Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana.
Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana.
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DOI：
10.1371/journal.pone.0257486
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Chirwa TF
中科院分区：
文献类型：
--
作者：
Narh-Bana SA;Kawonga M;Chirwa ED;Ibisomi L;Bonsu F;Chirwa TF
对人类免疫缺陷病毒感染者进行结核病筛查是世卫组织建议的一项干预措施，以控制结核病和艾滋病毒的双重流行。在何种程度上干预是坚持由艾滋病毒的医疗保健提供者（保真度）决定的干预措施的有效性，衡量病人的结果，但文献的保真度是稀缺的。这项研究评估了加纳艾滋病毒诊所结核病筛查国家指南的提供者实施忠诚度。这是一项横断面研究，使用结构化问卷收集数据，涉及加纳27个艾滋病毒诊所的243名艾滋病毒医疗保健提供者中的226名。总体忠诚度评分包括16个项目，最高评分为48分，分为筛查干预的三个组成部分（结核病诊断、结核病意识和结核病症状问卷）。对项目得分进行简单求和，以确定每个提供者的忠诚度得分。在本文中，我们定义的保真度水平为低，如果分数低于中位数的分数，否则被归类为高。背景因素可能与实施保真度水平进行了评估，使用基于聚类的逻辑回归。比值比和95%置信区间（CI）被用作相关性的度量。在接受采访的226名医疗保健提供者中，60%（135名）为女性，平均年龄为34.5岁（SD = 8.3）。他们中的大多数是临床医生[63%（142）]，并有大专以上非大专教育[62%（141）]。总体而言，53%（119）的医疗保健提供者被归类为以高保真度实施了干预。此外，56%（126）、53%（120）和59%（134）的提供者分别以高保真度实施了结核病诊断、结核病意识和结核病症状问卷调查。在对集群效应进行调整后，（AOR = 2.36，95%CI：1.09-5.10，p = <0.029），受过高等教育的人（AOR = 4.31，95%CI：2.12-9.10，p = 0.040），临床医生（AOR = 1.78，95%CI：1.07-3.50，p = 0.045）与同行相比更有可能遵守指南。忠诚度得分高于中位数的供应商数量略高于（6%）忠诚度得分低于中位数的数量。同样，对于每个组成部分，忠诚度得分高于中位数的供应商数量略高。这可以解释加纳干预结果的波动。我们发现，性别，职业和教育与供应商实施忠诚度。为了提高艾滋病毒医疗服务提供者的忠诚度，实现加纳艾滋病毒感染者结核病筛查干预的目标，就实施干预的所有组成部分进行进一步培训至关重要。
Tuberculosis screening of people living with human immunodeficiency virus is an intervention recommended by the WHO to control the dual epidemic of TB and HIV. The extent to which the intervention is adhered to by the HIV healthcare providers (fidelity) determines the intervention’s effectiveness as measured by patient outcomes, but literature on fidelity is scarce. This study assessed provider implementation fidelity to national guidelines on TB screening at HIV clinics in Ghana. It was a cross-sectional study that used structured questionnaires to gather data, involving 226 of 243 HIV healthcare providers in 27 HIV clinics across Ghana. The overall fidelity score comprised sixteen items with a maximum score of 48 grouped into three components of the screening intervention (TB diagnosis, TB awareness and TB symptoms questionnaire). Simple summation of item scores was done to determine fidelity score per provider. In this paper, we define the level of fidelity as low if the scores were below the median score and were otherwise categorized as high. Background factors potentially associated with implementation fidelity level were assessed using cluster-based logistic regression. Odds ratio with 95% confidence interval (CI) was used as the measure of association. Of the 226 healthcare providers interviewed, 60% (135) were females with a mean age of 34.5 years (SD = 8.3). Most of them were clinicians [63% (142)] and had post-secondary non-tertiary education [62% (141)]. Overall, 53% (119) of the healthcare providers were categorized to have implemented the intervention with high fidelity. Also, 56% (126), 53% (120), and 59% (134) of the providers implemented the TB diagnosis, TB awareness and TB symptoms questionnaire components respectively with high fidelity. After adjusting for cluster effect, female providers (AOR = 2.36, 95%CI: 1.09–5.10, p = <0.029), those with tertiary education (AOR = 4.31, 95%CI: 2.12–9.10, p = 0.040), and clinicians (AOR = 1.78, 95%CI: 1.07–3.50, p = 0.045) were more likely to adhere to the guidelines compared to their counterparts. The number of providers with fidelity scores above the median was marginally greater (6%) than the number with fidelity score below the median. Similarly, for each of the components, the number of providers with fidelity scores higher than the median was marginally higher. This could explain the existing fluctuations in the intervention outcomes in Ghana. We found gender, profession and education were associated with provider implementation fidelity. To improve fidelity level among HIV healthcare providers, and realize the aims of the TB screening intervention among PLHIV in Ghana, further training on implementing all components of the intervention is critical.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
10
作者：
Blodgett, JG;Hill, DJ;Tax, SS
通讯作者：
Tax, SS
DOI：
10.1097/qai.0000000000000485
发表时间：
2015-04-15
影响因子：
3.6
作者：
Date, Anand;Modi, Surbhi
通讯作者：
Modi, Surbhi
影响因子：
2.4
作者：
Ennett, S. T.;Haws, S.;Rohrbach, L. A.
通讯作者：
Rohrbach, L. A.
影响因子：
2.5
作者：
Breitenstein SM;Fogg L;Garvey C;Hill C;Resnick B;Gross D
通讯作者：
Gross D