Table 4.
Logic model for design of a novel implementation strategy to adapt and deliver household TB contact investigation.
| Resources | Activities | Outputs | Outcomes | Impact assessment |
|---|---|---|---|---|
| Evidence & Guidelines | Reviewing evidence | Adapted evidence | Implementation protocol | Drafting evaluation protocol |
| WHO | Document review | New TB diagnostic policies | Ethical approvals | Trial registration |
| TB-CARE | Attending CI training | CI implementation guide | Regulatory approvals | Design of fidelity studies |
| NTLP | Inviting local expert input | NTRL diagnostic guidelines | ||
| Systematic reviews | Identifying gaps | New CI literature | ||
| Targeted reviews | Projecting uptake | Cascade of CI delivery | ||
| Frontline stakeholders | Engaging & soliciting input | Summaries of input | Prepared stakeholders | Metrics for M&E |
| Index TB patients | Direct observation | Key behaviors | Education & training | Feasibility measures |
| Household contacts | Focus group discussions | Key themes | Pilot testing | Acceptability measures |
| Clinic patients | Surveys | Behavioral determinants | Direct observation | Fidelity measures |
| Clinic workers | Process mapping | Targeted interventions | Data review | Outcome measures |
| Lay health workers | Skill assessments | Behavior change techniques | Protocol revision | |
| Implementers | Building collaborations | Dialogue with implementers | Coordinated implementation | Disseminating results/plans |
| Uganda MoH | Exchanging information | New TB diagnostic policies | Sharing preliminary results | Local presentations |
| Capital City Council | One-on-one meetings | Facility renovations | CI/adherence support bundle | Local reports |
| Research groups | Exchanging ideas | Kampala TB CI rollout | Troubleshooting technologies | Scientific publications |
| International NGOs | Coordinating roll-out | Staffing agreements | ||
| Community NGOs | Negotiating staff allocation | Mobile app prototype | ||
| ICT vendors | Bidding & specification | Uganda TB CI Guidelines |
CI, contact investigation; ICT, Information & Communications Technology; M&E, monitoring and evaluation; MoH, Ministry of Health; NGOs, non-governmental organizations; NTLP, National Tuberculosis and Leprosy Programme; NTRL, National TB Reference Lab; TB, tuberculosis, WHO, World Health Organization.
The table shows the progression, from left to right, of the intervention adaptation and implementation design process, which was characterized by multi-level engagement with stakeholders in order to adapt the WHO recommended household TB contact investigation intervention to the local context and plan for implementation. We began with a formative phase (Resources, Activities, Outputs columns) in which we (1) identified key contact investigation behaviors and activities in collaboration with stakeholders; (2) employed mixed-methods data collection to explore key questions of interest; (3) applied an established theory of behavior change to identify barriers and facilitators of key contact investigation behaviors; and (4) tailored behavior change techniques into implementation strategies targeted to overcome barriers and enhance facilitators. We subsequently moved to a summative phase (Outcomes, Impact Assessment columns) where first piloted then adapted and evaluated the delivery of TB contact investigation, comparing a client-centered, mHealth-facilitated implementation strategy with a standard approach.