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

项目总结 这项以患者为导向的指导研究职业发展奖将为候选人准备一个 具有结核病(TB)研究博士培训的儿科护士从业者，将成为独立的 护士--具有实施科学专业知识的科学家。候选人的长期目标是领先 跨学科的全球卫生研究，以改善患者和人群结核病和结核病/艾滋病毒的健康结果。结核病 是南非的主要死亡原因，南非63%的结核病患者同时感染了艾滋病毒。如中所示 大多数结核病负担高的国家，南非历来将结核病努力集中在治疗那些已经患病的人上 虽然使用高效的结核病预防疗法(TPT)尚未得到广泛部署，但结核病的发病率仍在不断提高。Zithulele 东开普省的地区医院正在通过一个家庭将TPT纳入其实践- 提供TPT计划(Sabata Dalindyebo国王区(KSD)无结核病，又名kwit-TB)。这项研究将 在结核病负担较高的农村地区，提供有关家庭提供的结核病传播途径的证据。我们会 衡量护士和社区卫生工作者提供服务的范围、实施情况和有效性 在家庭中进行筛查，进行检测以排除结核病，以及启动和完成TPT。 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，完成TPT。目标1将通过多个项目审查KWIT-TB计划的覆盖范围 护理的步骤层层递增。这将为优化TPT计划的目标提供证据 未来。目标2将评估在完成全部计划的个人中实施该项目的有效性。 TPT疗程(每天6个月的异烟肼)，并检查艾滋病毒和抗逆转录病毒治疗作为修饰物的作用 效率的问题。最后，目标3将定性地描述对符合条件的结核病家庭接触者的看法。 影响TPT启动和完成的因素。这一目标将提供有关壁垒和 在类似环境下扩大TPT工作时需要考虑的促进者。 这位候选人仔细制定了以患者为导向的实施科学的职业轨迹， 满足NINR促进健康和预防疾病以及推进护理的方案优先事项 科学以改善世界公民的健康和福祉。这份职业发展计划整合了 结合实际指导研究的课程工作，以实现三个培训目标：(1)培养技能 实施科学，(2)发展在应用定量和定性方法方面的专门知识 护理和公共卫生研究，以及(3)建立护理领导力和管理技能，以更好地领导- 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.