Weighted fidelity of delivery of an intervention in the health facility: a case of TB screening among PLHIV in selected hospitals in Ghana

Abstract

BackgroundImplementation outcome assessment such as fidelity is essential in implementing health intervention. Limited studies that have been conducted have assessed fidelity separately at the healthcare provider level or facility level with managers. However, there might be variations in facility resources and their utilization, skewing such comparisons. We, therefore, would like to investigate whether a combined provider-facility level fidelity is a more effective assessment. We aim to describe the weighted fidelity of implementing the guidelines for TB screening among PLHIV and examine its effect on TB screening coverage at selected HIV clinics in Ghana.MethodsWe used cross-sectional study and collected data from 226 HIV care providers and 27 managers of district hospitals implementing the TB screening intervention at the HIV clinics. We also extracted information from TB registers monthly for 2018. Weighted fidelity was measured based on the extent to which the intervention was implemented, considering both the facility and the provider level assessments. Response scores and extracted data on fidelity were analyzed and summarized using the median and inter-quartile range for non-normal data such as fidelity scores and coverage and frequencies and percentages for categorical data such as resources availability. Linear regressions models were fitted for TB screening coverage using the fidelities separately.ResultsThe study revealed that the weighted fidelity median score was 67% (IQR: 59.9 – 74.9%), and the TB screening coverage was 71.3% (IQR: 56.9 – 96.7). Weighted fidelity of delivery was statistically associated with TB screening coverage (p<0.01). All the moderating factors investigated have no statistical association with weighted fidelity of delivery (p>0.05) except for IE&C. Facilities with TB IE&C materials available had a significantly (p=0.025) higher median fidelity score 75.4% (74.9 – 88.5) than their counterparts 65.7% (59.4 – 72.6).ConclusionsThe combined provider-facility level assessment of fidelity demonstrated that weighted fidelity of delivery is positively associated with TB screening coverage and provided a better platform for assessing implementation fidelity. It also showed that the availability of IE&C materials significantly moderates the weighted fidelity of delivery. Weighted fidelity is an efficient way of holistically assessing fidelity within health facilities.