Summary
Setting
An HIV clinic in Addis Ababa, Ethiopia.
Objective
The World Health Organization (WHO) recommends active tuberculosis (TB) case finding among people living with HIV (PLHIV) in resource-limited settings using a symptom-based algorithm and those without active TB disease should be offered isoniazid preventive therapy (IPT). We evaluated rates of adherence to these recommendations and the impact of a quality improvement (QI) intervention.
Design
A prospective study design was utilized to compare TB symptom screening and IPT administration rates before and after a QI intervention consisting of 1) educational sessions, 2) visual reminders and 3) use of a screening checklist.
Results
A total of 751 HIV-infected patient visits were evaluated. The proportion of patients screened for TB symptoms increased from 22% at baseline to 94% following the intervention (P<0.001). Screening rates improved from 51% to 81% (P<0.001) for physicians and from 3% to 100% (P<0.001) for nurses. Of the 281 patients with negative TB symptom screens and eligible for IPT, 4% were prescribed IPT before the intervention compared to 81%(P<0.001) afterward.
Conclusions
We found a QI intervention significantly increased WHO recommended TB screening rates and IPT administration. Utilizing nurses can help increase TB screening and IPT provision in resource-limited settings.
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