Targeted Implementation of Pulmonary Rehabilitation for Post-Tuberculosis Lung Disease - PROJECT SUMMARY Post-tuberculosis lung disease (PTLD) is a major complication of pulmonary tuberculosis (TB), contributing to significant impairment and early death among TB survivors in sub-Saharan Africa. Treatment for PTLD is complicated by the wide heterogeneity in disease patterns which exist. One treatment which reduces PTLD morbidity across clinical patterns is pulmonary rehabilitation (PR). PR consists of a combination of aerobic endurance training, strength and resistance exercises, structured education, and behavior change, each of which can be personalized according to individual characteristics and clinical patterns of lung disease. Yet, PR is often unavailable in high-TB burden settings due to its resource-intensive and multi-component nature. In order to make PR for PTLD more widely available in a way that is sustainable in resource-limited settings, we must 1) define the clinical patterns of PTLD and associated clinical outcomes so we can identify who has the greatest need for PR, 2) develop a structured process for tailoring PR programs for different settings, and 3) establish the feasibility and acceptability of a tailored program in a high-TB burden setting. Dr. Navuluri is a pulmonary-critical care physician with experience in chronic lung disease research in Kenya. She previously found that routinely available clinical data can be used to identify clinical patterns of disease in a setting where tools more commonly used for pattern identification, such as high-resolution computed tomography or complete pulmonary function testing, may not be available. She also found that individuals with PTLD and health system leaders identify a strong need for PR programs and that adapting individual components and aspects of PR program delivery can help address the multiple system-, provider-, and patient-level barriers which exist. To address this need, Dr. Navuluri will use Intervention Mapping for Adaption, a validated, theory- based framework, to complete three specific aims. In Aim 1, she will employ machine learning methods (specifically cluster analyses) to identify clinical patterns of PTLD and their impact on quality of life and functional status using routine clinical data. In Aim 2, she will use human-centered design methods to develop an implementation blueprint for adapting PR for individuals with PTLD across resource-limited settings and create an adapted PR program for use in Kenya. In Aim 3, she will conduct a single-arm pilot study to assess the feasibility, acceptability, adoption and fidelity of an adapted PR program and plan for a future large-scale hybrid implementation and effectiveness trial. Throughout this work, Dr. Navuluri will learn how to apply machine learning to inform implementation, use human-centered design to adapt interventions, and design implementation trials. The proposed studies and training will allow Dr. Navuluri to develop the necessary skillset for a successful, independent career in implementing evidence-based interventions to improve respiratory outcomes in resource-limited settings.
