Date of Award

January 2020

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Lucian Davis

Abstract

Tuberculosis (TB) is one of the leading causes of death worldwide and disproportionally burdens low- to middle-income countries (LMICs). Upon initiation of treatment for an active TB diagnosis, universal TB education and counseling (TEC) is recommended to promote knowledge and medication adherence. Though previous studies have shown that there are areas that can be improved when delivering routine TEC, there is limited data on how peer-led TEC can fill these gaps in Kampala, Uganda. Our study evaluated the efficacy of a peer-led TEC intervention among newly diagnosed adults initiating TB treatment in Kampala and assessed capacity for scale-up. We used a pre-post, prospective cohort study to compare two longitudinal cohorts and a parallel exploratory sequential study to evaluate implementation. Intervention outcomes included TB knowledge and retention between peer-led and routine TEC. Implementation outcomes included acceptability and feasibility among health workers. 80 patients were enrolled (June-July 2018) into routine TEC, including 22 (28%) women and 29 (36%) persons living with HIV. 81 patients were enrolled (August-November 2019) into peer-led TEC, including 25 (31%) women and 24 (30%) persons living with HIV. When comparing type of TEC, peer-led TEC had higher disease-specific knowledge scores post counseling (difference +21%, 95% CI +18% to +24%, P<.0001) and at two-weeks (Difference +18%, 95% CI +13% to +23%, P<.0001) and higher treatment-specific knowledge scores post counseling (Difference +14, 95% CI +10 to +18, P<.0001) and at two-weeks (Difference +4, 95% CI +1 to +10, P=.11). Our findings showed that peer-led TEC was more efficacious than routine TEC at improving TB knowledge. The exploratory sequential study found that peer-led TEC was perceived to be both acceptable and feasible. Future studies should address barriers to knowledge retention and scale-up of peer-led TEC.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/27/2021

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