Is there room for improvement? Intervening at facility and district level to improve access and quality of care in a well-performing TB Control Programme: the Cape Town experience

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dc.contributor.authorScott, Vera
dc.contributor.authorCaldwell, Judy
dc.contributor.authorAzevedo, Virginia
dc.date.accessioned2014-01-13T21:13:07Z
dc.date.available2014-01-13T21:13:07Z
dc.date.issued2012
dc.description.abstractObjectives. To use a quality improvement approach to improve access to and quality of tuberculosis (TB) diagnosis and care in Cape Town. Methods. Five HIV/AIDS/sexually transmitted infections/TB (HAST) evaluations were conducted from 2008 to 2010, with interviews with 99 facility managers and a folder review of over 850 client records per evaluation cycle. The data were used in a local quality improvement process: sub-district workshops identified key weaknesses and facility managers drew up action plans. Lessons learnt and successful strategies were shared at quarterly districtwide HIV/TB meetings. Results. Geographical access was good, but there were delays in treatment commencement times. Access for high-risk clients improved significantly with intensified TB case finding made routine in both the HIV counselling and testing and antiretroviral treatment (ART) services (p<0.01 for both). Access for children in contact with an infectious case has improved but is still low (42% investigated and treated). Quality of care was mostly high at baseline (adherence to treatment protocols 95%). Measurement of body mass index improved from 20% to 62%. The assessment of contraception improved from 27% to 58%. Care for co-infected clients showed improved use of customised HIV stationery and increased assessment for ART eligibility. Conclusions. The HAST audit contributed to the improved TB cure rates by supplementing routine information and involving sub-district managers, facility managers and facility staff in a quality improvement process that identified local opportunities for programme strengthening.en_US
dc.description.accreditationWeb of Scienceen_US
dc.identifier.citationScott, V., Caldwell, J., & Azevedo, V. (2012). Is there room for improvement? Intervening at facility and district level to improve access and quality of care in a well-performing TB Control Programme: the Cape Town experience. South African Medical Journal, 102(11): 837-840en_US
dc.identifier.issn0256-9574
dc.identifier.urihttp://hdl.handle.net/10566/947
dc.language.isoenen_US
dc.privacy.showsubmitterfalse
dc.publisherHealth and Medical Publishing Groupen_US
dc.rights© 2012 Scott et al; licensee Health and Medical Publishing Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited..
dc.source.urihttp://dx.doi.org/10.7196/SAMJ.5469
dc.status.ispeerreviewedtrue
dc.subjectQuality improvementen_US
dc.subjectTB programmeen_US
dc.titleIs there room for improvement? Intervening at facility and district level to improve access and quality of care in a well-performing TB Control Programme: the Cape Town experienceen_US
dc.typeArticleen_US

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Dr. Vera Scott (School of Public Health)