Active detection of HIV patients with tuberculosis at Geita District Hospital in Tanzania improved through the use of continuous quality improvement (CQI). Over four years, the percentage of patient files screened for tuberculosis increased from 63.7% to 99.9%. The number of tuberculosis cases detected also initially increased from 78 cases to 261 cases, then decreased to 106 cases. CQI methods like regular screening, testing, and follow-up of tuberculosis suspects helped improve case detection. Leadership support from hospital management was also key to the success of CQI efforts to enhance tuberculosis screening among HIV patients.

1. ACTIVE DETECTION OF HIV PATIENTS WITH TUBERCULOSIS AT
GEITA DISTRICT HOSPITAL: A REAL PRACTICE OF CQI
Ndalloh M. Ndalloh1
, Ernest Nkwabi1
, Modestus Kamonga2
, Kenneth Makata2
, Bernard Mbwele2
1. Geita District Hospital, P.O Box 40 Geita. Tanzania
2. Christian Social Services Commission, CSSC, P.O Box 905, Mwanza, Tanzania
Background
WHO has recently reported that one-third of Tanzanians estimated
to have Tuberculosis infection (TB) are not detected as they are not
reached by the current health delivery system and interventions
program. Reports from NTLP in 2012 and 2013, shows that TB case
detection rate has remained to be at 77% for 2 years. The main
challenge is inadequate access for TB care, poor methods of
screening and testing of TB cases.
Fortunately, there are a number of treatment options for people
living with HIV who also have either latent TB infection or TB
disease in Tanzania. However detection of TB cases from Care and
Treatment Centres have been quite difficult. The CSSC and Geita
District Hospital had a concern for using CQI to increase TB case
detection.
Methods
The CQI team of Geita District Hospital found many competing
problems and areas to address for QI. After using the criteria of the
urgency of the problem with focus on the conse¬quences of not
improving it, the feasibility of improving the situation, resource
implications and the availability of data to detection of TB cases
was found to be of priority.
The hospital management and CSSC in 2013 assisted CQI team to
work on access of clients screened for TB (TB screening tool, TSQ),
proper follow up of TB Suspects to be tested, technical support to
all staffs in the facility for TB testing and prevention, and
importance of TB Screening to all clients, linkage between CTC and
TB unit, documentation of the screening tool and review of
clinician’s notes, introduction of local register for TB suspect follow
up, AFB testing as well as X-ray testing for those who are smear
negative.
Results
In 2011, 63.7% of the files of patient’s current on Care and
Treatment were screened. In 2012, 88.5% of the files were
Figure 1. Case 1 Sample X-ray Film
of an HIV patient with Tuberculosis
features with AFB results negative
Figure 2. Case 2 Sample X-ray Film
of an HIV patient with Tuberculosis
features with AFB results negative
Figure 1. CQI meeting at
Geita District Hospital
screened. In 2013 the hospital management was involved and 99.5%
were screened and in 2014, 99.9% of the files were screened.
However there was a doubtful trend of the cases to be found as in
2011, 78 cases out of 2578 patients were detected. In 2012, 121 cases
out of 3084 patients were detected. In 2013, 261 cases were detected
out of 3313 cases and 2014, 106 cases were detected out of 2470
clients. All of the TB SUSPECT by X ray were tested by Gene expert
and 85 of 94, and 20 of 21 in 2013 and 2014 were positive.
After implementation of the programme in 2011 to 2014, clients who
were screened by TSQ and AFB and found positive by X ray were 230
and started ant-TB immediately. In 2011 screened negative with
positive X-ray were 22, in 2012 were 93, in 2013 were 94 and in 2014
were 21.
Discussions
Care and Treatment Clinics for HIV may have difficulty expanding their
scope for TB case detection based on the science for HIV and TB
interaction. Stepwise CQI approaches that are incorporating of PDSA
into a general facility’s work plan, has been successfully to show
quality improvement in resource-limited settings.
Conclusion
The health care workers had a strong commitment after the hospital
management was involved in TB case detection.
Recommendations
Active advocacy of facility level leadership to promote CQI in all areas
of health care delivery is important.