Improving Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) Treatment Monitoring in South Africa: Evaluation of an Advanced TB/HIV Course for Healthcare Workers.

Autor:	Galagan S; International Training & Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle., Jed S; I-TECH South Africa, Pretoria., Sumitani J; I-TECH South Africa, Pretoria., Gilvydis JM; International Training & Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle., Bakor A; I-TECH South Africa, Pretoria., Cooke R; University of Witswatersrand, Centre for Rural Health, Johannesburg, South Africa., Naidoo E; I-TECH South Africa, Pretoria., Winters D; International Training & Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle., Weaver MR; International Training & Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle.
Jazyk:	angličtina
Zdroj:	Open forum infectious diseases [Open Forum Infect Dis] 2016 Dec 07; Vol. 4 (1), pp. ofw248. Date of Electronic Publication: 2016 Dec 07 (Print Publication: 2017).
DOI:	10.1093/ofid/ofw248
Abstrakt:	Background: South Africa has dual epidemics of human immunodeficiency virus (HIV) and tuberculosis (TB). Nurse-focused training was combined with onsite mentoring for nurses to improve HIV and TB care. A pre-/postevaluation was conducted in 3 districts in South Africa to assess the effects of the course on clinical patient monitoring and integration of TB and HIV care. Methods: Two cross-sectional, unmatched samples of patient charts at 76 primary healthcare facilities were collected retrospectively in 2014 to evaluate the impact of training on treatment monitoring. Proportions of HIV patients receiving a viral load test 6 months after initiating antiretroviral therapy (ART) and TB patients receiving end of intensive phase sputum testing were compared pre- and posttraining. Analysis of creatinine clearance testing and integration of TB and HIV care were also performed. Results: Data were analyzed from 1074 pretraining and 1048 posttraining records among patients initiating ART and from 1063 pretraining and 1008 posttraining among patients initiating TB treatment. Documentation of a 6-month viral load test was 36.3%, and a TB test at end of intensive phase was 70.7%, and neither increased after training. Among patients with a viral load test, the percentage with viral load less than 50 copies/mL increased from 48.6% pretraining compared with 64.2% posttraining ( P = .001). Integration of TB and HIV care such as isoniazid preventive therapy increased significantly. Conclusions: The primary outcome measures did not change after training. However, the evaluation documented many other improvements in TB and HIV care that may have been supported by the course. (© The Author 2016. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.)
Databáze:	MEDLINE
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