Meribe S C, Adamu Y, Adebayo-Abikoye E, Lawal I, Amazue-Ezeuko I, Okeji N, Okoye I, Agaba P, Nelson R, Lee E, Chittenden L
US Army Medical Research Directorate-Africa/Nigeria, Walter Reed Army Institute of Research, Abuja, Nigeria.
Henry Jackson Foundation Medical Research International, Abuja, Nigeria.
Public Health Action. 2020 Jun 21;10(2):60-63. doi: 10.5588/pha.20.0003.
Tuberculosis preventive therapy (TPT) is recommended for tuberculosis (TB) prevention among people living with HIV (PLHIV) and other high-risk groups. The Nigerian Military HIV Program embarked on TPT-specific 'direct supportive supervision' (DSS) in May 2018 to increase TPT initiation and completion rates.
Interventional approaches included site visits to conduct root cause analysis, didactic teaching approach on the concepts of quality improvement and mentorship to address barriers. The DSS introduced TPT monitoring tools, sticker reminders on clients' folders, and bi-weekly data collection and review for decision making.
TPT initiation increased from a monthly pre-intervention median of 323 clients to monthly medians of 2611 during the 'surge' and 1212 clients during the 'sustained' phases. Due to an isoniazid stock-out, a 'dip phase', with a median of 559 clients was recorded. Overall, 10 463 clients were started on TPT in fiscal year (FY) 2018 and 12 596 in FY2019, with an overall initiation rate of 79%. Completion rates were respectively 73% and 70% for FY2018 and FY2019.
With the implementation of a tailored DSS, programmatic barriers to TPT were easily identified and quickly addressed to increase initiation and completion rates.
建议对艾滋病毒感染者（PLHIV）及其他高危人群进行结核病预防性治疗（TPT）以预防结核病。尼日利亚军事艾滋病毒项目于2018年5月开始实施针对TPT的“直接支持性监督”（DSS），以提高TPT的启动率和完成率。
干预方法包括进行实地考察以进行根本原因分析、采用关于质量改进概念的教学方法以及进行指导以消除障碍。DSS引入了TPT监测工具、在客户文件夹上粘贴提醒标签，并每两周收集和审查数据以供决策。
TPT的启动率从干预前每月中位数323例患者增加到“激增”阶段每月中位数2611例以及“持续”阶段每月中位数1212例。由于异烟肼缺货，记录到一个“下降阶段”，中位数为559例患者。总体而言，2018财年有10463例患者开始接受TPT治疗，2019财年有12596例，总体启动率为79%。2018财年和2019财年的完成率分别为73%和70%。
通过实施量身定制的DSS，TPT的项目障碍得以轻松识别并迅速解决，从而提高了启动率和完成率。
