• S Zaeh, R Kempker, E Stenehjem, H M Blumberg, O Temesgen, I Ofotokun, and A Tenna.
• Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
• Int. J. Tuberc. Lung Dis. 2013 Nov 1;17(11):1396-401.

BackgroundThe World Health Organization (WHO) recommends active tuberculosis (TB) case finding among people living with human immunodeficiency virus (HIV) in resource-limited settings using a symptom-based algorithm; those without active TB disease should be offered isoniazid preventive therapy (IPT).ObjectiveTo evaluate rates of adherence to WHO recommendations and the impact of a quality improvement intervention in an HIV clinic in Addis Ababa, Ethiopia.DesignA prospective study design was utilized to compare TB symptom screening and IPT administration rates before and after a quality improvement intervention consisting of 1) educational sessions, 2) visual reminders, and 3) use of a screening checklist.ResultsA total of 751 HIV-infected patient visits were evaluated. The proportion of patients screened for TB symptoms increased from 22% at baseline to 94% following the intervention (P < 0.001). Screening rates improved from 51% to 81% (P < 0.001) for physicians and from 3% to 100% (P < 0.001) for nurses. Of the 281 patients with negative TB symptom screens and eligible for IPT, 4% were prescribed IPT before the intervention compared to 81% after (P < 0.001).ConclusionsWe found that a quality improvement intervention significantly increased WHO-recommended TB screening rates and IPT administration. Utilizing nurses can help increase TB screening and IPT provision in resource-limited settings.

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