提高埃塞俄比亚儿童获得结核病预防治疗的机会：通过形成性研究为 CHIP-TB 试验设计基于家庭的接触者管理干预措施。

Improving access to tuberculosis preventive treatment for children in Ethiopia: designing a home-based contact management intervention for the CHIP-TB trial through formative research.

机构信息

Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street Room 3147, Baltimore, MD, 21287, USA.

Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA.

出版信息

BMC Health Serv Res. 2024 Sep 10;24(1):1043. doi: 10.1186/s12913-024-11451-9.

DOI:10.1186/s12913-024-11451-9

PMID:39252005

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11386379/

Abstract

BACKGROUND

Tuberculosis (TB) preventive treatment (TPT) is a long-standing recommendation for children exposed to TB but remains poorly implemented. Home-based contact management may increase access and coverage of TPT among children exposed to TB in their households.

METHODS

Sixty in-depth interviews were conducted with key informants including program managers, TB providers (known as TB focal persons), health extension workers and caregivers whose children had recently engaged with TB prevention services in Oromia, Ethiopia in 2021 to understand the barriers and facilitators to providing home-based TB prevention services for children aged < 15 years. Thematic content analysis was conducted including systematically coding each interview.

RESULTS

Home-based services were considered a family-centered intervention, addressing the time and financial constraints of clients. Stakeholders proposed a task-shared intervention between health extension workers and facility-based TB focal persons. They recommended that TB services be integrated into other home-based services, including HIV, nutrition, and vaccination services to reduce workload on the already overstretched health extension workers. Community awareness was considered essential to improve acceptability of home-based services and TPT in general among community members.

CONCLUSIONS

Decentralization of TPT should be supported by task-sharing initiation and follow up between health extension workers and facility-based TB focal persons and integration of home-based services. Active community engagement through several existing mechanisms can help improve acceptability for both home-based interventions and TPT promotion overall for children.

TRIAL REGISTRATION

The results presented here were from formative research related to the CHIP-TB Trial (Identifier NCT04369326) registered on April 30, 2020. This qualitative study was separately registered at NCT04494516 on 27 July 2020.

摘要

背景

结核病（TB）预防治疗（TPT）是一项针对接触 TB 的儿童的长期建议，但实施情况仍然不佳。家庭为基础的接触管理可以增加家庭中接触 TB 的儿童接受 TPT 的机会和覆盖面。

方法

2021 年，在埃塞俄比亚奥罗米亚地区，对 60 名利益攸关方进行了深入访谈，包括项目管理人员、TB 提供者（称为 TB 联络人）、卫生推广工作者和照顾其子女最近接受 TB 预防服务的照顾者，以了解为年龄<15 岁的儿童提供家庭为基础的 TB 预防服务的障碍和促进因素。进行了主题内容分析，包括系统地对每个访谈进行编码。

结果

家庭为基础的服务被认为是一种以家庭为中心的干预措施，解决了客户的时间和经济限制。利益攸关方提出了一种由卫生推广工作者和机构 TB 联络人共同承担的任务分担干预措施。他们建议将 TB 服务整合到其他家庭为基础的服务中，包括艾滋病毒、营养和疫苗接种服务，以减轻已经过度紧张的卫生推广工作者的工作量。社区意识被认为是提高社区成员对家庭为基础的服务和一般 TPT 的接受度的关键。