S C Meribe1, Y Adamu1, E Adebayo-Abikoye1,2, I Lawal1, I Amazue-Ezeuko1,2, N Okeji3, I Okoye1, P Agaba4,5, R Nelson1, E Lee4, L Chittenden1. 1. US Army Medical Research Directorate-Africa/Nigeria, Walter Reed Army Institute of Research, Abuja, Nigeria. 2. Henry Jackson Foundation Medical Research International, Abuja, Nigeria. 3. Nigerian Ministry of Defense-Health Implementation Programme, Abuja, Nigeria. 4. US Military HIV Research Program, Silver Spring, MD, USA. 5. Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
Abstract
BACKGROUND: Tuberculosis preventive therapy (TPT) is recommended for tuberculosis (TB) prevention among people living with HIV (PLHIV) and other high-risk groups. The Nigerian Military HIV Program embarked on TPT-specific 'direct supportive supervision' (DSS) in May 2018 to increase TPT initiation and completion rates. METHODS: Interventional approaches included site visits to conduct root cause analysis, didactic teaching approach on the concepts of quality improvement and mentorship to address barriers. The DSS introduced TPT monitoring tools, sticker reminders on clients' folders, and bi-weekly data collection and review for decision making. RESULTS: TPT initiation increased from a monthly pre-intervention median of 323 clients to monthly medians of 2611 during the 'surge' and 1212 clients during the 'sustained' phases. Due to an isoniazid stock-out, a 'dip phase', with a median of 559 clients was recorded. Overall, 10 463 clients were started on TPT in fiscal year (FY) 2018 and 12 596 in FY2019, with an overall initiation rate of 79%. Completion rates were respectively 73% and 70% for FY2018 and FY2019. CONCLUSION: With the implementation of a tailored DSS, programmatic barriers to TPT were easily identified and quickly addressed to increase initiation and completion rates.
BACKGROUND: Tuberculosis preventive therapy (TPT) is recommended for tuberculosis (TB) prevention among people living with HIV (PLHIV) and other high-risk groups. The Nigerian Military HIV Program embarked on TPT-specific 'direct supportive supervision' (DSS) in May 2018 to increase TPT initiation and completion rates. METHODS: Interventional approaches included site visits to conduct root cause analysis, didactic teaching approach on the concepts of quality improvement and mentorship to address barriers. The DSS introduced TPT monitoring tools, sticker reminders on clients' folders, and bi-weekly data collection and review for decision making. RESULTS: TPT initiation increased from a monthly pre-intervention median of 323 clients to monthly medians of 2611 during the 'surge' and 1212 clients during the 'sustained' phases. Due to an isoniazid stock-out, a 'dip phase', with a median of 559 clients was recorded. Overall, 10 463 clients were started on TPT in fiscal year (FY) 2018 and 12 596 in FY2019, with an overall initiation rate of 79%. Completion rates were respectively 73% and 70% for FY2018 and FY2019. CONCLUSION: With the implementation of a tailored DSS, programmatic barriers to TPT were easily identified and quickly addressed to increase initiation and completion rates.
Authors: B Odume; S C Meribe; T Odusote; M Ifunanya; H Debem; I Amazue-Ezeuko; O Ogbanufe; Y Adamu; D Onotu Journal: Public Health Action Date: 2020-03-21
Authors: Elizabeth H Lee; Kavitha Ganesan; Samoel A Khamadi; Stanley C Meribe; Dorothy Njeru; Yakubu Adamu; Fred Magala; Trevor A Crowell; Eniko Akom; Patricia Agaba; Priyanka Desai; Tiffany Hamm; Deydre Teyhen; Julie A Ake; Christina S Polyak; Douglas Shaffer; Fredrick Sawe; Patrick W Hickey Journal: Am J Trop Med Hyg Date: 2021-01 Impact factor: 3.707