Swedberg Catherine, Mazeri Stella, Mellanby Richard J, Hampson Katie, Chng Nai Rui
Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, United Kingdom.
Front Trop Dis. 2022 Jun 20;3:829132. doi: 10.3389/fitd.2022.829132.
As part of the 'Zero by 30' strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Semi-structured interviews were conducted with seventeen practitioners and researchers with international, national, and local expertise across Africa, Asia, and the Americas. Thematic analysis was undertaken using both inductive and deductive approaches. Four main themes were identified: 1) stakeholders' and practitioners' conceptualization of IBCM and its role in rabies elimination; 2) variation in how IBCM operates across different contexts; 3) barriers and facilitators of IBCM implementation in relation to risk assessment, PEP provisioning, animal investigation, One Health collaboration, and data reporting; and 4) the impact of the COVID-19 pandemic on IBCM programs. This study highlights the diversity within experts' conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. Programs spanned from highly endemic settings with limited access to PEP charged to the patient, to low endemicity settings with a large patient load associated with free PEP policies and sensitization. In practice, IBCM was tailored to meet the demands of the local context and level of rabies control. Thus, experts' experiences did not necessarily translate across contexts, affecting perceptions about the function, motivation for, and implementation of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goal.
作为“2030 年实现零死亡”战略的一部分，该战略旨在到 2030 年消除因犬介导的狂犬病导致的人类死亡，国际组织推荐了一个包括综合咬伤病例管理（IBCM）的“同一健康”框架。然而，对于 IBCM 在实际中的实施情况了解甚少。本研究旨在了解 IBCM 是如何被概念化的，探索 IBCM 在不同背景下是如何运作的，以及实施的障碍和促进因素。对来自非洲、亚洲和美洲的 17 位具有国际、国家和地方专业知识的从业者和研究人员进行了半结构化访谈。采用归纳法和演绎法进行主题分析。确定了四个主要主题：1）利益相关者和从业者对 IBCM 的概念化及其在消除狂犬病中的作用；2）IBCM 在不同背景下运作方式的差异；3）IBCM 在风险评估、暴露后预防（PEP）提供、动物调查、“同一健康”协作和数据报告方面实施的障碍和促进因素；4）2019 冠状病毒病疫情对 IBCM 项目的影响。本研究强调了专家对 IBCM 的概念化及其运作方式的多样性。所揭示的一系列观点表明，在卫生系统内组织 IBCM 有不同的方式，并非一种适用于所有情况的方法。可持续性问题仍然是实施过程中最大的挑战。每个地点的背景特征影响了 IBCM 的实施和潜在影响。项目范围从患者需付费且获得 PEP 机会有限的高流行地区，到因免费 PEP 政策和宣传而患者数量众多的低流行地区。在实践中，IBCM 是根据当地情况和狂犬病控制水平进行调整的。因此，专家的经验不一定能在不同背景下通用，这影响了对 IBCM 的功能、实施动机和实施情况的看法。为了设计和实施未来及当前的项目，应为接诊患者的卫生工作者提供关于评估咬人动物狂犬病病史和体征的指导。研究结果为 IBCM 的实施以及它如何支持旨在实现“2030 年零死亡”目标的项目提供了见解。
