Medical, Kibong'oto Infectious Diseases Hospital, Sanya Juu, Tanzania
Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania.
BMJ Open. 2021 Apr 28;11(4):e041521. doi: 10.1136/bmjopen-2020-041521.
Most sub-Saharan African countries endure a high burden of communicable infections but also face a rise of non-communicable diseases (NCDs). Interventions targeting particular epidemics are often executed within vertical programmes. We establish an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) model with three domains; stepwise training approach, integration of communicable and NCDs and a learning system. The model aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study. We aim to describe the ADEPT protocol with underpinned implementation and operational research on TB/DM.
The model implement a collaborative TB and DM services protocol as endorsed by WHO in Tanzania. Evaluation of the process and outcomes will follow the logic framework. A mixed research design with both qualitative and quantitative approaches will be used in applied research action. Anticipated implementation research outcomes include at the health facilities level for organising TB/DM services, pathways of patients with TB/DM seeking care in different health facilities, factors in service delivery that need deimplementation and the ADEPT model implementation feasibility, acceptability and fidelity. Expected operational research outcomes include additional identified patients with dual TB/DM, the prevalence of comorbidities like hypertension in patients with TB/DM and final treatment outcomes of TB/DM including treatment-related complications. Findings will inform the future policies and practices for integrating communicable and NCDs services.
Ethical approval was granted by The National Research Health Ethical Committee (Ref-No. NIMR/HQ/R.8a/Vol.IX/2988) and the implementation endorsed by the government authorities. Findings will be proactively disseminated through multiple mechanisms including peer-reviewed journals, and engagement with various stakeholders' example in conferences and social media.
大多数撒哈拉以南非洲国家承受着传染病负担,但也面临着非传染性疾病(NCDs)的上升。针对特定传染病的干预措施通常在垂直规划内实施。我们在坦桑尼亚建立了一个适应性疾病控制专家计划(ADEPT)模型,该模型有三个领域:逐步培训方法、传染病和 NCDs 的整合以及学习系统。该模型旨在通过整合传染病和 NCDs,利用结核病(TB)和糖尿病(DM)双重流行作为案例研究,将传统的垂直规划转变为适应性疾病管理方法。我们旨在描述 ADEPT 方案,并对 TB/DM 进行基础实施和运营研究。
该模型在坦桑尼亚实施了世界卫生组织(WHO)认可的合作 TB 和 DM 服务方案。将按照逻辑框架评估过程和结果。将采用混合研究设计,结合定性和定量方法,在应用研究行动中进行。预期的实施研究结果包括在卫生机构层面组织 TB/DM 服务,TB/DM 患者在不同卫生机构寻求护理的途径,服务提供中需要取消的因素以及 ADEPT 模型的实施可行性、可接受性和保真度。预期的运营研究结果包括额外确定的双重 TB/DM 患者、TB/DM 患者中高血压等合并症的患病率以及 TB/DM 的最终治疗结果,包括与治疗相关的并发症。研究结果将为整合传染病和 NCDs 服务的未来政策和实践提供信息。
国家研究健康伦理委员会(Ref-No. NIMR/HQ/R.8a/Vol.IX/2988)已批准该研究的伦理,并得到政府当局的批准。研究结果将通过多种机制积极传播,包括同行评议的期刊,并与各种利益相关者进行接触,例如会议和社交媒体。