Effect of On-Site Support on Laboratory Practice for Human Immunodeficiency Virus, Tuberculosis, and Malaria Testing.
OBJECTIVE
To evaluate the effect of on-site support in improving human immunodeficiency virus (HIV) rapid testing, tuberculosis (TB) sputum microscopy, and malaria microscopy among laboratory staff in a low-resource setting.


METHODS
This cluster randomized trial was conducted at 36 health facilities in Uganda. From April to December 2010, laboratory staff at 18 facilities participated in monthly on-site visits, and 18 served as control facilities. After intervention, 128 laboratory staff were observed performing 587 laboratory tests across three diseases: HIV rapid testing, TB sputum microscopy, and malaria microscopy. Outcomes were the proportion of laboratory procedures correctly completed for the three laboratory tests.


RESULTS
Laboratory staff in the intervention arm performed significantly better than the control arm in correctly completing laboratory procedures for all three laboratory tests, with an adjusted relative risk (95% confidence interval) of 1.18 (1.10-1.26) for HIV rapid testing, 1.29 (1.21-1.40) for TB sputum microscopy, and 1.19 (1.11-1.27) for malaria microscopy.


CONCLUSIONS
On-site support significantly improved laboratory practices in conducting HIV rapid testing, TB sputum microscopy, and malaria microscopy. It could be an effective method for improving laboratory practice, without taking limited laboratory staff away from health facilities for training.
From Accordia Global Health Foundation, Washington, DC Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium sburnett@path.org.
Sarah M
SM
Burnett
Infectious Diseases Institute, College of Health Sciences, University Research Co, LLC, Kampala, Uganda.
Martin K
MK
Mbonye
International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle.
Robert
R
Martin
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Allan
A
Ronald
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Stella
S
Zawedde-Muyanja
From Accordia Global Health Foundation, Washington, DC.
Kelly S
KS
Willis
Epidemiology for Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Robert
R
Colebunders
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Yukari C
YC
Manabe
International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle.
Marcia R
MR
Weaver
D003955:Diagnostic Tests, Routine; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007753:Laboratories; D008288:Malaria / Q000175:diagnosis*; D014376:Tuberculosis / Q000175:diagnosis*; D014454:Uganda
Continuous quality improvement; Educational outreach; HIV rapid testing; Laboratory practice; Malaria microscopy; Supportive supervision; TB sputum microscopy; Uganda