Understanding and addressing geographic barriers to accessing TB services in a high-burden urban setting

Active Project Grant Awarded Last action

Award ID
R01AI168424
Recipient
Awarding agency
Obligated
$5,276,991

Award facts

Assistance listing
93.855 Allergy and Infectious Diseases Research
Completion date 75% complete
Place of performance
Roxbury, MA 02118, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
Each year, over 10 million people become sick with tuberculosis (TB), and around 1.4 million DIE from the disease. Around 86% of people with TB live in middle-income countries, with a large proportion living in cities. To substantially decrease the global burden of TB, IT is necessary to ensure that people are diagnosed quickly and treated successfully. Geographic barriers to accessing health services - such as living far from a health center - can lead to poor health outcomes. However, there is limited knowledge about how geographic access barriers impact TB diagnosis and treatment outcomes in middle-income country urban settings. Health facilities are generally present in these settings, but people with TB, who are often socially and economically disadvantaged, face barriers in accessing them. We also lack tools for designing and targeting interventions that address access barriers and thus improve TB diagnosis and treatment. This proposal seeks to address these knowledge gaps using the "5 a's" conceptual framework, which describes five domains that drive health care access: availability, accessibility, accommodation, affordability, acceptability. To help understand how geographic accessibility barriers and other types of access barriers contribute to delayed TB diagnosis, we will apply structural equation modeling and simulation methods to data from TB patient surveys based on the 5 a's framework. To help programs target interventions to communities that are most at risk for delayed TB diagnosis and incomplete TB treatment, we will create community-level risk scores that incorporate measures of geographic accessibility as well as socioeconomic and demographic census data. To help programs develop effective treatment support interventions, we will conduct a discrete choice experiment to identify optimal packages of interventions aimed at addressing different types of access barriers during treatment, assessing how preferences differ among different demographic groups. This proposal is significant because the results will help TB programs to identify interventions that would be most effective for improving TB diagnosis and treatment, and target these interventions to the individuals and communities that need them most. This proposal is innovative because prior quantitative TB research studies have not used a health care access conceptual framework, structural equation modeling or conjoint analysis to understand how to address access barriers, or community risk scores to target interventions. In the long term, this research will help TB programs reduce delays to diagnosis and incomplete treatment rates, thus reducing the global burden of TB morbidity and mortality.

Transactions

Action Obligated Date
Amendment $642,522
Amendment $562,047
Amendment $57,205
Amendment $57,205
Amendment $514,856
Amendment $514,856
Amendment $514,856
Amendment $603,361
Amendment $603,361
Amendment $603,361
Original award $603,361
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Subawards

Subrecipient Amount Awarded
Socios En Salud Sucursal Peru Socios En Salud (SES) will be responsible for all data collection for the proposed award. For Aim 1, SES will help coordinate the transfer of de-identified data… $180,790
Brigham & Womens Hospital Inc. Dr. Yuen will develop the protocol for the survey-based human subjects research in Aims 2 and 3 and ensure IRB approval of the protocol at BWH and in Peru.… $820,264

Quick answers

Who received award R01AI168424?

R01AI168424 was awarded to Trustees Of Boston University by National Institute of Allergy and Infectious Diseases (National Institutes of Health) on February 1, 2023.

How much is award R01AI168424 worth?

$5,276,991 has been obligated on R01AI168424.

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