Claudia L Thompson
$893,525
Johns Hopkins University
Maryland
National Institute of Environmental Health Sciences (NIEHS)
Chronic respiratory diseases (CRDs) remain the third leading cause of death worldwide and their incidence is increasing. In 2019, it was estimated that 455 million people worldwide live with a CRD such as asthma, COPD, and chronic bronchitis. CRDs are responsible for 4 million deaths and 103.5 million disability-adjusted life years lost each year. The development and severity of CRDs is attributed to both environmental exposures and infectious causes. Individuals who live in densely populated cities in low- and middle-income countries (LMICs) are disproportionately affected by high levels of ambient particulate matter, indoor exposure to allergens, dust and tobacco smoke, and a high incidence of viral and bacterial infections. Therefore, to have a meaningful impact on the incidence and severity of CRDs, and prevent further lung function decline, a multi- component evidence-based intervention targeting multiple risk factors is needed. We seek to test the implementation and effectiveness of a tailored multi-component evidence-based intervention following a community health worker (CHW)-driven chronic care delivery model to protect lung health over a 40-month period using a Type I hybrid implementation-effectiveness randomized controlled trial in Bhaktapur, Nepal. The multi-component intervention will consist of: reducing environmental risk factors by targeting tobacco smoking through CHW-delivered messaging and education on smoking prevention and smoking cessation, and targeting indoor and ambient air pollution exposures by providing households with HEPA-indoor air purifiers and vacuum cleaners and encourage masking outdoors with N95 respirators when e-notified about days with high ambient air pollution; reducing infectious risks through an CHW-led vaccine campaign for annual influenza, COVID and pneumococcal vaccine in all eligible participants and household members; encouraging use of surgical masks in indoor public spaces during the peak winter season or at home when there are sick household contacts; and, improving physiologic health by encouraging physical activity through CHW- monitored pedometer goals. Aligned with the Consolidated Framework for Implementation Research, we will first conduct human-centered design workshops with community members and healthcare practitioners to tailor the multi-component intervention. We will then screen and identify 800 index participants aged ≥ 9 years (with a pre-bronchodilator FEV1/FVC Z-score ≤ 10th percentile and chronic cough or wheeze (i.e., at-risk participants). We will enroll index participants and household members and assign half of the households to the adapted intervention. Controls will be asked to continue usual care practices. We will evaluate the effect of the intervention on pre-bronchodilator FEV1 Z-score (primary outcome), respiratory symptoms, and evaluate implementation outcomes. We seek to facilitate scale-up of a multi-component intervention that responds to the real-world implementation context to protect lung health in Nepal and other LMICs.