School of Health Studies, Western University, London, Ontario, Canada.
Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland.
BMJ Open. 2019 May 9;9(5):e028073. doi: 10.1136/bmjopen-2018-028073.
Poor road and communication infrastructure pose major challenges to tuberculosis (TB) control in many regions of the world. TB surveillance and patient support often fall to community health workers (CHWs) who may lack the time or knowledge needed for this work. To meet the End TB Strategy goal of reducing TB incidence by 90% by 2035, the WHO calls for intensified research and innovation including the rapid uptake of new tools, interventions and strategies. Technologies that 'leapfrog' infrastructure challenges and support CHWs in TB control responsibilities have the potential to dramatically change TB outcomes in remote regions. Such technologies may strengthen TB control activities within challenged national tuberculosis treatment and control programmes (NTPs), and be adapted to address other public health challenges. The deployment of innovative technologies needs to be differentially adapted to context-specific factors. The Drone Observed Therapy System (DrOTS) project was launched in Madagascar in 2017 and integrates a bundle of innovative technologies including drones, digital adherence monitoring technology and mobile device-based educational videos to support TB control.
This mixed-methods study gathers and analyses cultural perceptions of the DrOTS project among key stakeholders: patients, community members, CHWs, village chiefs and NTP-DrOTS mobile health teams. Data from questionnaires, semistructured interviews, focus group discussions (FGD) and ethnographic observation gathered from June 2018 to June 2019 are thematically analysed and compared to identify patterns and singularities in how DrOTS stakeholders perceive and interact with DrOTS technologies, its enrolment processes, objectives and team.
Ethics approval was obtained from the National Bioethics Research Committee of Madagascar and Stony Brook University institutional review board. Study results will be submitted for peer-reviewed publication. In Madagascar, results will be presented in person to Ministry and other Malagasy decision-makers through the Institut Pasteur de Madagascar.
This study is designed to foreground the voices of patients and potential patients in the DrOTS programme. CHW participants in this study also supported the design of study information sessions and recruitment strategies. One member of the mobile health team provided detailed input on the wording and content of FGD and interview guides. Study findings will be presented via a report in French and Malagasy to CHW, mobile health team and other village-level participants who have email/internet access.
在世界上许多地区，糟糕的道路和通信基础设施给结核病（TB）的控制带来了重大挑战。结核病监测和患者支持工作往往由社区卫生工作者（CHW）承担，而他们可能缺乏完成这项工作所需的时间或知识。为了实现到 2035 年将结核病发病率降低 90%的终结结核病战略目标，世卫组织呼吁加强研究和创新，包括迅速采用新工具、干预措施和战略。能够克服基础设施挑战并支持 CHW 履行结核病控制职责的技术有可能极大地改变偏远地区的结核病结果。这些技术可能会加强有挑战的国家结核病治疗和控制规划（NTP）内的结核病控制活动，并适应解决其他公共卫生挑战。创新技术的部署需要根据具体情况进行差异化调整。DrONE Observed Therapy System (DrOTS) 项目于 2017 年在马达加斯加启动，它整合了一系列创新技术，包括无人机、数字依从性监测技术和基于移动设备的教育视频，以支持结核病控制。
这项混合方法研究收集并分析了关键利益攸关方对 DrOTS 项目的文化看法：患者、社区成员、CHW、村长和 NTP-DrOTS 移动卫生团队。2018 年 6 月至 2019 年 6 月期间收集的问卷调查、半结构化访谈、焦点小组讨论（FGD）和民族志观察的数据通过主题分析进行比较，以确定 DrOTS 利益攸关方如何感知和与 DrOTS 技术、其入组流程、目标和团队互动的模式和特点。
马达加斯加国家生物伦理研究委员会和石溪大学机构审查委员会已批准该研究。研究结果将提交同行评审发表。在马达加斯加，研究结果将通过巴斯德研究所提交给卫生和其他马达加斯加决策者。
这项研究旨在突显 DrOTS 计划中患者和潜在患者的声音。参与这项研究的 CHW 还支持研究信息会议和招募策略的设计。移动卫生团队的一名成员详细介绍了 FGD 和访谈指南的措辞和内容。研究结果将以法文和马尔加什文的报告形式呈现，供有电子邮件/互联网访问权限的 CHW、移动卫生团队和其他村级参与者使用。
