Achilles Katamba, Amanda J Gupta, Patricia Turimumahoro
et al.
Abstract Background Tuberculosis(TB) is among the leading causes of infectious death worldwide. Contact investigation is an evidence-based, World Health Organisation-endorsed intervention for timely TB diagnosis, treatment, and prevention but has not been widely and effectively implemented. Methods We are conducting a stepped-wedge, cluster-randomised, hybrid Type III implementation-effectiveness trial comparing a user-centred to a standard strategy for implementing TB contact investigation in 12 healthcare facilities in Uganda. The user-centred strategy consists of several client-focused components including (1) a TB-education booklet, (2) a contact-identification algorithm, (3) an instructional sputum-collection video, and (4) a community-health-rider service to transport clients, CHWs, and sputum samples, along with several healthcare-worker-focused components, including (1) collaborative improvement meetings, (2) regular audit-and-feedback reports, and (3) a digital group-chat application designed to develop a community of practice. Sites will cross-over from the standard to the user-centred strategy in six, eight-week transition steps following a randomly determined site-pairing scheme and timeline. The primary implementation outcome is the proportion of symptomatic close contacts completing TB evaluation within 60 days of TB treatment initiation by the index person with TB. The primary clinical effectiveness outcomes are the proportion of contacts diagnosed with and initiating active TB disease treatment and the proportion initiating TB preventative therapy within 60 days. We will assess outcomes from routine source documents using intention-to-treat analyses. We will also conduct nested mixed-methods studies of implementation fidelity and context and perform cost-effectiveness and impact modelling. The Makerere School of Public Health IRB(#554), the Uganda National Council for Science and Technology(#HS1720ES), and the Yale Institutional Review Board(#2000023199) approved the study and waived informed consent for the main trial implementation-effectiveness outcomes. We will submit results for publication in peer-reviewed journals and disseminate findings to local policymakers and representatives of affected communities. Discussion This pragmatic, quasi-experimental implementation trial will inform efforts to find and prevent undiagnosed persons with TB in high-burden settings using contact investigation. It will also help assess the suitability of human-centred design and communities of practice for tailoring implementation strategies and sustaining evidence-based interventions in low-and-middle-income countries. Trial registration The trial was registered(ClinicalTrials.gov Identifier NCT05640648) on 16 November 2022, after the trial launch on 7 March 2022.
Reindeer husbandry is the basis of the economy and way of life, the traditional occupation of the indigenous inhabitants of the North, Siberia and the Far East, and the most important branch of animal husbandry in the Republic of Sakha (Yakutia). Reindeer husbandry is associated with the cultural traditions, lifestyle and economy of the small national communities of the north. Yakutia is the traditional centre and the region of breeding domestic reindeer. Further development of reindeer husbandry, and increasing of the productivity and profitability of reindeer husbandry in Yakutia are impossible without proper organization and effective protection of domestic reindeer from various diseases, including parasitic ones, which cause significant damage to reindeer farms in the Republic. Reindeer are infected with 37 species of helminths. The results of the research of the authors of the article showed that all the studied deer had different types of helminths, and 100% were infected with gadfly larvae. The most frequent parasitic diseases in deer are monieziasis, larval echinococcosis, parenchymal, muscular and serosal cysticercosis, dictyocaulosis, nematodirellosis and elaphostrongylosis; moreover other parasitoses – edemagenosis and cephenomyosis – are recorded in 100% of deer. The authors of the article consider the infection of deer with larvae of subcutaneous and nasopharyngeal gadflies to be the number one problem.