A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa
Abstract Introduction : Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub‐optimally implemented. Quality improvement (QI) methods offer a low‐cost and easily implementable approach to strengthening heal...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-09-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.25803 |
| _version_ | 1797904000434044928 |
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| author | Santhanalakshmi Gengiah Pierre M. Barker Nonhlanhla Yende‐Zuma Mduduzi Mbatha Shane Naidoo Myra Taylor Marian Loveday Mesuli Mhlongo Clark Jackson Andrew J. Nunn Nesri Padayatchi Salim S. Abdool Karim Kogieleum Naidoo |
| author_facet | Santhanalakshmi Gengiah Pierre M. Barker Nonhlanhla Yende‐Zuma Mduduzi Mbatha Shane Naidoo Myra Taylor Marian Loveday Mesuli Mhlongo Clark Jackson Andrew J. Nunn Nesri Padayatchi Salim S. Abdool Karim Kogieleum Naidoo |
| author_sort | Santhanalakshmi Gengiah |
| collection | DOAJ |
| description | Abstract Introduction : Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub‐optimally implemented. Quality improvement (QI) methods offer a low‐cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV‐TB care in rural South African primary healthcare (PHC) clinics. Methods Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on‐site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study‐appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing. Results The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02–1.38; p=0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02–2.72; p=0·044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05; p=0.448), initiated on ART (91.7 vs. 95.5; RR=0.96; p=0.172) and VL testing (72.2% vs. 72.8%; RR=0.99; p=0.879) was similar in both groups. Conclusions QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV‐TB service delivery and increase the success of future QI scale‐up activities. |
| first_indexed | 2024-04-10T09:41:52Z |
| format | Article |
| id | doaj.art-3b6b6adedeb74fc1978ca6e52f52ba0e |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-04-10T09:41:52Z |
| publishDate | 2021-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-3b6b6adedeb74fc1978ca6e52f52ba0e2023-02-17T07:55:39ZengWileyJournal of the International AIDS Society1758-26522021-09-01249n/an/a10.1002/jia2.25803A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South AfricaSanthanalakshmi Gengiah0Pierre M. Barker1Nonhlanhla Yende‐Zuma2Mduduzi Mbatha3Shane Naidoo4Myra Taylor5Marian Loveday6Mesuli Mhlongo7Clark Jackson8Andrew J. Nunn9Nesri Padayatchi10Salim S. Abdool Karim11Kogieleum Naidoo12Centre for the AIDS Programme of Research in South Africa (CAPRISA) Durban South AfricaInstitute for Healthcare Improvement Cambridge Massachusetts USACentre for the AIDS Programme of Research in South Africa (CAPRISA) Durban South AfricaDepartment of Health Pretoria South AfricaDepartment of Health Pretoria South AfricaSchool of Nursing and Public Health University of KwaZulu‐Natal Durban South AfricaMRC‐CAPRISA HIV‐TB Pathogenesis and Treatment Research Unit Doris Duke Medical Research Institute University of KwaZulu‐Natal Durban South AfricaCentre for the AIDS Programme of Research in South Africa (CAPRISA) Durban South AfricaInstitute for Healthcare Improvement Cambridge Massachusetts USAMedical Research Council Clinical Trials Unit at University College London (UCL) London UKCentre for the AIDS Programme of Research in South Africa (CAPRISA) Durban South AfricaCentre for the AIDS Programme of Research in South Africa (CAPRISA) Durban South AfricaCentre for the AIDS Programme of Research in South Africa (CAPRISA) Durban South AfricaAbstract Introduction : Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub‐optimally implemented. Quality improvement (QI) methods offer a low‐cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV‐TB care in rural South African primary healthcare (PHC) clinics. Methods Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on‐site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study‐appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing. Results The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02–1.38; p=0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02–2.72; p=0·044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05; p=0.448), initiated on ART (91.7 vs. 95.5; RR=0.96; p=0.172) and VL testing (72.2% vs. 72.8%; RR=0.99; p=0.879) was similar in both groups. Conclusions QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV‐TB service delivery and increase the success of future QI scale‐up activities.https://doi.org/10.1002/jia2.25803cluster‐randomizedcollaborativesHIV‐TB servicesintegrationprimary healthcare clinicsquality improvement |
| spellingShingle | Santhanalakshmi Gengiah Pierre M. Barker Nonhlanhla Yende‐Zuma Mduduzi Mbatha Shane Naidoo Myra Taylor Marian Loveday Mesuli Mhlongo Clark Jackson Andrew J. Nunn Nesri Padayatchi Salim S. Abdool Karim Kogieleum Naidoo A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa Journal of the International AIDS Society cluster‐randomized collaboratives HIV‐TB services integration primary healthcare clinics quality improvement |
| title | A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa |
| title_full | A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa |
| title_fullStr | A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa |
| title_full_unstemmed | A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa |
| title_short | A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa |
| title_sort | cluster randomized controlled trial to improve the quality of integrated hiv tuberculosis services in primary healthcareclinics in south africa |
| topic | cluster‐randomized collaboratives HIV‐TB services integration primary healthcare clinics quality improvement |
| url | https://doi.org/10.1002/jia2.25803 |
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