Trial reportBMJ (Clinical research ed.)2011
Outreach education for integration of HIV/AIDS care, antiretroviral treatment, and tuberculosis care in primary care clinics in South Africa: PALSA PLUS pragmatic cluster randomised trial.
Trial report in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
48 citing papers in PubMed, 7 syntheses or guidelines pooled it, 79 citations in OpenAlex.
- Improving cascade outcomes for active TB: A global systematic review and meta-analysis of TB interventions.PLoS medicine · 2023Pooled it
- A Systematic Review of Linkage-to-Care and Antiretroviral Initiation Implementation Strategies in Low- and Middle-Income Countries Across Sub-Saharan Africa.AIDS and behavior · 2022Pooled it
- Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis.Respiratory research · 2021Pooled it
- The 'Practical Approach to Lung Health' in sub-Saharan Africa: a systematic review.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2016Pooled it
- Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care.Tropical medicine & international health : TM & IH · 2015Pooled it
- Tailored interventions to address determinants of practice.The Cochrane database of systematic reviews · 2015Pooled it
- Patient education and counselling for promoting adherence to treatment for tuberculosis.The Cochrane database of systematic reviews · 2012Pooled it
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- Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda.BMC public health · 2016Trial
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- Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial.BMJ (Clinical research ed.) · 2013Trial
- Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial.Lancet (London, England) · 2012Trial
- Task shifting and integration of HIV care into primary care in South Africa: the development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention.Implementation science : IS · 2011Trial
- From face-to-face to e-learning: transitioning to new training models to strengthen the health system by supporting primary healthcare workers in low- and middle-income countries.BMJ global health · 2026Article
- Mortality in HIV and tuberculosis patients following implementation of integrated HIV-TB treatment: Results from an open-label cluster-randomized trial.EClinicalMedicine · 2022Article
- Article
- Revamping of Chronic Respiratory Diseases in Low- and Middle-Income Countries.Frontiers in public health · 2021Review
- Addressing the quality and scope of paediatric primary care in South Africa: evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child).BMC health services research · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 4 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate whether PALSA PLUS, an on-site educational outreach programme of non-didactic, case based, iterative clinical education of staff, led by a trainer, can increase access to and comprehensiveness of care for patients with HIV/AIDS.
designCluster randomised trial.
settingPublic primary care clinics offering HIV/AIDS care, antiretroviral treatment (ART), tuberculosis care, and ambulatory primary care in Free State province, South Africa.
participantsFifteen clinics all implementing decentralisation and task shifting were randomised. The clinics cared for 400,000 general primary care patients and 10,136 patients in an HIV/AIDS/ART programme. There were 150 nurses.
interventionOn-site outreach education in eight clinics; no such education in seven (control).
main outcome measuresProvision of co-trimoxazole prophylaxis among patients referred to the HIV/AIDS/ART programme, and detection of cases of tuberculosis among those in the programme. Proportion of patients in the programme enrolled through general primary care consultations.
resultsPatients referred to the HIV/AIDS programme through general primary care at intervention clinics were more likely than those at control clinics to receive co-trimoxazole prophylaxis (41%, (2253/5523) v 32% (1340/4210); odds ratio 1.95, 95% confidence interval 1.11 to 3.40), and tuberculosis was more likely to be diagnosed among patients with HIV/AIDS/ART (7% (417/5793) v 6% (245/4343); 1.25, 1.01 to 1.55). Enrolment in the HIV/AIDS and ART programme through HIV testing in general primary care was not significantly increased (53% v 50%; 1.19, 0.51 to 2.77). Secondary outcomes were similar, except for weight gain, which was higher in the intervention group (2.3 kg v 1.9 kg, P<0.001).
conclusionThough outreach education is an effective and feasible strategy for improving comprehensiveness of care and wellbeing of patients with HIV/AIDS, there is no evidence that it increases access to the ART programme. It is now being widely implemented in South Africa.
trial registrationCurrent Controlled Trials ISRCTN 24820584.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.