KHANA Center for Population Health Research, Phnom Penh, Cambodia.
Faculty of Social Science and Humanities, Royal University of Phnom Penh, Phnom Penh, Cambodia.
PLoS One. 2019 Jul 2;14(7):e0210919. doi: 10.1371/journal.pone.0210919. eCollection 2019.
With support of the national tuberculosis (TB) program, KHANA (a local non-governmental organization in Cambodia) has implemented an innovative approach using a seed-and-recruit model to actively find TB cases in the community. The model engaged community members including TB survivors as seed and newly diagnosed people with TB as recruiters to recruit presumptive TB cases in their social network in a snowball approach for screening and linkage to treatment. This study aimed to explore the acceptability of the active case finding with the seed-and-recruit model in detecting new TB cases and determine the characteristics of successful seeds.
This qualitative study was conducted in four provinces (Banteay Meanchey, Kampong Chhnang, Siem Reap, and Takeo) in Cambodia in 2017. Fifty-six in-depth interviews and ten focus group discussions (with a total of 64 participants) were conducted with selected beneficiaries and key stakeholders at different levels to gain insights into the acceptability, strengths, and challenges in implementing the model and the characteristics of successful seeds. Transcripts were coded and content analyses were performed.
The seed-and-recruit active case finding model was generally well-received by the study participants. They saw the benefits of engaging TB survivors and utilizing their social network to find new TB cases in the community. The social embeddedness of the model within the local community was one of the major strengths. The success of the model also hinges on the integration with existing health facilities. Having an extensive social network, being motivated, and having good knowledge about TB were important characteristics of successful seeds. Study participants reported challenges in motivating the presumptive TB cases for screening, logistic capacities, and high workload during the implementation. However, there was a general consensus that the model ought to be expanded.
These findings indicate that the seed-and-recruit model is well-accepted by the beneficiaries and key stakeholders. Further studies are needed to more comprehensively evaluate the impacts and cost-effectiveness of the model for future expansion in Cambodia as well as in other resource-limited settings.
在国家结核病（TB）项目的支持下，KHANA（柬埔寨当地的非政府组织）采用了一种创新方法，利用种子招募模式积极在社区中发现结核病病例。该模式让包括结核病幸存者在内的社区成员充当种子，新确诊的结核病患者充当招募者，通过滚雪球的方式招募他们社交网络中的疑似结核病病例进行筛查并转介治疗。本研究旨在探讨采用种子招募模式主动发现病例在发现新结核病病例方面的可接受性，并确定成功种子的特征。
本定性研究于 2017 年在柬埔寨的磅湛省、磅清扬省、暹粒省和茶胶省进行。对不同层次的选定受益者和主要利益攸关方进行了 56 次深入访谈和 10 次焦点小组讨论（共 64 名参与者），以深入了解实施该模式的可接受性、优势和挑战，以及成功种子的特征。对记录的文字进行编码并进行内容分析。
种子招募主动发现病例模式普遍受到研究参与者的欢迎。他们认为，让结核病幸存者参与并利用他们的社交网络在社区中发现新的结核病病例是有益的。该模式在当地社区中的社会嵌入性是其主要优势之一。该模式的成功还取决于与现有卫生设施的整合。拥有广泛的社交网络、积极性和对结核病有良好的了解是成功种子的重要特征。研究参与者报告说，在开展工作期间，激励疑似结核病患者进行筛查、后勤能力和工作量大是面临的挑战。然而，人们普遍认为应该扩大该模式。
这些发现表明，种子招募模式受到受益者和主要利益攸关方的欢迎。需要进一步研究，以更全面地评估该模式在柬埔寨以及其他资源有限环境中的影响和成本效益，以便未来扩大该模式。
