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The Quality Improvement Effect

March 24, 2016

QI Team Sparks Dramatic Increase in Tuberculosis Therapy Enrollment at Regional Referral Hospital in Ethiopia

Around the world, tuberculosis (TB) accounts for almost half a million HIV-related deaths each year. While the provision of isoniazid preventive therapy (IPT) is proven to be highly effective at preventing tuberculosis in HIV-positive individuals, many HIV patients are not receiving the preventive care they need. In Ethiopia, about 11 percent of TB patients are co-infected with HIV.

With funds from PEPFAR through the CDC, ICAP has been working with the Federal Ministry of Health and Regional Health Bureaus to support health facilities in delivering integrated TB/HIV services across four regions in Ethiopia.

At Assosa General Hospital, the regional referral hospital in Benishangul-Gumuz Region, there are more than 1,000 patients receiving antiretroviral therapy (ART); however, only six percent had initiated IPT at enrollment in HIV care (as of May 2015). The low IPT enrollment among people living with HIV at Assosa General Hospital made the integration of preventive TB services a major priority.

To address these challenges, and improve TB care more broadly, ICAP led the development of a quality improvement team to introduce quality improvement concepts and tools to hospital staff. The team, comprised of hospital management and staff, and led by ICAP team members conducted analysis using QI methods to identify the key causes of low IPT uptake among patients. The team found a number of issues ranging from lack of understanding among patients to concerns about treatment resistance and increased pill burden.

“Many of the clients did not initiate IPT due to fear of the pill burden and lack of ongoing counseling on the benefit of IPT and TB preventive services,” said Osman Kemal, ART focal person at Asossa General Hospital.

In May 2015, the QI team used this information to implement a range of interventions to improve timely initiation of IPT for eligible HIV-positive patients. The team built patient knowledge and improved the skills and confidence of service providers by ensuring the availability of job aids and conducting a week-long mentorship program for ART providers on TB screening and the provision of IPT.

“My skill, knowledge and confidence on IPT provision have been boosted up after the week long mentorship,” said Mr. Kemal.

As a result of these quality initiatives and continued follow-up, a dramatic increase has taken place over a period of just eight months with the proportion of HIV-patients initiated on IPT increasing from six to 80 percent, representing a dramatic increase of IPT uptake among people living with HIV at Assosa Genera Hospital.

“The results of this quality improvement project on IPT highlight the importance of quality improvement in expanding effective health services,” said Dr. Zenebe Melaku, ICAP’s country director in Ethiopia.

“We look forward to continuing to support the Ministry and the Regional Health Bureaus to scale up implementation of quality improvement projects across the country.”