Qualitative Understanding of Community TB Services Pre and Post the CHIP-TB Trial

July 10, 2023 updated by: Johns Hopkins University

A Qualitative Study to Optimize a Community-Based Pediatric TB/HIV Prevention Intervention and Implementation Strategy

This qualitative study is designed to elicit the perspectives of relevant stakeholders to adapt a community-based TB/HIV intervention aimed on providing home-based TB prevention treatment (TPT) initiation for child TB contacts, to design its implementation strategy and, post intervention, to assess lessons learned for future scale up. Participants will include policy makers and health system managers, nurse and physician providers, community health team members, and child caregivers of TB-exposed children. Stakeholders will be asked to participate in two interviews, one prior to the cluster randomized trial assessing this intervention and one after the cluster randomized trial. Trained interviewers will conduct 1-hour semi-structured in-depth interviews that will be audio-recorded, translated and transcribed for thematic analysis using a priori and emergent domains of interest. Free-listing, ranking exercises and cultural consensus will be used to identify context-specific intervention adaptations and implementation strategies.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Detailed Description

Tuberculosis (TB) remains a top 10 cause of child mortality in sub-Saharan Africa. Short-course combination TB preventive therapy (TPT) regimens are highly effective with high completion rates and therefore hold promise to reduce the 1 million pediatric TB patients and 233,000 child TB deaths annually. TPT effectiveness requires improvement in access to pediatric TB preventive care. The World Health Organization (WHO) estimates only 23% of the 1.3 million TB-exposed children under 5 years old initiated TPT in 2017. The investigators' previous data suggest 50-75% of TB-exposed children under 5 years old fail to be either identified or linked to TB preventive care. Children under 5 years are at exceptionally high risk of TB disease due to not only immature immune systems, but also HIV infection and HIV exposure. Guidelines have long recommended TPT for children under 5 years, but have recently been expanded to children under 15 years. Developing and testing innovative health care delivery models to accompany new WHO-endorsed short-course combination TPT regimens is essential to reduce TB-associated global child morbidity and mortality.

Integrated community case management (iCCM) is a cost-effective intervention that increases child survival by bringing curative therapies to at risk children in the community. Recently, algorithms for screening pediatric patients with household exposure to TB have been simplified to include symptom screening only, eliminating costly laboratory and radiographic evaluations that are barriers to treatment and do not improve sensitivity and specificity of the assessment. The CHIP-TB Trial plans to assess whether integrated community-based pediatric TB/HIV prevention services is feasible, acceptable and effective in increasing TPT uptake among child TB contacts under 15 years in a cluster-randomized trial in South Africa and Ethiopia, two high-burden, resource-limited settings.

Nested within this larger trial, the investigators will use qualitative research to (1) describe the social context in which the community health teams perform the team's duties, (2) make context-specific adaptations to the intervention to maximize its effectiveness, (3) define a context-specific implementation strategy and evaluation plan, and (4) learn important lessons for the future scale up and dissemination of the community-based intervention.

The investigators will conduct 10-15 paired semi-structured individual in-depth interviews (IDI) for each of the four key stakeholder groups: (1) caregivers of TB-exposed children, (2) community health team members, (3) clinic-based nurse and clinic or hospital-based physician providers, and (4) health system managers and policy makers, for a total of ~120 IDIs (~60 in South Africa and ~60 in Ethiopia) both pre and post trial. Before the intervention the investigators will conduct a one-hour interview that will explore the inner setting of the community health team's environment from each stakeholder perspective and will develop and decide upon key intervention adaptations and implementation strategies for the community-based TB/HIV prevention program that will be assessed with a one-year cluster-randomized trial. Upon trial completion, the investigators will conduct another 10-15 semi-structured IDIs with each stakeholder group in each country (total ~120 IDIs) to identify key facilitators and barriers to the implementation. Thematic content analysis with an inductive approach will be used to analyze transcripts for both a priori and emergent domains of interest. A coding scheme will be adapted from Consolidated Framework for Implementation Research (CFIR) constructs. Free listing, ranking, and cultural consensus will be used to identify intervention adaptations and implementation strategies that are context specific. The investigators will use Smith's Saliency Index to analyze the free listed data, mean rank order to assess ranking exercises, and the Eigenvalue to evaluate consensus across groups all using the ANTHROPAC ® 4.0 software.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
183

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Nicole Salazar-Austin, MD
  • Phone Number: 410-614-3917
  • Email: nsalaza1@jhmi.edu

Study Locations

  • Ethiopia
      • Addis Ababa, Ethiopia
        • KNCV Tuberculosis Foundation
  • South Africa
      • Johannesburg, South Africa
        • The Aurum Institute

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

The study population will include key stakeholders from the target communities in South Africa (Ekurhuleni, Gauteng Province) and Ethiopia (East Shewa Zone of the Oromia regional state), including caregivers of TB-exposed children, community health teams including nurses and community health workers, clinic-based nurse and clinic/hospital-based physician providers, program managers and policy makers.

Description

Inclusion Criteria for Interview 1:

  • Adult caregiver (18 years of age or older) of a child (<15 years of age) who was exposed to TB in the last two years where at least one child was evaluated for and offered either TB preventive therapy or TB treatment.

or

  • Community health team members from one of the Ethiopian or South African clinics in which the CHIP-TB trial will be conducted.

or

  • TB nurse from one of the 16 Ethiopian or South African clinics in which the study will be conducted

or

  • Pediatrician or medical officer working in pediatrics at the relevant Ethiopian or South African District Hospital who sees outpatient pediatric consultations including TB-exposed children

or

  • Program manager or policy maker in the relevant Ethiopian or South African district or provincial office who manages TB, PMTCT, and/or other pediatric programming

Exclusion Criteria for Interview 1:

  • Any adult caregivers, community health team members, TB nurses, medical officers or pediatricians, program managers or policy makers who are unable or unwilling to provide informed consent for both the interview and audio-recording

Inclusion Criteria for Interview 2:

  • Any community health team members, TB nurses, medical officers or pediatricians, program managers or policy makers who participated in the program for at least 3 months
  • Any adult caregiver whose child participated in the community-based TB prevention program

Exclusion Criteria for Interview 2:

  • Any adult caregivers, community health team members, TB nurses, medical officers or pediatricians, program managers or policy makers who are unable or unwilling to provide informed consent for both the interview and audio-recording

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Pre-trial
This cohort of participants will be recruited preceding evaluation of the community-based pediatric TB prevention intervention (CHIP-TB; NCT04369326) to assist with design of the intervention and implementation strategy. Participants will include four stakeholder groups including: (1) policy makers, program managers, (2) nurse and physician clinicians, (3) community health team members, and (4) caregivers of child contacts from both South African and Ethiopian sites.
Post-trial
This cohort of participants will be recruited after evaluation of the community-based pediatric TB prevention intervention (CHIP-TB; NCT04369326) to assist with future scale up and dissemination of the intervention. Participants will include four stakeholder groups including: (1) policy makers, program managers, (2) nurse and physician clinicians, (3) community health team members, and (4) caregivers of child contacts from both South African and Ethiopian sites.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Perception of intervention adaptations as assessed by an in-depth interview
Time Frame: Within six months prior to CHIP-TB trial initiation
In-depth, semi-structured interviews will explore perceptions of context-specific adaptations to the community-based TB prevention intervention needed for success.
Within six months prior to CHIP-TB trial initiation
Perception of implementation strategies as assessed by an in-depth interview
Time Frame: Within six months prior to CHIP-TB trial initiation
In-depth, semi-structured interviews will explore perceptions of context-specific implementation strategies for the community-based TB prevention intervention needed for success.
Within six months prior to CHIP-TB trial initiation
Perception of the social context of the community-based health teams as assessed by an in-depth interview
Time Frame: Within six months prior to CHIP-TB trial initiation
In-depth, semi-structured interviews will explore the social context and inner setting of the community health teams.
Within six months prior to CHIP-TB trial initiation
Perception of the lessons learned as assessed by an in-depth interview
Time Frame: Within four months after CHIP-TB Trial completion
In-depth, semi-structured interviews will explore lessons learned for the future scale up and dissemination of the community-based TB prevention intervention.
Within four months after CHIP-TB Trial completion

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Johns Hopkins University

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Aurum Institute
UNITAID
KNCV Tuberculosis Foundation

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Nicole Salazar-Austin, MD, Johns Hopkins School of Medicine

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 4, 2021

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
June 30, 2023

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
June 30, 2023

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 27, 2020

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 30, 2020

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
July 31, 2020

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
July 12, 2023

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 10, 2023

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
July 1, 2023

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • IRB00237243

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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