Curran Robyn, Murdoch Jamie, van Rensburg André J, Bachmann Max, Awotiwon Ajibola, Ras Christy-Joy, Petersen Inge, Prince Martin, Moultrie Harry, Nzuza Mercury, Fairall Lara
Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa.
School of Life Course and Population Sciences, Department of Social Science and Health, King's College, London, UK.
Trop Med Int Health. 2023 Apr;28(4):324-334. doi: 10.1111/tmi.13860. Epub 2023 Feb 20.
The adverse effects of the COVID-19 pandemic on tuberculosis (TB) detection have been well documented. Despite shared symptoms, guidance for integrated screening for TBand COVID-19 are limited, and opportunities for health systems strengthening curtailed by lockdowns. We partnered with a high TB burden district in KwaZulu-Natal, South Africa, to co-develop an integrated approach to assessing COVID-19 and TB, delivered using online learning and quality improvement, and evaluated its performance on TB testing and detection.
We conducted a mixed methods study incorporating a quasi-experimental design and process evaluation in 10 intervention and 18 control clinics. Nurses in all 28 clinics were all provided access to a four-session online course to integrate TB and COVID-19 screening and testing, which was augmented with some webinar and in-person support at the 10 intervention clinics. We estimated the effects of exposure to this additional support using interrupted time series Poisson regression mixed models. Process evaluation data comprised interviews before and after the intervention. Thematic coding was employed to provide explanations for effects of the intervention.
Clinic-level support at intervention clinics was associated with a markedly higher uptake (177 nurses from 10 intervention clinics vs. 19 from 18 control clinics). Lack of familiarity with online learning, and a preference for group learning hindered the transition from face-to-face to online learning. Even so, any exposure to training was initially associated with higher rates of GeneXpert testing (adjusted incidence ratio [IRR] 1.11, 95% confidence interval 1.07-1.15) and higher positive TB diagnosis (IRR 1.38, 1.11-1.71).
These results add to the knowledge base regarding the effectiveness of interventions to strengthen TB case detection during the COVID-19 pandemic. The findings support the feasibility of a shift to online learning approaches in low-resource settings with appropriate support and suggest that even low-intensity interventions are capable of activating nurses to integrate existing disease control priorities during pandemic conditions.
2019年冠状病毒病（COVID-19）大流行对结核病检测的不利影响已有充分记录。尽管存在共同症状，但针对结核病和COVID-19综合筛查的指导有限，且封锁措施限制了卫生系统加强建设的机会。我们与南非夸祖鲁-纳塔尔省一个结核病负担较重的地区合作，共同开发一种评估COVID-19和结核病的综合方法，通过在线学习和质量改进来实施，并评估其在结核病检测方面的表现。
我们进行了一项混合方法研究，在10个干预诊所和18个对照诊所采用了准实验设计和过程评估。所有28个诊所的护士都有机会参加一个为期四节的在线课程，以整合结核病和COVID-19的筛查与检测，在10个干预诊所还通过一些网络研讨会和现场支持进行了强化。我们使用中断时间序列泊松回归混合模型估计了接触这种额外支持的效果。过程评估数据包括干预前后的访谈。采用主题编码来解释干预的效果。
干预诊所的诊所层面支持与明显更高的参与度相关（10个干预诊所的177名护士与18个对照诊所的19名护士）。对在线学习不熟悉以及对小组学习的偏好阻碍了从面对面学习到在线学习的转变。即便如此，任何培训接触最初都与更高的GeneXpert检测率（调整后的发病率比[IRR]为1.11，95%置信区间为1.07 - 1.15）和更高的结核病阳性诊断率（IRR为1.38，1.11 - 1.71）相关。
这些结果增加了关于在COVID-19大流行期间加强结核病病例检测干预措施有效性的知识库。研究结果支持在低资源环境中通过适当支持转向在线学习方法的可行性，并表明即使是低强度干预也能够促使护士在大流行情况下整合现有的疾病控制重点。
