Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana.
Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection.



To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package.



Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance.



A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers.



TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries.
Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA;
C
C
Emerson
Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA;
V
V
Lipke
Zambia Ministry of Health, Lusaka, Zambia.
N
N
Kapata
CDC Zambia, Lusaka, Zambia.
N
N
Mwananyambe
Zambia AIDS Related Tuberculosis (ZAMBART) Project, Lusaka, Zambia.
A
A
Mwinga
Botswana Ministry of Health, Gaborone, Botswana.
M
M
Garekwe
CDC Botswana, Gaborone, Botswana.
S
S
Lanje
African Comprehensive HIV/AIDS Partnership (ACHAP), Gaborone, Botswana.
Y
Y
Moshe
Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
S L
SL
Pals
Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
A K
AK
Nakashima
Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
B
B
Miller
D001902:Botswana / Q000453:epidemiology; D060085:Coinfection; D003906:Developing Countries / Q000191:economics; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D017053:Infection Control / Q000191:economics*; D007407:Interviews as Topic; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D015397:Program Evaluation; D011446:Prospective Studies; D036301:Qualitative Research; D058996:Quality Improvement / Q000191:economics; D019984:Quality Indicators, Health Care / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D015024:Zambia / Q000453:epidemiology