Baker Anna, Gupta Amanda J, Nanziri Leah, Ggita Joseph M, Hernandez-Ramirez Raul U, Shenoi Sheela V, Ayakaka Irene, Armstrong-Hough Mari, Katamba Achilles, Davis J Lucian
Yale School of Public Health.
Uganda Tuberculosis Implementation Research Consortium.
Res Sq. 2024 Feb 16:rs.3.rs-3956897. doi: 10.21203/rs.3.rs-3956897/v1.
Universal TB education and counseling (TEC) is routinely recommended for promoting knowledge and medication adherence, but the quality of delivery often varies because of inadequate clinic space, time, and health worker training. Peer-led counseling is a promising but understudied solution to these challenges. We sought to evaluate the efficacy of a peer-led TEC strategy among newly diagnosed adults initiating TB treatment in Kampala, Uganda.
We conducted a longitudinal, pre-post implementation study comparing the routine, healthcare-worker-led and peer-led strategies for delivery of TEC to consecutive adult persons with TB at a large, public primary-care clinic. Trained staff administered a standardized TB knowledge survey to all persons with TB immediately following TEC. We compared TB knowledge by type of TEC received using t-tests.
We enrolled 161 persons with TB, 80 who received conventional TEC from health workers between June and July 2018, and 81 who received peer-led TEC between August and November 2019. The proportions of women (28% vs. 31%, p = 0.64) and persons living with HIV (36% vs 30%, p = 0.37) were similar in the pre- and post-implementation periods. Peer-led TEC was associated with a more significant increase in disease-specific (difference +21%, 95% CI +18% to + 24%, p < 0.0001) and treatment-specific TB knowledge scores (difference +14%, 95% CI + 10% to + 18%, p< 0.0001) than routine healthcare worker-delivered TEC. All TB knowledge constructs were significantly higher for those in the post-implementation period than those in the pre-implementation period. Nine participants met our threshold for adequate knowledge (score ≥ 90%) for disease-specific TB knowledge in the pre-implementation period compared to 63 (78%) in the post-implementation period (+67%, 95% CI + 55% - +78%, p < 0.001). Twenty-eight (35%) met the adequate knowledge threshold for TB treatment-specific knowledge in the pre-implementation period compared to 60 (74%) in the post-implementation period (+ 39%, 95% CI + 25 to + 53%, p < 0.0001). Finally, the proportion achieving TB treatment success (cure or completed) increased substantially from the pre-implementation period (n = 49, 68%) to the post-implementation period (n = 63, 88%), a difference of + 19% (95% CI + 6% to + 33%, p = 0.005).
Our findings suggest that peer-led TEC is more efficacious than routine TEC at improving TB knowledge and treatment outcomes. Future studies should evaluate the implementation and effectiveness of the peer-led TEC strategy when scaled to a larger number of clinics.
普遍推荐开展结核病健康教育与咨询（TEC）以促进知识掌握和药物依从性，但由于诊所空间不足、时间有限以及卫生工作者培训不足，其实施质量往往参差不齐。同伴主导的咨询是应对这些挑战的一种有前景但研究不足的解决方案。我们试图评估在乌干达坎帕拉，针对新诊断开始接受结核病治疗的成年人，由同伴主导的TEC策略的效果。
我们进行了一项纵向的实施前后研究，比较在一家大型公立初级保健诊所，由医护人员主导的常规TEC策略和同伴主导的TEC策略，将其应用于连续的成年结核病患者。经过培训的工作人员在TEC结束后立即对所有结核病患者进行标准化的结核病知识调查。我们使用t检验比较接受不同类型TEC后的结核病知识情况。
我们纳入了161名结核病患者，其中80名在2018年6月至7月间接受了医护人员提供的常规TEC，81名在2019年8月至11月间接受了同伴主导的TEC。实施前后女性比例（28%对31%，p = 0.64）和艾滋病毒感染者比例（36%对30%，p = （此处原文有误，推测为p = 0.37）0.37）相似。与常规医护人员提供的TEC相比，同伴主导的TEC在疾病特异性（差异+21%，95%置信区间+18%至+24%，p < 0.0001）和治疗特异性结核病知识得分（差异+14%，95%置信区间+10%至+18%，p < 0.0001）方面有更显著的提高。实施后所有结核病知识结构得分均显著高于实施前。实施前有9名参与者达到我们设定的疾病特异性结核病知识充足知识阈值（得分≥90%），而实施后有63名（78%）达到（增加67%，95%置信区间+55% - +78%，p < 0.001）。实施前有28名（35%）达到结核病治疗特异性知识充足知识阈值，而实施后有60名（74%）达到（增加39%，95%置信区间+25%至+53%，p < 0.0001）。最后，实现结核病治疗成功（治愈或完成治疗）的比例从实施前的时期（n = 49，68%）大幅增加到实施后的时期（n = 63，88%），差异为+19%（95%置信区间+6%至+33%，p = 0.005）。
我们的研究结果表明，同伴主导的TEC在提高结核病知识和治疗效果方面比常规TEC更有效。未来的研究应评估同伴主导的TEC策略在扩大到更多诊所时的实施情况和有效性。
