Effect on tuberculosis outcomes of educational outreach to South African clinics during two randomised trials
Abstract:SETTING: Public sector primary care clinics in Free State Province, South Africa.
OBJECTIVES: To investigate the effects of on-site in-service clinical skills training for nurse practitioners on tuberculosis (TB) treatment outcomes in the same clinics.
DESIGN: Analysis of TB programme data from clinics taking part in two consecutive randomised trials of educational outreach aimed at improving respiratory and human immunodeficiency virus/acquired immune-deficiency syndrome care based on the Practical Approach to Lung Health. We compared treatment outcomes between control and intervention clinics among all patients diagnosed with TB during either trial.
RESULTS: During the two trials, participating clinics treated 4187 and 2333 TB patients, respectively. Neither intervention was associated with better outcomes overall. However, among retreatment patients, cure or completion rates in intervention clinics were significantly higher during the second trial (OR 1.78, 95%CI 1.13–2.76). Patients in clinics that had received both interventions had higher cure or completion rates (OR 1.99, 95%CI 1.53–2.58) and lower default rates (OR 0.25, 95%CI 0.097–0.63) than patients in clinics that had received neither intervention.
CONCLUSION: Although not primarily focused on TB treatment, the interventions appeared to improve successful treatment completion rates among TB retreatment cases. Integrated care programmes support attainment of important TB programme goals.
Document Type: Regular Paper
Affiliations: 1: Medical School, University of East Anglia, Norwich, UK 2: Knowledge Translation Unit, University of Cape Town Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa 3: Biostatistics Unit, Medical Research Council, Tygerberg, South Africa 4: Free State Health Department, Bloemfontein, South Africa 5: Department of Medicine, University of Cape Town, Cape Town, South Africa 6: Knowledge Translation Unit, University of Cape Town Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa; and Centre for Health Services Sciences, Sunnybrook Research Institute, Institute of Clinical Evaluative Sciences, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Publication date: 2010-03-01
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