AUTHOR=Davis J. Lucian , Ayakaka Irene , Ggita Joseph M. , Ochom Emmanuel , Babirye Diana , Turimumahoro Patricia , Gupta Amanda J. , Mugabe Frank R. , Armstrong-Hough Mari , Cattamanchi Adithya , Katamba Achilles 

TITLE=Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.837211

DOI=10.3389/fpubh.2022.837211

ISSN=2296-2565

ABSTRACT=Since 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own previously published, formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e. barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy. We introduced some components universally, including those designed to facilitate initial uptake of contact investigation, with positive results. Other components designed to facilitate completion of TB evaluation – home-based TB-HIV evaluation and follow-up text messaging – to comparative evaluation against usual care in a household cluster-randomized trial, with negative results due to failed implementation of home sputum collection and text messaging. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. A