Effect on tuberculosis outcomes of educational outreach to South African clinics during two randomised trials.
METHODS
Public sector primary care clinics in Free State Province, South Africa.


OBJECTIVE
To investigate the effects of on-site in-service clinical skills training for nurse practitioners on tuberculosis (TB) treatment outcomes in the same clinics.


METHODS
Analysis of TB programme data from clinics taking part in two consecutive randomised trials of educational outreach aimed at improving respiratory and human immunodeficiency virus/acquired immune-deficiency syndrome care based on the Practical Approach to Lung Health. We compared treatment outcomes between control and intervention clinics among all patients diagnosed with TB during either trial.


RESULTS
During the two trials, participating clinics treated 4187 and 2333 TB patients, respectively. Neither intervention was associated with better outcomes overall. However, among retreatment patients, cure or completion rates in intervention clinics were significantly higher during the second trial (OR 1.78, 95%CI 1.13-2.76). Patients in clinics that had received both interventions had higher cure or completion rates (OR 1.99, 95%CI 1.53-2.58) and lower default rates (OR 0.25, 95%CI 0.097-0.63) than patients in clinics that had received neither intervention.


CONCLUSIONS
Although not primarily focused on TB treatment, the interventions appeared to improve successful treatment completion rates among TB retreatment cases. Integrated care programmes support attainment of important TB programme goals.
Medical School, University of East Anglia, Norwich, UK. m.bachmann@uea.ac.uk
M O
MO
Bachmann
L R
LR
Fairall
C
C
Lombard
V
V
Timmerman
S
S
van der Merwe
E D
ED
Bateman
M
M
Zwarenstein
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000379:methods; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000193:education*; D011320:Primary Health Care / Q000379:methods; D017150:Public Sector; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents