title: Improving tuberculosis screening and isoniazid preventive therapy in an HIV clinic in Addis Ababa, Ethiopia.
abstract: BACKGROUND
  The World Health Organization (WHO) recommends active tuberculosis (TB) case finding among people living with human immunodeficiency virus (HIV) in resource-limited settings using a symptom-based algorithm; those without active TB disease should be offered isoniazid preventive therapy (IPT).
  
  
  OBJECTIVE
  To evaluate rates of adherence to WHO recommendations and the impact of a quality improvement intervention in an HIV clinic in Addis Ababa, Ethiopia.
  
  
  METHODS
  A prospective study design was utilized to compare TB symptom screening and IPT administration rates before and after a quality improvement intervention consisting of 1) educational sessions, 2) visual reminders, and 3) use of a screening checklist.
  
  
  RESULTS
  A total of 751 HIV-infected patient visits were evaluated. The proportion of patients screened for TB symptoms increased from 22% at baseline to 94% following the intervention (P < 0.001). Screening rates improved from 51% to 81% (P < 0.001) for physicians and from 3% to 100% (P < 0.001) for nurses. Of the 281 patients with negative TB symptom screens and eligible for IPT, 4% were prescribed IPT before the intervention compared to 81% after (P < 0.001).
  
  
  CONCLUSIONS
  We found that a quality improvement intervention significantly increased WHO-recommended TB screening rates and IPT administration. Utilizing nurses can help increase TB screening and IPT provision in resource-limited settings.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: S
authors.initials: S
authors.lastname: Zaeh
authors.forename: R
authors.initials: R
authors.lastname: Kempker
authors.forename: E
authors.initials: E
authors.lastname: Stenehjem
authors.forename: H M
authors.initials: HM
authors.lastname: Blumberg
authors.forename: O
authors.initials: O
authors.lastname: Temesgen
authors.forename: I
authors.initials: I
authors.lastname: Ofotokun
authors.forename: A
authors.initials: A
authors.lastname: Tenna
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D057189:Checklist / Q000592:standards; D060085:Coinfection; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D008403:Mass Screening / Q000451:nursing / Q000592:standards*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D017010:Reminder Systems / Q000592:standards; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid