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Principal Investigator: Andrew Kerkhoff
Organization: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Fiscal Year: 2024
Award: $199,800
Funding agency: National Institute of Allergy and Infectious Diseases
PROJECT SUMMARY/ABSTRACT
Three million global tuberculosis (TB) cases remain undiagnosed each year, which is a key factor underpinning
why TB is the leading cause of death among people living with HIV (PWH) and the leading infectious cause of
death worldwide. While community-wide screening for TB in high-burden settings is recommended by WHO and
may reduce community prevalence, it is unlikely to be a scalable TB control strategy. Leveraging trained peers
(recent TB patients) to undertake community-based, systematic TB screening among non-household contacts
of newly diagnosed TB patients, including casual contacts at community venues, may be an efficient and
sustainable strategy to facilitate early TB diagnosis and linkage to care; however, little is known about whether
such a strategy is feasible and acceptable to undertake in low-resource, high TB burden settings.
Through targeted training and strong mentorship in implementation science methods, I will develop and evaluate
a theory-informed, multicomponent, peer-led strategy to undertake community-based, systematic TB screening
among non-household contacts of newly diagnosed TB patients attending two public health facilities in Lusaka,
Zambia. This proposal builds upon the research collaboration I began developing during my infectious disease
fellowship and leverages the robust experience and infrastructure of the Centre for Infectious Diseases Research
in Zambia (CIDRZ). In Aim 1, I will undertake mixed-methods research among key stakeholders to identify
barriers to undertaking TB screening among non-household contacts using peers. In Aim 2, I will use a discrete
choice experiment among TB patients, at-risk community members, and community venue owners, to determine
their preferences for the mode of delivery for the implementation strategy components. Findings from Aims 1
and 2 will inform the design of a multicomponent, peer-led TB contact tracing strategy among non-household
contacts that will be evaluated in Aim 3, during a 6-month pilot to assess its feasibility, acceptability and reach.
My overall training objective is to develop implementation science expertise; I will accomplish this by undertaking
carefully selected coursework, workshops, and seminars, and through the guidance of highly accomplished
mentors who are experts in international Implementation science research, mixed-methods research and
multicomponent TB/HIV implementation strategies. My training objectives sequentially map onto my research
aims and are to: (1) gain experience in the application of mixed-methods for implementation science research;
(2) develop expertise in using implementation science methods to develop multicomponent implementation
strategies; (3) develop a strong foundation in study designs and analysis approaches for interventional
implementation research. My career goal is to be an independent physician-scientist who applies implementation
science methods to improve TB and HIV outcomes in low-resource settings. The findings generated from this
K23 award will inform an R01 proposal to undertake an adaptive, cluster randomized trial evaluating a peer-led,
multicomponent TB case finding strategy in Zambia.
Terms: <21+ years old><AIDS Virus><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Adult><Adult Human><Africa South of the Sahara><Anti-HIV Positivity><Caring><Cause of Death><Clinic><Clinical Research><Clinical Study><Cluster randomization trial><Cluster randomized trial><Collaborations><Communicable Disease Contact Tracing><Communicable Diseases><Communities><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Contact Tracing><Detection><Diagnosis><Education><Educational aspects><Educational workshop><Effectiveness><Enrollment><Face><Fellowship><Foundations><Gender Role><Goals><HIV><HIV Positive><HIV Positivity><HIV Seroconversion><HIV Seronegativities><HIV Seronegativity><HIV Seropositivity><HIV antibody positive><HIV negative><HIV/Mtb><HIV/TB><HIV/mycobacterium tuberculosis><HIV/tuberculosis><HTLV-III Seroconversion><HTLV-III Seronegativities><HTLV-III Seronegativity><HTLV-III Seropositivity><Health><Health Facilities><Health care facility><Healthcare Facility><Household><Human Immunodeficiency Viruses><Individual><Infectious Disease Contact Tracing><Infectious Disease Pathway><Infectious Diseases><Infectious Diseases / Laboratory><Infectious Diseases Research><Infectious Disorder><Infrastructure><International><Intervention><Intervention Strategies><Interview><Investigators><K23 Award><K23 Mechanism><K23 Program><Knowledge><LAV-HTLV-III><Location><Low-resource area><Low-resource community><Low-resource environment><Low-resource region><Low-resource setting><Lymphadenopathy-Associated Virus><M tuberculosis infection><M. tb infection><M. tuberculosis infection><M. tuberculosis/HIV><M.tb infection><M.tuberculosis infection><MTB infection><Maps><Mentored Patient-Oriented Research Career Development Award><Mentored Patient-Oriented Research Career Development Award (K23)><Mentors><Mentorship><Methods><Mycobacterium tuberculosis (MTB) infection><Mycobacterium tuberculosis infection><Newly Diagnosed><Northern Rhodesia><Outcome><Patients><Persons><Physicians><Pilot Projects><Prevalence><Provider><Public Health><RE-AIM><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Recommendation><Research><Research Design><Research Methodology><Research Methods><Research Personnel><Research Resources><Researchers><Resource-constrained area><Resource-constrained community><Resource-constrained environment><Resource-constrained region><Resource-constrained setting><Resource-limited area><Resource-limited community><Resource-limited environment><Resource-limited region><Resource-limited setting><Resource-poor area><Resource-poor community><Resource-poor environment><Resource-poor region><Resource-poor setting><Resources><Risk><Scientist><Sex Roles><Social support><South Africa><Study Type><Sub-Saharan Africa><Subsaharan Africa><Survey Instrument><Surveys><TB diagnosis><TB infection><Theory of Change><Time><Tracer><Training><Transmission><Travel><Tuberculosis><Tuberculosis diagnosis><Virus-HIV><Work><Workshop><World Health Organization><Zambia><acceptability and feasibility><adulthood><behavior change><care facilities><career><case finding><clinical epidemiology><design><designing><diagnosed with TB><diagnosed with Tuberculosis><diagnostic tool><disseminated TB><disseminated tuberculosis><enroll><experience><experiment><experimental research><experimental study><experiments><faces><facial><high risk group><high risk individual><high risk people><high risk population><implementation intervention><implementation research><implementation science><implementation strategy><improved><improved outcome><indexing><infection due to Mycobacterium tuberculosis><interventional strategy><member><new diagnostics><next generation diagnostics><novel diagnostics><outreach><peer><pilot study><preference><reach, efficacy, adoption, implementation, and maintenance><research and methods><screening><screenings><social stigma><social support network><stigma><strategies for implementation><study design><theories><transmission process><tuberculosis infection><tuberculous spondyloarthropathy>