Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States; School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; National Tuberculosis and Leprosy Control Programme, Uganda Ministry of Health, Kampala, Uganda; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States; Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States; University of California San Francisco Center for Vulnerable Populations, San Francisco General Hospital and Trauma Center, San Francisco, CA, United States
Chaisson, L.H., Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States; Katamba, A., School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, Infectious Diseases Research Collaboration, Kampala, Uganda; Haguma, P., Infectious Diseases Research Collaboration, Kampala, Uganda; Ochom, E., Infectious Diseases Research Collaboration, Kampala, Uganda; Ayakaka, I., Infectious Diseases Research Collaboration, Kampala, Uganda; Mugabe, F., National Tuberculosis and Leprosy Control Programme, Uganda Ministry of Health, Kampala, Uganda; Miller, C., Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States; Vittinghoff, E., Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States; Davis, J.L., Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States, Infectious Diseases Research Collaboration, Kampala, Uganda, Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States; Handley, M.A., Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States, University of California San Francisco Center for Vulnerable Populations, San Francisco General Hospital and Trauma Center, San Francisco, CA, United States; Cattamanchi, A., Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States, Infectious Diseases Research Collaboration, Kampala, Uganda, Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
Background: Tuberculosis (TB) remains under-diagnosed in many countries, in part due to poor evaluation practices at health facilities. Theory-informed strategies are needed to improve implementation of TB evaluation guidelines. We aimed to evaluate the impact of performance feedback and same-day smear microscopy on the quality of TB evaluation at 6 health centers in rural Uganda. Methods: We tested components of a multi-faceted intervention to improve adherence to the International Standards for Tuberculosis Care(ISTC): performance feedback and same-day smear microscopy. The strategies were selected based on a qualitative assessment guided by the Theory of Planned Behavior and the PRECEDE model. We collected patient data 6 months before and after the introduction of each intervention component, and compared ISTC adherence in the pre- and post-intervention periods for adults with cough ≥ 2 weeks' duration. Results: The performance feedback evaluation included 1,446 adults; 838 (58%) were evaluated during the pre-intervention period and 608 (42%) during the post-intervention period. Performance feedback resulted in a 15% (95%CI +10% to +20%, p<0.001) increase in the proportion of patients receiving ISTC-adherent care. The same-day microscopy evaluation included 1,950 adults; 907 (47%) were evaluated during the pre-intervention period and 1,043 (53%) during the post-intervention period. Same-day microscopy was associated with a 14% (95%CI +10% to +18%, p<0.001) increase in the proportion of patients receiving ISTC-adherent care. Conclusions: Performance feedback and same-day microscopy should be considered along with ISTC training as part of a multi-faceted intervention to improve the quality of TB evaluation in other high TB burden countries. © 2015 Chaisson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.