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Human-centered Design and Communities of Practice to Improve Delivery of Home-based TB Contact Investigation in Uganda

Award Number: R01AI104824
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY/ABSTRACT Household contact investigation is an evidence-based, WHO-recommended approach to finding undiagnosed patients with tuberculosis (TB) that is now being implemented in high-burden, low-income countries. During the current award period, we have identified major gaps in the delivery of TB contact investigation in Kampala, Uganda; characterized these gaps in behavioral terms; and designed, implemented, and evaluated a theory- informed strategy targeting these gaps in a household-clustered, randomized trial. Unfortunately, the strategy, “home-based” TB contact investigation, was not effective in increasing either TB evaluation or diagnosis, although contacts and health workers both preferred it. Fidelity of delivery of the intervention's core components – home HIV and TB testing and results reporting via text messaging – was low, suggesting a need to refine the models of delivery. Human-Centered Design (HCD) offers a novel approach to improving the fit of interventions to household members using co-creation, rapid prototyping, and iterative testing to identify more engaging delivery solutions. Communities of Practice – close networks of professionals that form to provide peer support and share tacit knowledge – are increasingly recognized as resources to promote and sustain quality in health care. Therefore, we propose to collaborate with IDEO.org, a global innovator in Human- Centered Design, to refine the delivery of home-based TB contact investigation. We will also engage lay health workers using Communities of Practice to adapt and sustain delivery of core intervention components. We will then evaluate the refined implementation strategy in a stepped-wedge, cluster-randomized trial in six urban Ugandan communities not involved in the HCD refinements. We will determine if the HCD-refined strategy – home-based TB contact investigation delivered via lay health worker communities of practice – improves the quality, yield, and sustainability of household TB contact investigation relative to a standard strategy. Finally, we will carry out a detailed process evaluation with nested mixed-methods studies to assess fidelity/adaptation, sustainability, and their determinants, as well as an economic evaluation (including empirical costing) to determine cost and cost-effectiveness. We will carry out this work with programmatic partners in the real-world environment provided by the Uganda TB Implementation Research Consortium. Our well-established team of investigators has relevant methodological experience (Human-Centered Design, implementation science, biostatistics, mixed-methods, economic evaluation) and content expertise (HIV, TB diagnostics and contact investigation, mobile technology). This research will make a significant contribution to public health by determining if, how, and why novel, patient-centered models for delivering household contact investigation in low-income countries are effective, efficient, sustainable, and cost-effective. We will also produce generalizable knowledge about the value of Human-Centered Design and Communities of Practice as tools and methods for improving fit and delivery of implementation strategies in low-income settings.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $692,966 )
2023	2023	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	000	10	12/14/2022	NON-COMPETING CONTINUATION	$692,966
														Subtotal = $692,966

Issue Date FY: 2022 ( Subtotal = $685,913 )
2022	2022	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	000	9	1/12/2022	NON-COMPETING CONTINUATION	$685,913
														Subtotal = $685,913

Issue Date FY: 2021 ( Subtotal = $695,368 )
2021	2021	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	000	8	12/29/2020	NON-COMPETING CONTINUATION	$695,368
2021	2021	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	001	8	12/30/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $695,368

Issue Date FY: 2020 ( Subtotal = $735,214 )
2020	2020	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	000	7	1/29/2020	NON-COMPETING CONTINUATION	$735,214
														Subtotal = $735,214

Issue Date FY: 2019 ( Subtotal = $832,890 )
2019	2019	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	001	6	1/10/2019	COMPETING CONTINUATION	$832,890
2019	2019	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	002	6	1/29/2019	COMPETING CONTINUATION	$0
2019	2019	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	003	6	5/3/2019	COMPETING CONTINUATION	$0
2019	2019	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	005	6	5/24/2019	COMPETING CONTINUATION	$166,662
2019	2019	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	006	6	7/1/2019	COMPETING CONTINUATION	$0
2019	2017	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	004	5	5/24/2019	NON-COMPETING CONTINUATION	-$166,662
2019	2017	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	000	5	1/7/2019	NON-COMPETING CONTINUATION	$0
														Subtotal = $832,890

Issue Date FY: 2017 ( Subtotal = $532,316 )
2017	2017	YALE UNIVERSITY	105 WALL ST	NEW HAVEN	CT	06511	NEW HAVEN	USA	Allergy and Infectious Diseases Research	000	5	5/17/2017	NON-COMPETING CONTINUATION	$532,316
														Subtotal = $532,316

Issue Date FY: 2016 ( Subtotal = $532,316 )
2016	2016	YALE UNIVERSITY	47 College Street	NEW HAVEN	CT	06520	NEW HAVEN	USA	Allergy and Infectious Diseases Research	000	4	5/17/2016	NON-COMPETING CONTINUATION	$532,316
														Subtotal = $532,316

Issue Date FY: 2015 ( Subtotal = $598,779 )
2015	2015	YALE UNIVERSITY	47 College Street	NEW HAVEN	CT	06520	NEW HAVEN	USA	Allergy and Infectious Diseases Research	000	3	6/9/2015	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$598,779
														Subtotal = $598,779

Issue Date FY: 2014 ( Subtotal = $641,329 )
2014	2014	UNIVERSITY OF CALIFORNIA-SAN FRANCISCO	BOX 0812	SAN FRANCISCO	CA	94143	SAN FRANCISCO	USA	Allergy and Infectious Diseases Research	000	2	5/19/2014	NON-COMPETING CONTINUATION	$641,329
														Subtotal = $641,329

Issue Date FY: 2013 ( Subtotal = $719,424 )
2013	2013	UNIVERSITY OF CALIFORNIA-SAN FRANCISCO	BOX 0812	SAN FRANCISCO	CA	94143	SAN FRANCISCO	USA	Allergy and Infectious Diseases Research	000	1	6/17/2013	NEW	$719,424
2013	2013	UNIVERSITY OF CALIFORNIA-SAN FRANCISCO	BOX 0812	SAN FRANCISCO	CA	94143	SAN FRANCISCO	USA	Allergy and Infectious Diseases Research	001	1	7/15/2013	NEW	$0
														Subtotal = $719,424

Grand Total All Awards = $6,666,515

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Human-centered Design and Communities of Practice to Improve Delivery of Home-based TB Contact Investigation in Uganda

Award Number: R01AI104824

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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