Abstract
BackgroundThe true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya, and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 GeneXpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel.MethodsWe used an iterative process, going back and forth from quantitative and qualitative empiric data to reviewing literature, and applying the Behaviour Change Wheel guide. The key questions reflected on included (i) what is the problem we are trying to solve; (ii) what behaviours are we trying to change and in what way; (iii) what will it take to bring about desired change; (iv) what types of interventions are likely to bring about desired change; (v) what should be the specific intervention content and how should this be implemented?ResultsThe following behaviour change intervention functions were identified as follows: (i) training: imparting practical skills; (ii) modelling: providing an example for people to aspire/imitate; (iii) persuasion: using communication to induce positive or negative feelings or stimulate action; (iv) environmental restructuring: changing the physical or social context; and (v) education: increasing knowledge or understanding. The process resulted in a multi-faceted intervention package composed of redesigning of child tuberculosis training; careful selection of champions; use of audit and feedback linked to group problem solving; and workflow restructuring with role specification.ConclusionThe intervention components were selected for their effectiveness (from literature), affordability, acceptability, and practicability and designed so that TB programme officers and hospital managers can be supported to implement them with relative ease, alongside their daily duties. This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems.
Highlights
The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year
This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems
We used the Expert Recommendations for Implementing Change (ERIC) taxonomy to ensure consistent language in our intervention design, which adds to the body of work that can be comparable in future reviews of implementation studies
Summary
The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. By 2018, there were 183 GeneXpert® machines in Kenyan public hospitals Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. WHO recommends the use of Xpert® MTB/RIF (Xpert®) as a first-line TB diagnostic test and by 2018 there were 183 machines in Kenya in public hospitals across the country [10]. Despite these efforts by the NTP of training and making machines available, underuse of TB diagnostic tests in Kenya is quite high [6, 11]
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