Improving Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) Treatment Monitoring in South Africa: Evaluation of an Advanced TB/HIV Course for Healthcare Workers. (7th December 2016)

• Record Type: Journal Article
• Authors: Galagan, Sean; Jed, Suzanne; Sumitani, Jeri; Gilvydis, Jennifer M.; Bakor, Albert; Cooke, Richard; Naidoo, Evasen; Winters, Debra; Weaver, Marcia R.
• Is Part Of: Open forum infectious diseases. Volume 4:Number 1(2017)
• Publication Date: 2016-12-07
• Subjects: HIV -- integration of care -- tuberculosis; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofw248
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: South Africa has dual epidemics of human immunodeficiency virus (HIV) and tuberculosis (TB). Nurse-focused training was combined with onsite mentoring for nurses to improve HIV and TB care. A pre-/postevaluation was conducted in 3 districts in South Africa to assess the effects of the course on clinical patient monitoring and integration of TB and HIV care. Methods: Two cross-sectional, unmatched samples of patient charts at 76 primary healthcare facilities were collected retrospectively in 2014 to evaluate the impact of training on treatment monitoring. Proportions of HIV patients receiving a viral load test 6 months after initiating antiretroviral therapy (ART) and TB patients receiving end of intensive phase sputum testing were compared pre- and posttraining. Analysis of creatinine clearance testing and integration of TB and HIV care were also performed. Results: Data were analyzed from 1074 pretraining and 1048 posttraining records among patients initiating ART and from 1063 pretraining and 1008 posttraining among patients initiating TB treatment. Documentation of a 6-month viral load test was 36.3%, and a TB test at end of intensive phase was 70.7%, and neither increased after training. Among patients with a viral load test, the percentage with viral load less than 50 copies/mL increased from 48.6% pretraining compared with 64.2% posttraining ( P = .001). Integration of TB and HIV care such as isoniazid preventive therapy increased significantly. Conclusions: The primary outcome measures did not change after training. However, the evaluation documented many other improvements in TB and HIV care that may have been supported by the course.