Medical Research Council, Tygerberg, West Cape.
S Afr Med J. 2011 Nov 28;101(12):887-90.
Despite the prioritisation of TB, HIV and STI programmes in South Africa, service targets are not achieved, have had little effect, and the magnitude of the epidemics continues to escalate. Objective. To report on a participatory quality improvement intervention designed to evaluate these priority programmes in primary health care (PHC) clinics in a rural district in KwaZulu-Natal.
A participatory quality improvement intervention with district health managers, PHC supervisors and researchers was used to modify a TB/HIV/STI audit tool for use in a rural area, conduct a district-wide clinic audit, assess performance, set targets and develop plans to address the problems identified.
We highlight weaknesses in training and support of staff at PHC clinics, pharmaceutical and laboratory failures, and inadequate monitoring of patients as contributing to poor TB, HIV and STI service implementation. In the 25 facilities audited, 71% of the clinical staff had received no training in TB diagnosis and management, and 46% of the facilities were visited monthly by a PHC supervisor. Eighty per cent of the facilities experienced non-availability of essential drugs and supplies; polymerase chain reaction (PCR) results were not documented for 54% of specimens assessed, and the mean length of time between eligibility for ART and starting treatment was 47 days.
Through a participatory approach, a TB/HIV/STI audit tool was successfully adapted and implemented in a rural district. It yielded information enabling managers to identify obstacles to TB, HIV and STI service implementation and develop plans to address these. The audit can be used by the district to monitor priority services at a primary level.
尽管南非将结核病、艾滋病病毒和性传播感染方案列为优先事项，但这些方案的服务指标仍未实现，收效甚微，疫情规模仍在不断扩大。目的：报告一项参与式质量改进干预措施，该措施旨在评估夸祖鲁-纳塔尔省农村地区初级卫生保健（PHC）诊所中这些优先方案的实施情况。
采用参与式质量改进干预措施，与地区卫生管理人员、PHC 主管和研究人员合作，修改了结核病/艾滋病病毒/性传播感染审计工具，以便在农村地区使用，开展了一次全地区诊所审计，评估绩效，设定目标，并制定计划解决发现的问题。
我们强调了 PHC 诊所工作人员在培训和支持方面的薄弱环节、药品和实验室方面的失败以及对患者监测的不足，这些都是导致结核病、艾滋病病毒和性传播感染服务实施不力的原因。在接受审计的 25 个设施中，71%的临床工作人员没有接受过结核病诊断和管理方面的培训，46%的设施每月由 PHC 主管进行一次访问。80%的设施出现基本药物和用品短缺；54%评估的标本未记录聚合酶链反应（PCR）结果，符合开始接受抗逆转录病毒治疗条件到开始治疗的平均时间为 47 天。
通过参与式方法，成功地对结核病/艾滋病病毒/性传播感染审计工具进行了改编和实施，为管理者提供了信息，使其能够确定结核病、艾滋病病毒和性传播感染服务实施的障碍，并制定解决这些障碍的计划。该审计可由地区用于监测初级卫生保健的重点服务。
