Assessing compliance to Tuberculosis/HIV standards of care through clinical audits at referral hospitals in Uganda
- Respiratory Diseases
- Sexually Transmitted Diseases
Background
Continuous monitoring of Tuberculosis (TB)/HIV standards of care at facilities enhances the quality of TB/HIV care. Uganda has, for over a decade, implemented TB/HIV integrated care at ART clinics; however, little is known about the performance of these facilities regarding TB/HIV care. We assessed compliance to standards of integrated TB/HIV care at referral hospitals in Uganda.
Methods
We conducted clinical audits, between July and August 2020, at 15 referral hospitals in Uganda. We assessed files of TB/HIV co-infected patients who were diagnosed between January and December 2019. Lot quality assurance sampling(LQAS) principles were used to guide the sampling and auditing of files as well as determine the compliance level. Each file was audited against the 18 criteria for integrated TB/HIV care. A hospital was compliant when it met the 80% target based on the LQAS decision rules. We estimated rates of compliance to standards across hospitals.
Results
A total of 639 files of TB/HIV co-infected patients were assessed. Two hundred forty-seven(39%) files were for females, 248(39%) for males, and 144(22%) for adolescents and children. Only four of 639 files met all the standard criteria. Overall, none of the hospitals met the 80% LQAS compliance target with the highest having 40% and the lowest 0%. The compliance rates to the TB/HIV standards of care were lower among children(55%) compared to men(60%) and women(61%). Across hospitals, the compliance rate was highest for “patient weight measurement at every visit”(94.3%) and “Correct dosage of Septrin prophylaxis”(93.1%) but, was lowest for “Monitoring for side effects”(30.2%) and “sputum monitoring”(40.7%).
Conclusion
Compliance to TB/HIV standards of care was low. Strategies to improve quality of TB/HIV care should target pharmacovigilance and sputum monitoring, particularly among adolescents and children. The LQAS method proved feasible and can be used to assess TB/HIV care at lower-level health facilities, which are likely to be worse.
Continuous monitoring of Tuberculosis (TB)/HIV standards of care at facilities enhances the quality of TB/HIV care. Uganda has, for over a decade, implemented TB/HIV integrated care at ART clinics; however, little is known about the performance of these facilities regarding TB/HIV care. We assessed compliance to standards of integrated TB/HIV care at referral hospitals in Uganda.
Methods
We conducted clinical audits, between July and August 2020, at 15 referral hospitals in Uganda. We assessed files of TB/HIV co-infected patients who were diagnosed between January and December 2019. Lot quality assurance sampling(LQAS) principles were used to guide the sampling and auditing of files as well as determine the compliance level. Each file was audited against the 18 criteria for integrated TB/HIV care. A hospital was compliant when it met the 80% target based on the LQAS decision rules. We estimated rates of compliance to standards across hospitals.
Results
A total of 639 files of TB/HIV co-infected patients were assessed. Two hundred forty-seven(39%) files were for females, 248(39%) for males, and 144(22%) for adolescents and children. Only four of 639 files met all the standard criteria. Overall, none of the hospitals met the 80% LQAS compliance target with the highest having 40% and the lowest 0%. The compliance rates to the TB/HIV standards of care were lower among children(55%) compared to men(60%) and women(61%). Across hospitals, the compliance rate was highest for “patient weight measurement at every visit”(94.3%) and “Correct dosage of Septrin prophylaxis”(93.1%) but, was lowest for “Monitoring for side effects”(30.2%) and “sputum monitoring”(40.7%).
Conclusion
Compliance to TB/HIV standards of care was low. Strategies to improve quality of TB/HIV care should target pharmacovigilance and sputum monitoring, particularly among adolescents and children. The LQAS method proved feasible and can be used to assess TB/HIV care at lower-level health facilities, which are likely to be worse.