Continuous quality improvement in HIV and TB services at selected healthcare facilities in South Africa

Gaga, Sisanda; Mqoqi, Nokuzola; Chimatira, Raymond; Moko, Singilizwe; Igumbor, Jude

doi:10.4102/sajhivmed.v22i1.1202

Cited by 3 publications

(6 citation statements)

References 19 publications

(29 reference statements)

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“…This is good because mishandling and improper storage of sputum can affect its quality, leading to incorrect diagnoses. Some of our study findings were congruent with those from another audit conducted in South Africa, which reported HIV counseling and testing for TB patients as one of the highest audit scores [ 21 ]. Integrating HIV/TB services at public healthcare facilities is relatively new and has experienced implementation challenges [ 32 , 33 ], which led to missed opportunities to care for TB patients appropriately [ 34 ].…”

Section: Discussionsupporting

confidence: 90%

“…Our study also identified areas of weaker compliance with national standards. Similar research has shown that poor adherence to TB guidelines is often linked to high work volumes [ 21 ]. In contrast, our findings showed no associations between the number of patients seen and the audit scores obtained.…”

Section: Discussionmentioning

confidence: 99%

“…Although South Africa has implemented continuous quality improvement to consistently assess the performance of TB and HIV services [ 20 , 21 ], to our knowledge, no assessments of TB services have been published since the start of the COVID-19 pandemic. For this reason, the study aimed to assess the quality TB diagnostic services at primary healthcare clinics (PHCs) in the eThekwini district, South Africa.…”

Section: Introductionmentioning

confidence: 99%

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Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa

Dlangalala,

Musekiwa,

Mashamba-Thompson

2024

PLoS ONE

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Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson’s pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa

Dlangalala,

Musekiwa,

Mashamba-Thompson

2024

PLoS ONE

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“…Of the estimated 10 million people with active tuberculosis (TB) globally, three million were 'missed' by health systems [2]. Finding these people unaccounted for is a global health priority, and initiatives that have combined traditional TB case-finding approaches with quality improvement (QI) approaches for detecting patients with TB who are unaccounted for in health facilities and at the community level have shown success in a number of countries in Africa [12][13][14][15][16]. Tanzania is 1 of the 30 high TB burden countries [17] and 1 of the 13 countries in which 75% of people with TB are unaccounted for and that is prioritized for the Global Fund Catalytic investment [18,19].…”

Section: Introductionmentioning

confidence: 99%

Enhancing Tuberculosis Case-Finding: A Case of Quality Improvement Initiative in Tanzania

Wandwalo

Kamara²,

Yassin

et al. 2022

TropicalMed

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Background: Tanzania is 1 of the 30 high TB burden countries and 1 of the 13 countries in which 75% of people with TB are unaccounted for and that is prioritized for the Global Fund Catalytic investment and Strategic Initiative support. Tanzania decided to strengthen its National TB Programme to find these people with TB who are unaccounted for by identifying evidence-driven innovations to deliver high-quality services and to improve the efficiency of TB case-finding. A quality improvement (QI) initiative was implemented by the National Tuberculosis and Leprosy Programme to enhance TB case-finding. The initiative involved identifying gaps in the quality of services, introducing new tools, improving the work capacity of health care workers through training and mentorship sessions, strengthening laboratory and referral services, and implementing mandatory TB screening of all patients attending health facilities. We aimed to assess the effectiveness of QI initiative to enhance TB case-findings at the health facility level. Method: A cross-sectional design, and intervention and control facilities randomly selected for an evaluation of the QI initiative were used. Twenty facilities from the Dodoma region across all health care system levels (dispensaries, health centres, and hospitals) were involved in this evaluation. The facilities were randomly divided into either the intervention or control groups at a 1:1 ratio (10 intervention and 10 control facilities). Data routinely collected from program registers from January 2016 to June 2017 were used. Result: The evaluation registered a 52% increase in TB case notification in Q1 of 2017 compared with in Q1 of 2016 and, similarly, a 52% increase in Q2 of 2017 compared with in Q2 of 2016, with 9 out of 10 intervention sites reporting increases in their quarterly TB case notifications. There were no positive changes in the ‘control facilities’ where routine services were provided, with half of the facilities showing a decrease in TB case notification from baseline. Conclusion: This QI initiative has the potential to support a long-term comprehensive approach to ending TB and to improve the quality of the foundations of the health care system. This initiative sets a reliable pace for health facilities to efficiently respond to and manage TB case-finding interventions put into action. Tanzania’s experience with implementing QI interventions could serve as a model for improving TB case notifications in other settings.

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“…Healthcare financing [73] and length of stay hospitals [15] Process maps ANC HIV testing [ Pie charts Diabetic care [31] Histograms Diabetic care [31] Boxplots Diabetic care [31] Star plots Diabetic care [31] Variability graph Diabetic care [31] P-charts Maternal care [77] Chart sticker Pressure ulcer care [ [53,56,99], particularly a significant 18% increase in the overall quality of service performance [48], improved patient counselling, adherence to appropriate procedures, and infection prevention [48,68], and optimised workflow [52].…”

Section: Pareto Diagrammentioning

confidence: 99%

A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact

Endalamaw,

Khatri,

Mengistu

et al. 2024

BMC Health Serv Res

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Background The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts. Methods This qualitative scoping review was conducted using Arksey and O’Malley’s methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works. Results A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI. Conclusions Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it’s crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.

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Continuous quality improvement in HIV and TB services at selected healthcare facilities in South Africa

Cited by 3 publications

References 19 publications

Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa

Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa

Enhancing Tuberculosis Case-Finding: A Case of Quality Improvement Initiative in Tanzania

A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact

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