Feasibility of an mobile application as a tool for multidrug-resistant tuberculosis contact monitoring in Peru.

This study aimed to validate an ODK digital mobile application (ODK-DMA) in contacts exposed to multidrug-resistant tuberculosis (MDR-TB) in Lima, Peru. Using a questionnaire in an application on a mobile device, we registered 129 household contacts of 29 index cases of MDR-TB under treatment in 10 health facilities in South Lima in August 2018. The mean time of registration per contact was found to be 4 minutes. The prevalence of active TB symptoms among MDR-TB contacts was 3.1%. An acceptability questionnaire was completed by 31 respondents; all reported feeling comfortable or very comfortable with recording their data in the ODK-DMA, although 10% expressed concerns about confidentiality. We concluded that the ODK-DMA was a feasible and acceptable tool for registering household contacts exposed to cases with MDR-TB. Future studies should consider the use of mobile platforms for the monitoring of MDR-TB contacts

Identificación de las prioridades nacionales de investigación en COVID-19 (SARS-CoV-2) y otros virus respiratorios con potencial pandémico: Descripción del proceso peruano

Research priorities are a fundamental component of national health research systems. In the year 2021, the National Institute of Health led the process of identifying the "national research priorities in COVID-19 (SARS-CoV-2) and other respiratory viruses with pandemic potential: Preparing for the next pandemic, 2022-2026”. The process was developed following the previous methodology for identification of research priorities used by the Instituto Nacional de Salud (Perú), which was to be adapted to a virtual environment, with four phases. Six strategic objectives to be achieved were formulated and served as an umbrella for the identification of national priorities, a total of 21 research priorities were identified. It is recommended that a plan for the implementation of research priorities be formulated and executed and that the Ministry of Health, through its different instances, take the necessary steps to obtain and allocate resources to the generation of evidence within the framework of priorities.Las prioridades de investigación son un componente fundamental de los sistemas nacionales de investigación en salud. En el año 2021, el Instituto Nacional de Salud lideró el proceso de identificación de las “prioridades nacionales de investigación en COVID-19 (SARS-CoV-2) y otros virus respiratorios con potencial pandémico: Preparándonos para la siguiente pandemia, 2022-2026”. El proceso siguió la metodología previamente utilizada por el Instituto Nacional de Salud (Perú) para la identificación de prioridades de identificación, la que se tuvo que adaptar a un entorno totalmente virtual, con cuatro fases. Se formularon seis objetivos estratégicos a alcanzar y que sirvieron de paraguas para la identificación de las prioridades nacionales, se identificaron en total 21 prioridades de investigación. Se recomienda se formule y ejecute un plan de implementación de las prioridades de investigación y que el Ministerio de Salud a través de sus diferentes instancias realice las gestiones necesarias para conseguir y destinar recursos a la generación de evidencia en el marco de las prioridades

Stated preferences of doctors for choosing a job in rural areas of Peru: a discrete choice experiment.

BACKGROUND: Doctors' scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors' stated preferences for rural jobs. METHODS AND FINDINGS: A labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho's capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%. CONCLUSIONS: Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden

Isoniazid preventive therapy completion in children under 5 years old who are contacts of tuberculosis cases in Lima, Peru: study protocol for an open-label, cluster-randomized superiority trial

Abstract Background Children &lt; 5 years old in contact with TB cases are at high risk for developing severe and fatal forms of TB. Contact investigation, BCG vaccination, and isoniazid preventive therapy (IPT) are the most effective strategies to prevent TB among children. However, the implementation of IPT faces challenges at several stages of the cascade of care of TB infection among children, particularly those less than 5 years old. In Peru, a large proportion of children do not complete IPT, which highlights the need to design effective interventions that enhance preventive therapy adherence and completion. Although the body of evidence for such interventions has grown, interventions in medium TB incidence settings are lacking. This study aims to test the effectiveness, acceptability, and feasibility of an intervention package to increase information and motivation to complete IPT among children &lt; 5 who have been prescribed IPT. Methods An open-label, cluster-randomized superiority trial will be conducted in two districts in South Lima, Peru. Thirty health facilities will be randomized as clusters, 10 to the intervention and 20 to control (standard of care). We aim to recruit 10 children from different households in each cluster. Participants will be caretakers of children aged &lt; 5 years old who initiated IPT. The intervention consists of educational material, and short message services (SMS) reminders and motivators. The primary outcomes will be the proportion of children who picked up &gt; 90% of the 24 weeks of IPT (22 pick-ups) and the proportion of children who picked up the 24 weeks of IPT. The standard of care is a weekly pick-up with monthly check-ups in a health facility. Feasibility and acceptability of the intervention will be assessed through an interview with the caretaker. Discussion Unfavorable outcomes of TB in young children, high effectiveness of IPT, and low rates of IPT completion highlight the need to enhance adherence and completion of IPT among children &lt; 5 years old. Testing of a context-adapted intervention is needed to improve IPT completion rates and therefore TB prevention in young children. Trial registration ClinicalTrials.gov NCT03881228. Registered on March 19, 2019. </jats:sec