Adherence to Guidelines for Tuberculosis Treatment and Prophylaxis in HIV-Infected Adults Admitted to Hospitals in Mwanza, Tanzania: A Pre- and Post-Training Evaluative Study
- Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS – Bugando] : 2022
- xvii; 161 Pages Includes References and Appendices
Abstract:
Background: Early detection and treatment of opportunistic infections are crucial in preventing premature deaths and improving the quality of life among persons living with HIV (PLWH). In Tanzania, it is estimated that of 154,000 (range 73,000 -266,000) new cases of TB in 2017, about 31% are estimated to have TB-HIV co-infection. This rate of TB-HIV co-infection is likely caused by poor adherence to ART among PLWH and failure of health care providers to adhere to TB treatment and prophylaxis guidelines.
Aim of the study: This study sought to explore the barriers and enablers to TB treatment and prophylaxis guidelines adherence and to assess the improvement in knowledge and self-report practice to TB treatment and prophylaxis guidelines adherence among healthcare providers after implementing short, focused training on TB treatment in Mwanza region.
Methods: This study used a mixed-method approach i.e. an A Pre- and Post-training study and In-depth interview and. First, we conducted in-depth interviews (IDIs) with 20 healthcare providers involved in the care of TB-HIV co-infection patients. The IDIs explored barriers and enablers to adherence to TB treatment and prophylaxis guidelines. Then we implemented short, focused training on TB treatment and prophylaxis guidelines. We used 35 pre- and post-training surveys to assess the improvement in knowledge and self-report practice to TB treatment and prophylaxis guidelines adherence among healthcare providers.
Results: In the qualitative interviews, healthcare workers discussed in detail the barriers and enablers to TB treatment and prophylaxis guidelines adherence. Healthcare workers consistently reported a shortage of guidelines, diagnostic equipment, and manpower as a primary barrier to guideline adherence. However, healthcare workers attributed reduced workload and improved communication among the enablers to guideline adherence. In pre- and post-training surveys, after the training the mean score for the knowledge test increased from 59.3% to 85.9% (mean difference = 26.7%, 95%CI; 20.7-32.6). Also, a significant difference in the level of practice was observed in all aspects of management of TB-HIV, except TB testing.
Conclusion: This study revealed that there was an increase in level of knowledge regarding TB-HIV management following structured programmed training of the health workers. Compared to the pre-training report, healthcare workers showed improvement in screening and treating TB in patients with HIV in the post-training survey. It is recommended that the inclusion of health workers in the development of treatment guidelines may promote their use and adherence. Supportive supervision from TB/HIV program supervisors and trainers should be made available constantly and debriefing sessions conducted with health workers regularly. Regular in-service training for all stakeholders should be implemented, seminars or workshop with health workers designed to update them and offer refresher courses. Further research in this practice could evaluate improvements in the implementation of guidelines as well as the impact thereafter.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386 Email: vc@bugando.ac.tz Website: www.bugando.ac.tz