implementation science, meeting NINR's programmatic priorities to promote health and prevent disease, and to advance nursing science to improve the health and well-being of the world's citizens. This career development plan integrates coursework with practical mentored research to achieve three training goals: (1) develop skills in implementation science, (2) develop expertise in the application of quantitative and qualitative methods in nursing and public health research, and (3) build nursing leadership and managerial skills to lead well- organized, scaled research and clinical trials.