在缅甸疟疾消除环境中扩大社区卫生工作者职责对疟疾血液检查率的有效性：一项开放阶梯楔形整群随机对照试验。

Effectiveness of an expanded role for community health workers on malaria blood examination rates in malaria elimination settings in Myanmar: an open stepped-wedge, cluster-randomised controlled trial.

作者信息

Htike Win, Galau Naw Hkawng, Cutts Julia C, Simpson Julie A, Scott Nick, O'Flaherty Katherine, Agius Paul A, Fowkes Freya J I

机构信息

Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, Australia.

Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, 207 Bouverie Street, Parkville, VIC 3053, Australia.

出版信息

Lancet Reg Health Southeast Asia. 2024 Oct 17;31:100499. doi: 10.1016/j.lansea.2024.100499. eCollection 2024 Dec.

DOI:10.1016/j.lansea.2024.100499

PMID:39492851

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11531616/

Abstract

BACKGROUND

As Greater Mekong Subregion countries approach malaria elimination, the motivation and social role of community health workers (CHWs), and malaria blood examination rates, have declined in parallel with decreasing malaria burden. To address this issue, a health system model which expanded the role for CHWs was co-designed with communities and health stakeholders in the Mekong Subregion and field-tested in Myanmar.

METHODS

An open stepped-wedge cluster-randomised (at the village-level) controlled trial (ClinicalTrials.govNCT04695886) was conducted in 72 villages in Myanmar from Nov 1, 2021 to April 17, 2022 to evaluate the effectiveness and cost-effectiveness of the expanded CHW model. One-off and continuous implementation costs of the models were calculated.

FINDINGS

A total of 2886 malaria rapid diagnostic tests (RDTs) (control period: 1365; intervention period: 1521) were undertaken across 72 villages during the 24-week study period. Compared to the existing CHW model, the introduction of an expanded role for CHWs resulted in a 23% relative increase in village weekly malaria blood examination rates by RDT, the primary outcome, (adjusted incidence rate ratio (AIRR) = 1.23, 95% CI = 1.01, 1.50, p = 0.036), adjusting for time and season. A 3.3-fold relative increase in village weekly referral rate of dengue, tuberculosis, diarrhoea, or RDT-negative fever cases after the introduction of the expanded CHW model (AIRR = 3.17, 95% CI = 1.23, 8.18, p = 0.017), was also observed. The total cost per CHW per five-year period was US$14,794 for the expanded CHW model and $5816 for the existing CHW model.

INTERPRETATION

An expanded CHW model, co-designed with communities and health stakeholders, can increase malaria blood examination rates in malaria elimination settings and referral rates for other infectious diseases. Expanded CHW models will facilitate maintaining annual blood examination rates required for malaria elimination accreditation by the WHO.

FUNDING

An International Multilateral Donor (QSE-M-UNOPS-BI-20864-007-40).

摘要

背景

随着大湄公河次区域国家接近消除疟疾目标，社区卫生工作者（CHW）的积极性和社会作用以及疟疾血液检查率，都随着疟疾负担的减轻而同步下降。为解决这一问题，与湄公河次区域的社区和卫生利益相关者共同设计了一种扩大CHW作用的卫生系统模式，并在缅甸进行了实地测试。

方法

2021年11月1日至2022年4月17日，在缅甸的72个村庄进行了一项开放的阶梯式楔形整群随机（村级）对照试验（ClinicalTrials.govNCT04695886），以评估扩大CHW模式的有效性和成本效益。计算了该模式的一次性和持续实施成本。

结果

在为期24周的研究期间，72个村庄共进行了2886次疟疾快速诊断检测（RDT）（对照期：1365次；干预期：1521次）。与现有的CHW模式相比，扩大CHW的作用使作为主要结果的村庄每周疟疾血液RDT检查率相对提高了23%（调整后的发病率比（AIRR）=1.23，95%置信区间=1.01，1.50，p=0.036），并对时间和季节进行了调整。在引入扩大的CHW模式后，登革热、结核病、腹泻或RDT阴性发热病例的村庄每周转诊率相对提高了3.3倍（AIRR=3.17，95%置信区间=1.23，8.18，p=0.017）。扩大的CHW模式每五年每个CHW的总成本为14794美元，现有CHW模式为5816美元。