Yale University

A Theory-informed Education and Counseling Intervention for HIV-TB Treatment Adherence (TEACH) in South Africa and Uganda

Principle Investigator(s):

Funder: National Institute of Mental Health
Project period:
Grant Type: Pilot Project

Abstract Text:

Poor treatment adherence is among the most important barriers to TB control, especially in sub-Saharan Africa. A substantial proportion of persons living with HIV (PLHIV) in the region fail to complete life-saving treatment for active TB, leading to avertable deaths and promoting spread of drug-resistant TB. Guidelines universally recommend education and counseling prior to initiating TB treatment to promote adherence, and a limited evidence base has shown that these interventions can be effective in improving patient-important outcomes such as treatment adherence, retention in care, and treatment completion. Nevertheless, extensive qualitative research highlights the multi-factorial barriers to delivery of education and counseling prior to initiation of HIV-TB treatment in routine settings. Furthermore, the lack of specific evidence or guidance in international guidelines about how to deliver education and counseling so that it addresses not only deficits in biomedical knowledge but also the social and behavioral factors constitutes a major knowledge gap. Therefore, we propose to carry-out a mixed-methods study to develop a theory-informed TB education and counseling intervention for PLHIV initiating therapy for active drug-susceptible TB at our study sites in rural Tugela Ferry, South Africa, and urban Kampala, Uganda. This work will be nested within ongoing, independent communitybased
implementation research and care programs embedded within national TB treatment programs, and will exploit pre-existing qualitative data and established capacity for mixed-methods research. Specifically, we propose in Aim 1 to exploit previously collected focus group discussions with health workers and prospective surveys of patients and health workers to develop a novel, theory-informed TB education and counseling intervention for HIV-TB patients initiating TB treatment. In Aim 2, we will train health workers to deliver the intervention, and perform a pilot study assessing its feasibility, acceptability, and face validity in 40 new HIV-TB patients using objective, theory-informed measures collected from both health workers and patients. Strengths of the proposal include its use of established infrastructure for qualitative data collection, including externally supported on-site trainees and research staff; previously collected data; and the experience of the investigators applying behavioral theories and frameworks to intervention design in resource-constrained settings through multi-disciplinary collaborations. The expected impact is to catalyze a new multi-country, multi-setting research partnership focused on applying implementation science to develop new more robust, externally valid HIV-TB interventions. It will also provide preliminary data to inform a future NIH R01 application in this area. Over the long term, this reseach will inform HIV-TB treatment guidelines, and help enhance treatment adherence, retention, and engagement of PLHIV in identifying secondary cases among close contacts at high risk of undiagnosed HIV and TB.