Scaling up implementation of ART: Organizational culture and early mortality of patients initiated on ART in Nairobi, Kenya.
Scaling up implementation of ART: Organizational culture and early mortality of patients initiated on ART in Nairobi, Kenya.
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DOI：
10.1371/journal.pone.0190344
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Ayah R
中科院分区：
文献类型：
--
作者：
Ayah R
Scaling up the antiretroviral (ART) program in Kenya has involved a strategy of using clinical guidelines coupled with decentralization of treatment sites. However decentralization pushes clinical responsibility downwards to health facilities run by lower cadre staff. Whether the organizational culture in health facilities affects the outcomes despite the use of clinical guidelines has not been explored. This study aimed to demonstrate the relationship between organizational culture and early mortality and those lost to follow up (LTFU) among patients enrolled for HIV care. A stratified sample of 31 health facilities in Nairobi County offering ART services were surveyed. Data of patients enrolled on ART and LTFU for the 12 months ending 30th June 2013 were abstracted. Mortality and LTFU were determined and used to rank health facilities. In the facilities with the lowest and highest mortality and LTFU key informant interviews were conducted using a tool adapted from team climate assessment measurement questionnaire and competing value framework tool to assess organizational culture. The strength of association between early mortality, LTFU and organizational culture was tested. Half (51.8%) of the 5,808 patients enrolled into care in 31 health facilities over the 12-month study period were started on ART. Of these 48 (1.6% 95% CI 0.8%-2.4%) died within three months of starting treatment, while a further 125 (4.2% 95% CI 2.1%-6.6%) were LTFU giving an attrition rate of 5.7% (95% CI 3.3%-8.6%). Tuberculosis was the most common comorbidity associated with high early mortality and high LTFU. Organizational culture, specifically an adhocratic type was found to be associated with low early mortality and low LTFU of patients enrolled for HIV care (P = 0.034). The use of ART clinical guidelines in a decentralized health systems are not sufficient to achieve required service delivery outcomes. The attrition rate above would mean 85,000 Kenyans missing care based on current HIV disease burden figures. Deliberate efforts to improve individual health facility leadership and inculcate an adhocratic culture may lower mortality and morbidity associated with initiating ART.
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影响因子：
4.5
作者：
Marchand, Alain;Haines, Victor Y., III;Dextras-Gauthier, Julie
通讯作者：
Dextras-Gauthier, Julie
根据竞争价值框架评估组织文化工具：探索性和验证性因素分析。
影响因子：
7.2
作者：
Helfrich, Christian D.;Li, Yu-Fang;Mohr, David C.;Meterko, Mark;Sales, Anne E.
通讯作者：
Sales, Anne E.
DOI：
10.1097/qai.0b013e3181e0c4cf
发表时间：
2010-08
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Fenner L;Brinkhof MW;Keiser O;Weigel R;Cornell M;Moultrie H;Prozesky H;Technau K;Eley B;Vaz P;Pascoe M;Giddy J;Van Cutsem G;Wood R;Egger M;Davies MA;International epidemiologic Databases to Evaluate AIDS in Southern Africa
通讯作者：
International epidemiologic Databases to Evaluate AIDS in Southern Africa
影响因子：
3.8
作者：
Chaiyachati, Krisda H.;Ogbuoji, Osondu;Baernighausen, Till
通讯作者：
Baernighausen, Till
影响因子：
168.9
作者：
Braitstein, P;Brinkhof, MWG;Egger, M
通讯作者：
Egger, M