RESEARCH ARTICLE
Theory-Informed Interventions to Improve the Quality of Tuberculosis Evaluation at Ugandan Health Centers: A QuasiExperimental Study Lelia H. Chaisson1☯*, Achilles Katamba2,3☯, Priscilla Haguma3, Emmanuel Ochom3, Irene Ayakaka3, Frank Mugabe4, Cecily Miller5, Eric Vittinghoff5, J. Lucian Davis1,3,6, Margaret A. Handley5,7, Adithya Cattamanchi1,3,6*
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OPEN ACCESS Citation: Chaisson LH, Katamba A, Haguma P, Ochom E, Ayakaka I, Mugabe F, et al. (2015) TheoryInformed Interventions to Improve the Quality of Tuberculosis Evaluation at Ugandan Health Centers: A Quasi-Experimental Study. PLoS ONE 10(7): e0132573. doi:10.1371/journal.pone.0132573 Editor: Nerges Mistry, The Foundation for Medical Research, INDIA Received: January 13, 2015 Accepted: June 17, 2015 Published: July 14, 2015 Copyright: © 2015 Chaisson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: Work was supported by the National Institutes of Health (www.nih.gov; (R21 AI096158 (AC), P60MD006902 (MAH), UL1 TR000004 (MAH))) and a Joint Global Health Trials scheme pilot grant from the UK Department for International Development, the Medical Research Council, and the Wellcome Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
1 Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America, 2 School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, 3 Infectious Diseases Research Collaboration, Kampala, Uganda, 4 National Tuberculosis and Leprosy Control Programme, Uganda Ministry of Health, Kampala, Uganda, 5 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America, 6 Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America, 7 University of California San Francisco Center for Vulnerable Populations, San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America ☯ These authors contributed equally to this work. *
[email protected] (AC);
[email protected] (LHC)
Abstract Background Tuberculosis (TB) remains under-diagnosed in many countries, in part due to poor evaluation practices at health facilities. Theory-informed strategies are needed to improve implementation of TB evaluation guidelines. We aimed to evaluate the impact of performance feedback and same-day smear microscopy on the quality of TB evaluation at 6 health centers in rural Uganda.
Methods We tested components of a multi-faceted intervention to improve adherence to the International Standards for Tuberculosis Care(ISTC): performance feedback and same-day smear microscopy. The strategies were selected based on a qualitative assessment guided by the Theory of Planned Behavior and the PRECEDE model. We collected patient data 6 months before and after the introduction of each intervention component, and compared ISTC adherence in the pre- and post-intervention periods for adults with cough 2 weeks’ duration.
Results The performance feedback evaluation included 1,446 adults; 838 (58%) were evaluated during the pre-intervention period and 608 (42%) during the post-intervention period. Performance feedback resulted in a 15% (95%CI +10% to +20%, p
