G Caturegli1, J Materi1, A Lombardo1, M Milovanovic2, N Yende2, E Variava3, J E Golub1,4, N A Martinson2, C J Hoffmann1. 1. Division of Infectious Disease, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. 2. Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg South Africa. 3. Department of Medicine, Tshepong Hospital, Klerksdorp, South Africa. 4. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Abstract
BACKGROUND: All people with HIV who screen negative for active tuberculosis (TB) should receive isoniazid preventive therapy (IPT). IPT implementation remains substantially below the 90% WHO target. This study sought to further understanding of IPT prescription by piloting a simplified prescribing approach. SETTING: Primary care clinics in Matlosana, South Africa. DESIGN: This was a mixed-methods implementation study. METHODS: Nine providers were recruited and underwent training on 2018 WHO guidelines. A simplified prescribing tool containing antiretroviral therapy (ART) and IPT prescriptions was introduced into the workflow for 2 weeks. Prescription data were collected from file review. Interviews were conducted with prescribers. RESULTS: During the study period, 41 patients were evaluated for ART initiation; 34 (83%) files used the simplified prescribing tool. Thirty-seven (90%) patients were eligible for same-day ART and IPT initiation, of whom 36 (97%) received IPT prescription. Qualitative interviews identified the following barriers to IPT prescription: cognitive burden, extensive documentation, limited management support, paucity of training, stock-outs, and patient-related factors. Provider acceptability of the tool was favorable, with unanimous recommendation to colleagues on the basis of streamlining documentation and reminding to prescribe. CONCLUSIONS: This simplified prescribing device for IPT was feasible to implement. Streamlining documentation and reminding providers to prescribe can reduce work-flow barriers to IPT provision.
BACKGROUND: All people with HIV who screen negative for active tuberculosis (TB) should receive isoniazid preventive therapy (IPT). IPT implementation remains substantially below the 90% WHO target. This study sought to further understanding of IPT prescription by piloting a simplified prescribing approach. SETTING: Primary care clinics in Matlosana, South Africa. DESIGN: This was a mixed-methods implementation study. METHODS: Nine providers were recruited and underwent training on 2018 WHO guidelines. A simplified prescribing tool containing antiretroviral therapy (ART) and IPT prescriptions was introduced into the workflow for 2 weeks. Prescription data were collected from file review. Interviews were conducted with prescribers. RESULTS: During the study period, 41 patients were evaluated for ART initiation; 34 (83%) files used the simplified prescribing tool. Thirty-seven (90%) patients were eligible for same-day ART and IPT initiation, of whom 36 (97%) received IPT prescription. Qualitative interviews identified the following barriers to IPT prescription: cognitive burden, extensive documentation, limited management support, paucity of training, stock-outs, and patient-related factors. Provider acceptability of the tool was favorable, with unanimous recommendation to colleagues on the basis of streamlining documentation and reminding to prescribe. CONCLUSIONS: This simplified prescribing device for IPT was feasible to implement. Streamlining documentation and reminding providers to prescribe can reduce work-flow barriers to IPT provision.
Authors: Haileyesus Getahun; Reuben Granich; Delphine Sculier; Christian Gunneberg; Leopold Blanc; Paul Nunn; Mario Raviglione Journal: AIDS Date: 2010-11 Impact factor: 4.177
Authors: Cynthia L Gong; Kenneth M Zangwill; Joel W Hay; Daniella Meeker; Jason N Doctor Journal: J Gen Intern Med Date: 2018-05-08 Impact factor: 5.128
Authors: Eva Van Ginderdeuren; Jean Bassett; Colleen Hanrahan; Lillian Mutunga; Annelies Van Rie Journal: PLoS One Date: 2019-02-14 Impact factor: 3.240
Authors: Su-Ying Liang; Cheryl D Stults; Veena G Jones; Qiwen Huang; Jeremy Sutton; Guy Tennyson; Albert S Chan Journal: JMIR Hum Factors Date: 2022-03-30