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Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana
INTRODUCTION: Tuberculosis screening of people living with human immunodeficiency virus is an intervention recommended by the WHO to control the dual epidemic of TB and HIV. The extent to which the intervention is adhered to by the HIV healthcare providers (fidelity) determines the intervention’s ef...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448304/ https://www.ncbi.nlm.nih.gov/pubmed/34534240 http://dx.doi.org/10.1371/journal.pone.0257486 |
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author | Narh-Bana, Solomon A. Kawonga, Mary Chirwa, Esnat D. Ibisomi, Latifat Bonsu, Frank Chirwa, Tobias F. |
author_facet | Narh-Bana, Solomon A. Kawonga, Mary Chirwa, Esnat D. Ibisomi, Latifat Bonsu, Frank Chirwa, Tobias F. |
author_sort | Narh-Bana, Solomon A. |
collection | PubMed |
description | INTRODUCTION: Tuberculosis screening of people living with human immunodeficiency virus is an intervention recommended by the WHO to control the dual epidemic of TB and HIV. The extent to which the intervention is adhered to by the HIV healthcare providers (fidelity) determines the intervention’s effectiveness as measured by patient outcomes, but literature on fidelity is scarce. This study assessed provider implementation fidelity to national guidelines on TB screening at HIV clinics in Ghana. METHODS: It was a cross-sectional study that used structured questionnaires to gather data, involving 226 of 243 HIV healthcare providers in 27 HIV clinics across Ghana. The overall fidelity score comprised sixteen items with a maximum score of 48 grouped into three components of the screening intervention (TB diagnosis, TB awareness and TB symptoms questionnaire). Simple summation of item scores was done to determine fidelity score per provider. In this paper, we define the level of fidelity as low if the scores were below the median score and were otherwise categorized as high. Background factors potentially associated with implementation fidelity level were assessed using cluster-based logistic regression. Odds ratio with 95% confidence interval (CI) was used as the measure of association. RESULTS: Of the 226 healthcare providers interviewed, 60% (135) were females with a mean age of 34.5 years (SD = 8.3). Most of them were clinicians [63% (142)] and had post-secondary non-tertiary education [62% (141)]. Overall, 53% (119) of the healthcare providers were categorized to have implemented the intervention with high fidelity. Also, 56% (126), 53% (120), and 59% (134) of the providers implemented the TB diagnosis, TB awareness and TB symptoms questionnaire components respectively with high fidelity. After adjusting for cluster effect, female providers (AOR = 2.36, 95%CI: 1.09–5.10, p = <0.029), those with tertiary education (AOR = 4.31, 95%CI: 2.12–9.10, p = 0.040), and clinicians (AOR = 1.78, 95%CI: 1.07–3.50, p = 0.045) were more likely to adhere to the guidelines compared to their counterparts. CONCLUSION: The number of providers with fidelity scores above the median was marginally greater (6%) than the number with fidelity score below the median. Similarly, for each of the components, the number of providers with fidelity scores higher than the median was marginally higher. This could explain the existing fluctuations in the intervention outcomes in Ghana. We found gender, profession and education were associated with provider implementation fidelity. To improve fidelity level among HIV healthcare providers, and realize the aims of the TB screening intervention among PLHIV in Ghana, further training on implementing all components of the intervention is critical. |
format | Online Article Text |
id | pubmed-8448304 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-84483042021-09-18 Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana Narh-Bana, Solomon A. Kawonga, Mary Chirwa, Esnat D. Ibisomi, Latifat Bonsu, Frank Chirwa, Tobias F. PLoS One Research Article INTRODUCTION: Tuberculosis screening of people living with human immunodeficiency virus is an intervention recommended by the WHO to control the dual epidemic of TB and HIV. The extent to which the intervention is adhered to by the HIV healthcare providers (fidelity) determines the intervention’s effectiveness as measured by patient outcomes, but literature on fidelity is scarce. This study assessed provider implementation fidelity to national guidelines on TB screening at HIV clinics in Ghana. METHODS: It was a cross-sectional study that used structured questionnaires to gather data, involving 226 of 243 HIV healthcare providers in 27 HIV clinics across Ghana. The overall fidelity score comprised sixteen items with a maximum score of 48 grouped into three components of the screening intervention (TB diagnosis, TB awareness and TB symptoms questionnaire). Simple summation of item scores was done to determine fidelity score per provider. In this paper, we define the level of fidelity as low if the scores were below the median score and were otherwise categorized as high. Background factors potentially associated with implementation fidelity level were assessed using cluster-based logistic regression. Odds ratio with 95% confidence interval (CI) was used as the measure of association. RESULTS: Of the 226 healthcare providers interviewed, 60% (135) were females with a mean age of 34.5 years (SD = 8.3). Most of them were clinicians [63% (142)] and had post-secondary non-tertiary education [62% (141)]. Overall, 53% (119) of the healthcare providers were categorized to have implemented the intervention with high fidelity. Also, 56% (126), 53% (120), and 59% (134) of the providers implemented the TB diagnosis, TB awareness and TB symptoms questionnaire components respectively with high fidelity. After adjusting for cluster effect, female providers (AOR = 2.36, 95%CI: 1.09–5.10, p = <0.029), those with tertiary education (AOR = 4.31, 95%CI: 2.12–9.10, p = 0.040), and clinicians (AOR = 1.78, 95%CI: 1.07–3.50, p = 0.045) were more likely to adhere to the guidelines compared to their counterparts. CONCLUSION: The number of providers with fidelity scores above the median was marginally greater (6%) than the number with fidelity score below the median. Similarly, for each of the components, the number of providers with fidelity scores higher than the median was marginally higher. This could explain the existing fluctuations in the intervention outcomes in Ghana. We found gender, profession and education were associated with provider implementation fidelity. To improve fidelity level among HIV healthcare providers, and realize the aims of the TB screening intervention among PLHIV in Ghana, further training on implementing all components of the intervention is critical. Public Library of Science 2021-09-17 /pmc/articles/PMC8448304/ /pubmed/34534240 http://dx.doi.org/10.1371/journal.pone.0257486 Text en © 2021 Narh-Bana et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Narh-Bana, Solomon A. Kawonga, Mary Chirwa, Esnat D. Ibisomi, Latifat Bonsu, Frank Chirwa, Tobias F. Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana |
title | Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana |
title_full | Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana |
title_fullStr | Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana |
title_full_unstemmed | Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana |
title_short | Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana |
title_sort | fidelity of implementation of tb screening guidelines by health providers at selected hiv clinics in ghana |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448304/ https://www.ncbi.nlm.nih.gov/pubmed/34534240 http://dx.doi.org/10.1371/journal.pone.0257486 |
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