Tuberculosis Working Group, Infectious Disease Research Centre, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia.
Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia.
F1000Res. 2021 Apr 27;10:327. doi: 10.12688/f1000research.52089.2. eCollection 2021.
A significant proportion of tuberculosis (TB) patients globally make their initial visit for medical care to either an informal provider or a private practitioner, and many are not formally notified. Involvement of private practitioners (PPs) in a public-private mix for TB (TB-PPM) provides an opportunity for improving TB control. However, context-specific interventions beyond public-private agreements and mandatory notification are needed. In this study we will evaluate whether a tailored intervention package can increase TB notifications from PPs in Indonesia. This is a cluster-randomized trial of a multi-component public health intervention. 36 community health centre (CHC) areas will be selected as study locations and randomly allocated to intervention and control arms (1:1). PPs in the intervention areas will be identified using a mapping exercise and recruited into the study if they are eligible and consent. They will receive a tailored intervention package including in-person education about TB management along with bimonthly electronic refreshers, context-specific selection of referral pathways, and access to a TB-reporting app developed in collaboration with the National TB programme. The primary hypothesis is that the intervention package will increase the TB notification rate. The primary outcome will be measured by collecting notification data from the CHCs in intervention and control arms at the end of a 1-year observation period and comparing with the 1-year pre-intervention. The primary analysis will be intention-to-treat at the cluster level, using a generalised mixed model with repeated measures of TB notifications for 1 year pre- and 1 year post-intervention. The results from this study will provide evidence on whether a tailored intervention package is effective in increasing the number of TB notifications, and whether the PPs refer presumptive TB cases correctly. The study results will guide policy in the development of TB-PPM in Indonesia and similar settings.
全球相当一部分结核病 (TB) 患者最初会选择到非正规医疗机构或私人医生处就医，且许多人未被正式通知。私人医生（PPs）参与公私混合结核病防治（TB-PPM）为改善结核病控制提供了机会。但是，除了公私协议和强制通知之外，还需要针对具体情况进行干预。在这项研究中，我们将评估定制的干预方案是否可以增加印度尼西亚私人医生报告结核病的数量。 这是一项多组分公共卫生干预措施的集群随机试验。将选择 36 个社区卫生中心（CHC）区域作为研究地点，并将其随机分配到干预组和对照组（1:1）。通过制图练习确定干预区域的私人医生，并在符合条件和同意的情况下招募他们参加研究。他们将接受定制的干预方案，包括关于结核病管理的面对面教育，以及每两个月一次的电子更新、根据具体情况选择转诊途径，并使用与国家结核病规划合作开发的结核病报告应用程序。主要假设是干预方案将提高结核病报告率。主要结果将通过在干预和对照组的 CHC 收集干预后 1 年观察期结束时的通知数据来衡量，并与干预前 1 年的数据进行比较。主要分析将是在集群水平上进行意向治疗分析，使用广义混合模型对干预前 1 年和干预后 1 年的结核病通知进行重复测量。 该研究的结果将提供有关定制干预方案是否能有效增加结核病报告数量以及私人医生是否能正确转诊疑似结核病病例的证据。研究结果将为印度尼西亚和类似环境中公私混合结核病防治工作的政策制定提供指导。
