Theory-Informed Interventions to Improve the Quality of Tuberculosis Evaluation at Ugandan Health Centers: A Quasi- Experimental Study

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Date
2015Author
Chaisson, Lelia H.
Katamba, Achilles
Haguma, Priscilla
Ochom, Emmanuel
Ayakaka, Irene
Mugabe, Frank
Miller, Cecily
Vittinghoff, Eric
Davis, J. Lucian
Handley, Margaret A.
Cattamanchi, Adithya
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Show full item recordAbstract
Tuberculosis (TB) remains under-diagnosed in many countries, in part due to poor evaluation
practices at health facilities. Theory-informed strategies are needed to improve implementation
of TB evaluation guidelines. We aimed to evaluate the impact of performance
feedback and same-day smear microscopy on the quality of TB evaluation at 6 health centers
in rural Uganda.
Methods
We tested components of a multi-faceted intervention to improve adherence to the International
Standards for Tuberculosis Care(ISTC): performance feedback and same-day smear
microscopy. The strategies were selected based on a qualitative assessment guided by the
Theory of Planned Behavior and the PRECEDE model. We collected patient data 6 months
before and after the introduction of each intervention component, and compared ISTC adherence
in the pre- and post-intervention periods for adults with cough 2 weeks’ duration.
Results
The performance feedback evaluation included 1,446 adults; 838 (58%) were evaluated
during the pre-intervention period and 608 (42%) during the post-intervention period. Performance
feedback resulted in a 15% (95%CI +10%to +20%, p<0.001) increase in the proportion of patients receiving ISTC-adherent care. The same-day microscopy evaluation
included 1,950 adults; 907 (47%) were evaluated during the pre-intervention period and
1,043 (53%) during the post-intervention period. Same-day microscopy was associated
with a 14% (95%CI +10%to +18%, p<0.001) increase in the proportion of patients receiving
ISTC-adherent care.
Conclusions
Performance feedback and same-day microscopy should be considered along with ISTC
training as part of a multi-faceted intervention to improve the quality of TB evaluation in
other high TB burden countries.
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- Medical and Health Sciences [2894]