ArticleGlobal health action
Tuberculosis screening in patients with HIV: use of audit and feedback to improve quality of care in Ghana.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Improving cascade outcomes for active TB: A global systematic review and meta-analysis of TB interventions.PLoS medicine · 2023Pooled it
- Factors influencing tuberculosis preventive practices among people living with HIV/AIDS enrolled in secondary health facilities in Lagos, Nigeria.African health sciences · 2023Article
- Roles and challenges of nurses in tuberculosis care in Africa: A narrative review.Journal of clinical tuberculosis and other mycobacterial diseases · 2023Review
- Strengthening HIV and HIV co-morbidity care in low- and middle-income countries: insights from behavioural economics to improve healthcare worker behaviour.Journal of the International AIDS Society · 2023Article
- The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Article
- Global progress and gaps in tuberculosis screening and treatment among people with HIV: experience from 32 countries.AIDS (London, England) · 2021Article
- Realizing the "40 by 2022" Commitment from the United Nations High-Level Meeting on the Fight to End Tuberculosis: What Will It Take to Meet Rapid Diagnostic Testing Needs?Global health, science and practice · 2019Article
- Performance of and Factors Associated With Tuberculosis Screening and Diagnosis Among People Living With HIV: Analysis of 2012-2016 Routine HIV Data in Tanzania.Frontiers in public health · 2019Article
- C-reactive protein as a screening test for HIV-associated pulmonary tuberculosis prior to antiretroviral therapy in South Africa.AIDS (London, England) · 2018Article
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9 authors.
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Abstract
backgroundTuberculosis screening of people living with HIV (PLHIV) can contribute to early tuberculosis diagnosis and improved patient outcomes. Evidence-based guidelines for tuberculosis screening are available, but literature assessing their implementation and the quality of clinical practice is scarce.
objectivesTo assess tuberculosis screening practices and the effectiveness of audit and performance feedback to improve quality of tuberculosis screening at HIV care clinics in Ghana.
designHealthcare providers at 10 large HIV care clinics prospectively registered patient consultations during May and October 2014, before and after a performance feedback intervention in August 2014. The outcomes of interest were overall tuberculosis suspicion rate during consultations and provider adherence to the International Standards for Tuberculosis Care and the World Health Organizations' guidelines for symptom-based tuberculosis screening among PLHIV.
resultsTwenty-one healthcare providers registered a total of 2,666 consultations; 1,368 consultations before and 1,298 consultations after the feedback intervention. Tuberculosis suspicion rate during consultation increased from 12.6 to 20.9% after feedback (odds ratio, OR 1.83; 95% confidence interval, CI: 1.09-3.09). Before feedback, sputum smear microscopy was requested for 58.7% of patients with suspected tuberculosis, for 47.2% of patients with cough ≥2 weeks, and for 27.5% of patients with a positive World Health Organization (WHO) symptom screen (any of current cough, fever, weight loss or night sweats). After feedback, patients with a positive WHO symptom screen were more likely to be suspected of tuberculosis (OR 2.21; 95% CI: 1.19-4.09) and referred for microscopy (OR 2.71; 95% CI: 1.25-5.86).
conclusionsA simple prospective audit tool identified flaws in clinical practices for tuberculosis screening of PLHIV. There was no systematic identification of people with suspected active tuberculosis. We found low initial tuberculosis suspicion rate compounded by low referral rates of relevant patients for sputum smear microscopy. Adherence to recommended standards and guidelines for tuberculosis screening improved after performance feedback.
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