The Impact of Involving Informal Health Providers for Tuberculosis Control in Sudan (Triage-Plus)

Triage Plus for TB: Improving Community-Based Provision for TB in Africa. The Impact of Involving Informal Health Providers for Tuberculosis Control in Sudan

Training and engaging of unpaid informal providers (such as tea-sellers, women's groups, youth clubs, small traders and religious groups) from poorer localities in TB disease recognition, referral and community awareness raising will increase the access of TB patients to formal health facilities and decrease their delay in initiating TB treatment.

Study Overview

• Status: Completed
• Conditions: Tuberculosis
• Intervention / Treatment: Behavioral: Referral of presumptive of TB cases by informal providers

Detailed Description

Barriers to accessing health services faced by poor and vulnerable populations are numerous in developing countries. These include; geography, income poverty, lack of trust in the quality of public health services, and lack of empowerment of women and adolescent girls (as patients and carers) to mobilize adequate and timely resources to access these services.

The project aims to test if TB case detection can be increased by engaging informal health care providers in active case finding. In one urban district of Khartoum, these providers will be trained to work as first point of entry to the health system using a comprehensive package that includes disease recognition, health communication, and patient referral. In a comparator urban district of Khartoum, no attempts will be made to engage informal providers.

By comparing data of TB patients and Lab registers between the intervention and comparator districts in Khartoum, this project aims to test if, and to what extent, these expected effects can be realized.

Overall this is a trial of a health policy so individual patients will not be recruited or randomized to one intervention or the other. Rather the policy is being applied in one district while the other district is being used as a comparator.

• Study Type: Interventional
• Enrollment (Actual): 380
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sudan
  • Khartoum, Sudan
    • The Epidemiological Laboratory (EpiLab)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Access point for health seeking by the poor and vulnerable
• Active and well known in community
• Intervention activities can be confined to intervention area
• Based in community/locality
• Longevity; long standing
• Present in control and intervention areas
• Able and willing to complete the training to be Triage-Plus providers (ie giving formal consent)

Exclusion Criteria:

• Formal health providers, e.g. clinics, labs, hospitals (MOH, NGO or private)
• Internationally funded organizations, e.g. international NGOs
• Civil servants e.g. teachers

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Ombda Locality: informal providers; Ombda locality is located in Western Khartoum and populated with population size of 988,163. Intervention: 380 unpaid Informal providers trained to recognise TB symptoms and to refer presumptive TB cases to formal health care facilities within the area.	Behavioral: Referral of presumptive of TB cases by informal providers; Training of informal providers to effectively refer TB suspects in the community to the primary health care system
No Intervention: Jabal Awlia Locality; The control arm: A locality in south eastern site of Khartoum state populated with 942,429. No intervention took place

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total number of TB patients registered and start receiving treatment in formal health care facilities	This will be measured by comparing Data from routine patients registered in formal TB management units in the intervention arm and compare it with the same routine data from the control arm. similar data for the previous year will undergo the same comparison as time control for both arms	12 months

Collaborators and Investigators

• Sponsor: Liverpool School of Tropical Medicine
• Collaborators: The Epidemiological Laboratory (EpiLab), Khartoum-Sudan.; The Norwegian Heart and Lung Patients Association (LHL)
• Investigators: Principal Investigator: S. Bertel ("Bertie") Squire, MB BChir, MD, Liverpool School of Tropical Medicine

Study record dates

Study Major Dates

• Study Start: January 1, 2009
• Primary Completion (Actual): March 1, 2012
• Study Completion (Actual): April 1, 2012

Study Registration Dates

• First Submitted: April 24, 2013
• First Submitted That Met QC Criteria: April 25, 2013
• First Posted (Estimate): April 26, 2013

Study Record Updates

• Last Update Posted (Estimate): April 26, 2013
• Last Update Submitted That Met QC Criteria: April 25, 2013
• Last Verified: April 1, 2013

More Information

Terms related to this study

• Keywords: Tuberculosis; Informal providers; Informal carers; Barriers to health system
• Additional Relevant MeSH Terms: Infections; Bacterial Infections; Bacterial Infections and Mycoses; Gram-Positive Bacterial Infections; Actinomycetales Infections; Mycobacterium Infections; Tuberculosis
• Other Study ID Numbers: 11.03RS