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Table 6 Application of the RE-AIM framework to this project

From: Bridging the knowledge-practice gap in tuberculosis contact management in a high-burden setting: a mixed-methods protocol for a multicenter health system strengthening study

RE-AIM dimension and operational definition

Plan

Indicators

How will I and the intervention reach the targeted population?

Reach is the absolute number or proportion of individuals who are willing to participate in a given initiative.

• Project staff will visit clinics directly and meet with relevant local stakeholders. We already have support and permission from relevant local authorities to undertake the study.

• TB staff at the participating health facilities will be trained in workshops and informal on-the-job interactions to undertake the intervention, comprising identifying TB symptoms and asymptomatic TB contacts, referral, education of patients, prescribing, and monitoring.

• Project staff will also have direct contact with selected, consenting TB patients and their contacts through referral by clinic staff, for interviews and provision of education.

• Proportion of health providers who participate in the intervention

• Uptake of contact investigation among smear sputum positive TB individual

• Uptake of preventive therapy among child contact of smear sputum positive TB cases

How do I know my intervention is effective?

Effectiveness is the impact of an intervention on outcomes, including potential negative effects, quality of life, and economic outcomes.

• Relevant data will be collected regularly. The listed quantitative outcome measures will demonstrate whether interventions are working

• Results of staff interviews will show whether staff have adequate knowledge of the process of contact management, and whether they are satisfied with the project.

• Significant change in the practice of contact investigation and preventive treatment identified using ARIMA model

• Number of new TB cases (adult and children) identified from contact investigation

• Number of children eligible for preventive therapy identified from contact investigation

• Number of eligible children commence on preventive therapy

• Adherence to preventive therapy among eligible contacts

How do I develop organizational support to deliver my intervention?

Adoption is the absolute number, proportion, and representativeness of settings and intervention agents who are willing to initiate a program.

• This has been achieved already through face-to-face meetings with and endorsement from the Timika Health Authority (Dinas Kesehatan Timika), as well as endorsement of the study protocol by the National TB expert committee. A partnership agreement has been signed with all selected health facilities.

• Number of healthcare workers who were trained and actively participated in the program will be measured.

• Health staff perception about the appropriateness, comfort, relative advantage, and credibility of the intervention

• Proportion of TB nurses, TB physicians, head of Puskesmas, hospital managements, and district health office staff who are willing to accept, support. and participate in the intervention

• The extent of support and participation of TB-related health staff and stakeholders in the contact investigation and preventive therapy program

How do I ensure the intervention is delivered properly?

Implementation refers to the intervention agents’ fidelity to the various elements of the intervention’s protocol

• Project staff will directly supervise project implementation. The research team (study nurses working with doctoral researcher) has been well trained and already has a strong background in TB management.

• Data checking will be undertaken regularly during the project.

• Fidelity of the intervention

• The extent to which the intervention can be carried out in Puskesmas and Hospital

• Gap between indigenous and non-indigenous Papuan people in the access and quality of the intervention

How do I incorporate the intervention, so it is delivered over the long-term?

Maintenance is the extent to which a program or policy becomes institutionalized or part of the routine organizational practices and policies.

• The use of continuous quality improvement will embed practice locally and sustainably.

• Some actions to repair logistic barriers to TB contact tracing (e.g., lack of medication supply) are being overcome early in the study—this effect will be sustained.

• Train-the-trainer concepts will be employed to ensure sustainability of knowledge within healthcare centers.

• Inclusion of budget for isoniazid prevention therapy and contact investigation in primary care facilities or hospital budgets can also be indicators of program sustainability.

• The extent to which the intervention is institutionalized or maintained within health facility and district health system

• Integration of the intervention to the other existing program in health facilities.

  1. Puskesmas pusat kesehatan masyarakat (community health center)