Assessing and improving care for patients with TB/HIV/STIs in a rural district in KwaZulu-Natal South Africa
Year: 2011
Type: article
Abstract: Setting: Despite the prioritisation of TB, HIV and STI programmes \nin South Africa, service targets are not achieved, have had little \neffect, and the magnitude of the epidemics continues to escalate. \nObjective. To report on a participatory quality improvement \nintervention designed to evaluate these priority programmes in \nprimary health care (PHC) clinics in a rural district in KwaZulu-Natal. \nMethods: A participatory quality improvement intervention with \ndistrict health managers, PHC supervisors and researchers was \nused to modify a TB/HIV/STI audit tool for use in a rural area, \nconduct a district-wide clinic audit, assess performance, set targets \nand develop plans to address the problems identified. \nResults: We highlight weaknesses in training and support of \nstaff at PHC clinics, pharmaceutical and laboratory failures, and \ninadequate monitoring of patients as contributing to poor TB, \nHIV and STI service implementation. In the 25 facilities audited, \n71% of the clinical staff had received no training in TB diagnosis \nand management, and 46% of the facilities were visited monthly \nby a PHC supervisor. Eighty per cent of the facilities experienced \nnon-availability of essential drugs and supplies; polymerase chain \nreaction (PCR) results were not documented for 54% of specimens \nassessed, and the mean length of time between eligibility for ART \nand starting treatment was 47 days. \nConclusion: Through a participatory approach, a TB/HIV/STI \naudit tool was successfully adapted and implemented in a rural \ndistrict. It yielded information enabling managers to identify \nobstacles to TB, HIV and STI service implementation and develop \nplans to address these. The audit can be used by the district to \nmonitor priority services at a primary level.
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2107842678