Tuberculosis Social Network Project Impact Evaluation 2016-2017 - India

Abstract
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Globally, tuberculosis (TB) affects some 8.7 million people. Women and children in the developing world are particularly vulnerable. The disease has high mortality rates, but even for survivors, the consequences can be debilitating, with long-term health consequences. Highly effective treatments are free and available to patients in developing countries, but many of those infected with TB are neither diagnosed nor in treatment. The under-detection of TB represents a key challenge for health officials in developing countries because identifying those who have the disease is crucial to the success of any treatment program.

Geographic coverage
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10 cities across three states (Delhi National Capital Region, Madhya Pradesh, and Rajasthan)

Analysis unit
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Individuals

Universe
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Operation ASHA patients receiving treatment for drug-susceptible TB who were at least two weeks into their course of medication when the baseline surveys commenced. The sample was expanded to include patients who had completed their six-month treatment in the three months before the start of the baseline surveys as well.

Kind of data
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Sample survey data [ssd]

Sampling procedure
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This study consisted of a randomized controlled trial implemented in 122 Directly Observed Treatment Short Course (DOTS) centers in 10 cities across three states (Delhi National Capital Region, Madhya Pradesh, and Rajasthan). The intervention was implemented by JPAL-South Asia in five waves between January 2016 and October 2017.

We augmented Operation ASHA's established use of community health workers and DOTS treatment by incorporating various types of referrals of new suspects by existing patients. Specifically, we used a cross-randomized design to test, respectively, three types of incentives for referrals and three types of outreach to prospective TB patients. The baseline sample included all Operation ASHA patients receiving treatment for drug-susceptible TB who were at least two weeks into their medication course when the baseline surveys commenced. We expanded the sample to include patients who had completed their six-month treatment in the three months before the start of the baseline surveys. Existing patients were either in the intensive phase (IP) of treatment, where they came to the clinic three times per week, or in the continuing phase (CP) of treatment (typically following IP), which required them to come to the clinic once a week. In cases where the patient was a minor, the survey questions and interventions were addressed to the legal guardian. The experiment was rolled out in five waves between March 2016 and October 2017. To address the possibility of spillover effects between patients, we randomized by center. A total of 3,176 patients were included in our study.

Mode of data collection
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Computer Assisted Personal Interview [capi]

Research instrument
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Four survey instruments were used for this study:

Baseline Survey:
- Section A: General Information
- Section B: PII Information
- Section C: Demographics
- Section D: Household Information
- Section E: Health
- Section F: Information Sharing
- Section G: Referrals
- Section H: Survey Status Code
- Section I: Re-Entering Unique ID Code
- Section J: Comments
- Section Y: Record GPS Coordinates

Endline Survey:
- Section AAA: General Information
- Section AA: PII Information
- Section A: TB Treatment
- Section B: Referral Cards
- Section C: Reward Information
- Section D: Optimism and Happiness
- Section E: Buy-Back Scheme
- Section F: Comments
- Section G: Survey Status Code
- Section H: Re-Entering Unique ID Code
- Section Y: Record GPS Coordinates
- Section Z: Survey Accompaniment

New Patient Survey:
- Section A: General Information
- Section B: PII Information
- Section C: Demographics
- Section D: Household Information
- Section E: Health
- Section F: Information Sharing
- Section G: Quality of Care
- Section H: Optimism and Happiness
- Section I: Survey Status Code
- Section J: Re-Entering Unique ID Code
- Section K: Comments
- Section Y: Record GPS Coordinates
- Section Z: Survey Accompaniment

Referral Survey:
- Section A: General Information
- Section B: PII Information
- Section C: Demographics
- Section D: Household Information
- Section X: Referral Scheme Related Information
- Section E: Health
- Section F: Information Sharing
- Section G: Quality of Care
- Section H: Optimism and Happiness
- Section I: Survey Status Code
- Section J: Re-Entering Unique ID Code
- Section K: Comments
- Section Y: Record GPS Coordinates

The questionnaires are provided in English and Hindi and are made available for download.

摘要
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在全球范围内，结核病（TB）影响着约870万人。在发展中国家，妇女和儿童尤其易受其害。该疾病具有较高的死亡率，即使是幸存者，其后果也可能导致终身残疾，并伴随长期的健康影响。对于发展中国家的患者，高度有效的治疗方案是免费且可获得的，但许多感染结核病的人既未得到诊断也未接受治疗。在发展中国家，结核病的未检测出率构成了对卫生官员的关键挑战，因为识别患病者对于任何治疗计划的成功至关重要。
地理覆盖范围
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涵盖三个州（德里首都地区、马哈拉施特拉邦和拉贾斯坦邦）的10个城市。
分析单元
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个体。
总体
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在基准调查开始时，接受药物治疗性结核病治疗的 ASHA 运动患者，他们在药物治疗的基线调查开始时至少已经服用药物两周。样本扩大到包括在基线调查开始前三个月内完成六个月治疗的患者。
数据类型
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样本调查数据 [ssd]。
抽样程序
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本研究包括一项在德里首都地区、马哈拉施特拉邦和拉贾斯坦邦的10个城市中的122个直接观察治疗短疗程（DOTS）中心实施的随机对照试验。干预措施由 JPAL-South Asia 在2016年1月至2017年10月之间的五个波次中实施。
我们通过整合现有患者对新疑似病例的各种类型转介，增强了 ASHA 运动社区健康工作者和 DOTS 治疗的既有使用。具体而言，我们采用交叉随机设计，分别测试三种转介激励措施和三种针对潜在结核病患者的外展服务。基线样本包括在基线调查开始时，至少已经服用药物两周的接受药物治疗性结核病治疗的 ASHA 运动患者。我们将样本扩大到包括在基线调查开始前三个月内完成六个月治疗的患者。现有患者要么处于治疗强化阶段（IP），每周需到诊所三次，要么处于治疗持续阶段（CP）（通常在 IP 之后），每周需到诊所一次。如果患者为未成年人，调查问题和干预措施将针对法定监护人进行。实验在2016年3月至2017年10月之间的五个波次中展开。为了解决患者之间可能存在的溢出效应，我们按中心进行随机分配。共有3,176名患者被纳入我们的研究。
数据收集方式
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计算机辅助个人访谈 [capi]。
研究工具
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本研究使用了四种调查工具：
基线调查：
- A节：一般信息
- B节：个人信息
- C节：人口统计信息
- D节：家庭信息
- E节：健康
- F节：信息共享
- G节：转介
- H节：调查状态代码
- I节：重新进入唯一ID代码
- J节：评论
- Y节：记录GPS坐标

终期调查：
- AAA节：一般信息
- AA节：个人信息
- A节：结核病治疗
- B节：转介卡
- C节：奖励信息
- D节：乐观和幸福感
- E节：回购计划
- F节：评论
- G节：调查状态代码
- H节：重新进入唯一ID代码
- Y节：记录GPS坐标
- Z节：调查陪同

新患者调查：
- A节：一般信息
- B节：个人信息
- C节：人口统计信息
- D节：家庭信息
- E节：健康
- F节：信息共享
- G节：医疗服务质量
- H节：乐观和幸福感
- I节：调查状态代码
- J节：重新进入唯一ID代码
- K节：评论
- Y节：记录GPS坐标
- Z节：调查陪同

转介调查：
- A节：一般信息
- B节：个人信息
- C节：人口统计信息
- D节：家庭信息
- X节：转介计划相关信息
- E节：健康
- F节：信息共享
- G节：医疗服务质量
- H节：乐观和幸福感
- I节：调查状态代码
- J节：重新进入唯一ID代码
- K节：评论
- Y节：记录GPS坐标

调查问卷以英语和印地语提供，并可下载。