RT Journal Article
SR Electronic
T1 A Quality Improvement Intervention to Inform Scale-Up of Integrated HIV-TB Services: Lessons Learned From KwaZulu-Natal, South Africa
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 444
OP 458
DO 10.9745/GHSP-D-21-00157
VO 9
IS 3
A1 Santhanalakshmi Gengiah
A1 Kogieleum Naidoo
A1 Regina Mlobeli
A1 Maureen F. Tshabalala
A1 Andrew J. Nunn
A1 Nesri Padayatchi
A1 Nonhlanhla Yende-Zuma
A1 Myra Taylor
A1 Pierre M. Barker
A1 Marian Loveday
YR 2021
UL http://www.ghspjournal.org/content/9/3/444.abstract
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.