Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana

• Published in: The international journal of tuberculosis and lung disease Vol. 20; no. 7; pp. 941 - 947
• Main Authors: Emerson, C., Lipke, V., Kapata, N., Mwananyambe, N., Mwinga, A., Garekwe, M., Lanje, S., Moshe, Y., Pals, S. L., Nakashima, A. K., Miller, B.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.07.2016
• Subjects: Botswana - epidemiology; Coinfection; Developing Countries - economics; Health Care Costs; Health Care Workers; HIV Infections - diagnosis; HIV Infections - economics; HIV Infections - epidemiology; HIV Infections - therapy; Human immunodeficiency virus; Humans; Infection Control - economics; Interviews as Topic; Lentivirus; Monitoring; Mycobacterium; Nosocomial Transmission; Outpatient Clinics, Hospital - economics; Program Evaluation; Prospective Studies; Qualitative Research; Quality Improvement - economics; Quality Indicators, Health Care - economics; Risk Reduction; Time Factors; Treatment Outcome; Tuberculosis - diagnosis; Tuberculosis - epidemiology; Tuberculosis - mortality; Tuberculosis - prevention & control; Zambia - epidemiology; Botswana; Zambia
• ISSN: 1027-3719; 1815-7920; 1815-7920
• DOI: 10.5588/ijtld.15.0892

SETTING: Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection.OBJECTIVE: To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package.DESIGN: Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance.RESULTS: A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers.CONCLUSION: TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries.