Task-Shifting Pediatric TB/HIV Prevention to Community Health Workers in South Africa

项目摘要 结核病和艾滋病毒是撒哈拉以南非洲儿童死亡的十大原因。短程联合结核病 预防治疗(TPT)和预防母婴传播(PMTCT)非常有效，有望减少12万新艾滋病毒 确诊和102,000名儿童结核病死亡，其中大多数发生在感染艾滋病毒或接触艾滋病毒的人群中， 未感染(HEU)儿童。TPT和防止母婴传播的有效性要求更好地获得儿科预防 关心。在南非，近三分之二感染结核病的儿童也感染了艾滋病毒。把这些整合起来 将预防服务融入以社区为基础的干预措施可以改善获得护理的机会，缩短 诊断和治疗结核病和艾滋病毒，并最终降低与结核病和艾滋病毒有关的儿童死亡率。之前 研究表明，社区卫生工作者可以成功地筛查和治疗幼儿 肺炎、疟疾和新生儿败血症。他们在开展以社区为基础的儿科结核病/艾滋病毒方面的有效性 预防服务是未知的。在本次K23奖项中，我们提出了以下研究目标：1)使用 利益相关者的意见，以适应以社区为基础的儿科结核病/艾滋病毒预防干预措施，并设计 相关的执行战略，2)确定由 社区卫生工作者，以及3)确定基于社区的接触者追踪还是基于诊所的接触者追踪 增加对5岁以下高危儿童的识别。这项研究将嵌套在国际药品采购机制 旨在催化“3HP”摄取的项目，这是一种新的TPT方案，由每周利福喷丁/异烟肼组成，用于 艾滋病毒携带者和接触结核病的儿童。到目前为止，我已经在设计、指挥和 临床试验分析。我将用高级课程和实践经验来补充这次培训1) 定性研究设计、数据收集和分析；2)实施科学框架的应用 分析背景、优化干预措施并评估实施流程，以及3)设计和 卫生服务研究分析。总而言之，这套技能将使我能够进行混合效率- 实施结核病和艾滋病毒预防的临床试验，将有助于更好地了解 干预措施在告知可持续性和可转移性方面的有效性。这些研究和 职业发展计划将在国际导师团队的指导下完成， 在结核病和艾滋病毒、实施科学、定性研究、儿科和卫生服务研究方面的专门知识。 通过此K23奖项收集的数据和获得的技能将导致R01申请，该申请将严格 测试以社区为基础的干预和实施策略在改善临床结核病和 艾滋病毒预防成果。在接下来的四年里，通过拟议的导师制、课程安排和 研究，我将发展必要的专业知识，成为一名独立的临床医生科学家和专家 在儿科结核病和艾滋病毒预防领域，强烈支持我实现我的职业目标：设计和 实施与结核病有关的公共卫生战略，旨在消除儿童结核病和艾滋病毒疾病。

Project Summary TB and HIV are Top 10 causes of child mortality in sub-Saharan Africa. Short-course combination TB preventive therapy (TPT) and PMTCT are highly effective and hold promise to reduce the 120,000 new HIV diagnoses and the 102,000 child TB deaths, of which most occurred in HIV-infected or HIV exposed and uninfected (HEU) children. TPT and PMTCT effectiveness require improved access to pediatric preventive care. In South Africa, nearly two thirds of TB-exposed children are also HIV-exposed. Integrating these prevention services into one community-based intervention could improve access to care, shorten time to diagnosis and treatment of TB and HIV, and ultimately reduce TB and HIV associated child mortality. Prior studies have shown community health workers can successfully screen and treat young children for pneumonia, malaria and neonatal sepsis. Their effectiveness in conducting community-based pediatric TB/HIV prevention services is unknown. During this K23 Award, we propose the following research aims: 1) use stakeholder input to adapt a community-based, pediatric TB/HIV prevention intervention and design an associated implementation strategy, 2) determine the accuracy of TB/HIV preventive care provided by a community health worker, and 3) determine whether community-based versus clinic-based contact tracing increases the identification of at-risk children under 5 years old. This research will be nested in a UNITAID project that aims to catalyze uptake of “3HP,” a new TPT regimen consisting of weekly rifapentine/isoniazid for people living with HIV and TB-exposed children. To date, I have acquired skills in the design, conduct and analysis of clinical trials. I will compliment this training with advanced coursework and practical experience in 1) qualitative study design, data collection and analysis, 2) the application of implementation science frameworks to analyze context, optimize interventions and evaluate implementation processes, and 3) the design and analysis of health services research. Together, this skill set will allow me to conduct hybrid effectiveness- implementation clinical trials in TB and HIV prevention that will allow for improved understanding of an intervention's effectiveness to inform sustainability and transferability to other settings. These research and career development plans will be accomplished under the guidance of an international team of mentors with expertise in TB and HIV, implementation science, qualitative research, pediatrics and health services research. The data collected and skills earned through this K23 Award will lead to an R01 application that will rigorously test the community-based intervention and implementation strategy's effectiveness in improving clinical TB and HIV prevention outcomes. Over the next four years, through the proposed mentorship, coursework and research, I will develop the expertise necessary to become an independent clinician scientist and expert in the field of pediatric TB and HIV prevention, strongly positioning me to achieve my career objective: to design and implement TB-related public health strategies aimed at the elimination of pediatric TB and HIV disease.