PT - JOURNAL ARTICLE AU - Santhanalakshmi Gengiah AU - Kogieleum Naidoo AU - Regina Mlobeli AU - Maureen F. Tshabalala AU - Andrew J. Nunn AU - Nesri Padayatchi AU - Nonhlanhla Yende-Zuma AU - Myra Taylor AU - Pierre M. Barker AU - Marian Loveday TI - A Quality Improvement Intervention to Inform Scale-Up of Integrated HIV-TB Services: Lessons Learned From KwaZulu-Natal, South Africa AID - 10.9745/GHSP-D-21-00157 DP - 2021 Sep 30 TA - Global Health: Science and Practice PG - 444--458 VI - 9 IP - 3 4099 - http://www.ghspjournal.org/content/9/3/444.short 4100 - http://www.ghspjournal.org/content/9/3/444.full SO - GLOB HEALTH SCI PRACT2021 Sep 30; 9 AB - Key FindingsThe quality improvement (QI) intervention was able to guide clinic staff in developing simple but effective change interventions, using resources already available, to improve HIV-TB integrated service delivery.The QI intervention implemented dramatically improved isoniazid preventive therapy initiation rates among eligible HIV patients and resulted in moderate improvements in HIV testing and screening, TB screening, and viral load monitoring.Key ImplicationsProgram managers should ensure that all categories of health care workers from all levels of the health care system are included in QI workshops or learning sessions to harness the knowledge and experiences of all role players working within the system.QI implementers should consider adopting a combination approach to improvement interventions, such as QI training combined with mentorship, collaborative learning, and data QI activities.To strengthen and ensure the success of QI interventions, senior-level program managers should consider allocating resources (human, financial, and infrastructure) dedicated to data QI for a sustainable and effective QI program.Introduction:In South Africa, mortality rates among HIV-TB coinfected patients are among the highest in the world. The key to reducing mortality is integrating HIV-TB services, however, a generalizable implementation method and package of tested change ideas to guide the scale-up of integrated HIV-TB services are unavailable. We describe the implementation of a quality improvement (QI) intervention, health systems’ weaknesses, change ideas, and lessons learned in improving integrated HIV-TB services.Methods:Between December 1, 2016, and December 31, 2018, 8 nurse supervisors overseeing 20 primary health care (PHC) clinics formed a learning collaborative to improve a set of HIV-TB process indicators. HIV-TB process indicators comprised: HIV testing services (HTS), TB screening among PHC clinic attendees, isoniazid preventive therapy (IPT) for eligible HIV patients, antiretroviral therapy (ART) for HIV-TB coinfected patients, and viral load (VL) testing at month 12. Routine HIV-TB process data were collected and analyzed.Results:Key change interventions, generated by health care workers, included: patient-flow redesign, daily data quality checks; prior identification of patients eligible for IPT and VL testing. Between baseline and post-QI intervention, IPT initiation rates increased from 15.9% to 76.4% (P=.019), HTS increased from 84.8% to 94.5% (P=.110), TB screening increased from 76.2% to 85.2% (P=.040), and VL testing increased from 61.4% to 74.0% (P=.045). ART initiation decreased from 95.8% to 94.1% (P=.481).Discussion:Although integrating HIV-TB services is standard guidance, existing process gaps to achieve integration can be closed using QI methods. QI interventions can rapidly improve the performance of processes, particularly if baseline performance is low. Improving data quality enhances the success of QI initiatives.