Research Project 2

在尼日利亚等非洲国家，每小时有150多人死于与肝炎相关的肝病，其中包括 肝细胞癌(HCC)和其他肝癌。这种死亡在很大程度上可归因于乙肝 病毒(乙肝病毒)。出生后24小时内接种一次乙肝疫苗，随后接种三次 额外的五价乙肝疫苗(在出生后6周、10周和14周)提供持久免疫， 大幅降低乙肝病毒和肝癌的风险。尼日利亚国家指南推荐HEB-BD 为所有新生儿接种疫苗，并将其作为国家免疫方案的一部分免费提供，但 吸收不是最优的，突出了实施科学研究的必要性，以制定与当地相关的 提高乙肝疫苗接种率的策略。我们提出了一种众包的方法来提高及时性 尼日利亚乙肝疫苗接种覆盖率。众包让一群人解决了全部或部分 问题，然后实施选定的解决方案。我们的团队使用众包来开发宣传信息 接受乙肝病毒检测，为全球肝炎指南提供信息，并提高低收入地区肝炎社区的参与度 和中等收入国家(LMIC)。我们的研究将集中于制定和实施战略，以 增加社区诊所、居家分娩和医院外其他地点的乙肝疫苗接种 大多数孕妇都得到了护理。实施科学研究的综合框架 (CFIR)和概念图将指导我们对影响吸纳和维持的因素进行评估。 我们的具体目标是：1)确定孕妇对乙肝疫苗接种的偏好 社区参与的众包研究并敲定实施战略，以增加乙肝-BD 疫苗接种；2)确定最终的众包乙肝-疯牛病疫苗接种干预措施的有效性 在使用以社区为基础的门诊级分组随机对照试验的孕妇队列中。训练有素的社区 卫生工作者将在群众性随机对照试验中实施最终干预 干预与标准护理(即打印的指南)在720名二元组(孕妇和 新生儿)在36个社区诊所(n=1440)；和3)使用混合方法研究以确定 影响众包乙肝疫苗接种率和持久度的多层次因素 主要结果是通过临床记录确定接种了乙肝疫苗。次要结果是服务 以社区为基础的诊所一级的维持，这里的定义是核心要素的维持百分比 最后一次活动是在试验12个月后衡量的，具有持续的好处和实施能力 在每个社区诊所。我们的研究是对U54全球申请的回应 公平癌症控制的实施科学和国家癌症的战略重点 研究所。这项研究将提供一个独特的机会来扩大乙肝疫苗的覆盖面，推动公平 在传统上在执行科学中代表性不足的环境中进行执行科学研究。

Every hour, over 150 people die of hepatitis-related liver diseases in African countries like Nigeria, including hepatocellular carcinoma (HCC) and other liver cancers. Much of this death is attributable to the hepatitis B virus (HBV). A hepatitis B birth dose (HepB-BD) vaccine initiated within 24 hours of birth, followed by three additional pentavalent HBV vaccines (at six, 10, and 14 weeks after birth), provide durable immunity, substantially decreasing the risk of HBV and liver cancer. Nigerian national guidelines recommend HepB-BD vaccination for all newborns and provides them for free as part of the national immunization protocol, yet uptake is suboptimal, highlighting the need for implementation science research to develop locally relevant strategies to increase HepB-BD vaccine uptake. We propose a crowdsourcing approach to enhance timely coverage of HepB-BD vaccination in Nigeria. Crowdsourcing has a group of people solve all or part of a problem, then implement selected solutions. Our team used crowdsourcing to develop messages promoting HBV testing uptake, inform global hepatitis guidelines, and enhance hepatitis community engagement in low and middle-income countries (LMICs). Our study will focus on developing and implementing strategies to increase HepB-BD vaccination at community clinics, home births, and other sites outside of hospitals where most pregnant women receive care. The Consolidated Framework for Implementation Science Research (CFIR) and concept mapping will guide our evaluation of factors influencing uptake and sustainment. Our specific aims are: 1) To determine pregnant women's preferences on HepB-BD vaccination using community-engaged crowdsourcing research and finalize an implementation strategy to increase HepB-BD vaccination; 2) To determine the effectiveness of a finalized crowdsourced HepB-BD vaccination intervention among a cohort of pregnant women using a community-based clinic-level cluster RCT. Trained community health workers will implement the final intervention in a cluster randomized control trial of the crowdsourced intervention versus standard care (i.e. printed guidelines) among a cohort of 720 dyads (pregnant women and newborns) at 36 community-based clinics (n=1440); and 3) To use mixed methods research to determine multi-level factors that influence uptake and sustainment of crowdsourced HepB-BD vaccination over time. Primary outcome is HepB-BD vaccination ascertained by clinic records. Secondary outcome is service sustainment at the community-based clinic level, defined here as the percent sustainment of core elements of the final campaign measured 12 months after the trial, with sustained benefits and capacity for implementation at each community-based clinic. Our study is responsive to the U54 request for applications for global implementation science for equitable cancer control and and the strategic priorities of the National Cancer Institute. This study will provide a unique opportunity to expand HBV vaccine coverage, driving equitable implementation science research in settings traditionally under-represented in implementation science.