The Impact of Involving Informal Health Providers for Tuberculosis Control in Sudan

Study Overview
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Brief Summary
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Training and engaging of unpaid informal providers (such as tea-sellers, women's groups, youth clubs, small traders and religious groups) from poorer localities in TB disease recognition, referral and community awareness raising will increase the access of TB patients to formal health facilities and decrease their delay in initiating TB treatment.

Detailed Description
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Barriers to accessing health services faced by poor and vulnerable populations are numerous in developing countries. These include; geography, income poverty, lack of trust in the quality of public health services, and lack of empowerment of women and adolescent girls (as patients and carers) to mobilize adequate and timely resources to access these services. The project aims to test if TB case detection can be increased by engaging informal health care providers in active case finding. In one urban district of Khartoum, these providers will be trained to work as first point of entry to the health system using a comprehensive package that includes disease recognition, health communication, and patient referral. In a comparator urban district of Khartoum, no attempts will be made to engage informal providers. By comparing data of TB patients and Lab registers between the intervention and comparator districts in Khartoum, this project aims to test if, and to what extent, these expected effects can be realized. Overall this is a trial of a health policy so individual patients will not be recruited or randomized to one intervention or the other. Rather the policy is being applied in one district while the other district is being used as a comparator.

Official Title
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Triage Plus for TB: Improving Community-Based Provision for TB in Africa. The Impact of Involving Informal Health Providers for Tuberculosis Control in Sudan

Conditions
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Tuberculosis

Intervention / Treatment
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* Behavioral: Referral of presumptive of TB cases by informal providers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Access point for health seeking by the poor and vulnerable Active and well known in community Intervention activities can be confined to intervention area Based in community/locality Longevity; long standing Present in control and intervention areas Able and willing to complete the training to be Triage-Plus providers (ie giving formal consent) Exclusion Criteria: Formal health providers, e.g. clinics, labs, hospitals (MOH, NGO or private) Internationally funded organizations, e.g. international NGOs Civil servants e.g. teachers

Ages Eligible for Study
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Minimum Age: 14 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ombda Locality: informal providers<br>Ombda locality is located in Western Khartoum and populated with population size of 988,163. Intervention: 380 unpaid Informal providers trained to recognise TB symptoms and to refer presumptive TB cases to formal health care facilities within the area. | Behavioral: Referral of presumptive of TB cases by informal providers<br>* Training of informal providers to effectively refer TB suspects in the community to the primary health care system<br>|
| No Intervention: Jabal Awlia Locality<br>The control arm: A locality in south eastern site of Khartoum state populated with 942,429. No intervention took place | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total number of TB patients registered and start receiving treatment in formal health care facilities | This will be measured by comparing Data from routine patients registered in formal TB management units in the intervention arm and compare it with the same routine data from the control arm. similar data for the previous year will undergo the same comparison as time control for both arms | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Tuberculosis, Informal providers, Informal carers, Barriers to health system