Improving tuberculosis screening and isoniazid preventive therapy in an HIV clinic in Addis Ababa, Ethiopia

Abstract

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.

Barriers in the implementation of isoniazid preventive therapy for people living with HIV in Northern Ethiopia: a mixed quantitative and qualitative study

“…A study in South Africa also reported lack of awareness on the benefits of IPT and the guidelines and recommendations by prescribers as primary barrier to IPT implementation [17]. Provision of a clear up-to-date policy and provision of trainings has been found to improve IPT implementation in other studies [25–27]. Trainings and good communication are vital for proper understanding of the policy and avoid ambiguities on IPT provision among health providers.…”

Point-of-Care Testing for Cryptococcal Disease Among Hospitalized Human Immunodeficiency Virus–Infected Adults in Ethiopia

“…Such an approach has been implemented in screening for pulmonary TB among HIV-infected persons in RLS, where the absence of four symptoms has been found to have a high NPV for disease and thus abdicates the need for further workup. 20,21 We chose symptoms and signs that are characteristic of CM and readily attainable by clinicians. Although the specificity and PPV were low, the absence of fever (reported or documented), neck stiffness, headache, and meningismus had a 98% NPV for cryptococcemia and 100% for CM.…”

Dotting the Three I's for collaborative TB-HIV activities: evaluation of a pilot programme in Kathmandu, Nepal

“…The non-completion rate of 11%, although on the lower end of the spectrum, is similar to other settings. 22 Most of the sociode- …”