Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda

Frontiers in Public Health

article

J. Lucian Davis¹  Irene Ayakaka⁴  Joseph M. Ggita⁴  Emmanuel Ochom⁴  Diana Babirye⁴  Patricia Turimumahoro⁴  Amanda J. Gupta¹  Frank R. Mugabe⁶  Mari Armstrong-Hough⁴  Adithya Cattamanchi⁴  Achilles Katamba⁴ 

[1] Department of Epidemiology of Microbial Diseases, Yale School of Public Health;Center for Methods in Implementation and Prevention Science, Yale School of Public Health;Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine;Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University;Liverpool School of Tropical Medicine, Liverpool School of Tropical Medicine ,(LSTM) International Multidisciplinary Programme to Address Lung Health and TB in Africa ,(IMPALA) Program;Uganda Ministry of Health;Department of Social and Behavioral Sciences, School of Global Public Health, New York University;Department of Epidemiology, School of Global Public Health, New York University;Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco General Hospital, University of California;Curry International Tuberculosis Center, University of California;Division of Epidemiology and Biostatistics, University of California;Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University

关键词: implementation strategies;    implementation science;    intervention design;    tuberculosis;    Uganda;    low-and-middle-income countries;    implementation mapping;    contact investigation;   

DOI  :  10.3389/fpubh.2022.837211

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Since 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e., barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy, which we compared to usual care in a household cluster-randomized trial. We introduced some components in both arms, including those designed to facilitate initial uptake of contact investigation, with improvement relative to historical controls. Other components that we introduced to facilitate completion of TB evaluation—home-based TB-HIV evaluation and follow-up text messaging—returned negative results due to implementation failures. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. Future studies should explore the use of experimental methods such as micro-randomized trials to identify the most active components of implementation strategies, as well as more creative and entrepreneurial methods such as human-centered design to better adapt the forms and fit of implementation strategies to end users.

【 授权许可】

CC BY