Assessing implementation fidelity (adherence) of TB prevention in people living with HIV in selected clinics in central province, ZAMBIA

Abstract

Background The World Health Organization 2015 tuberculosis report presented an estimated 10.4 million new tuberculosis (TB) incident cases of which about 1.2 million cases (11% of the total TB cases notified) were human immunodeficiency virus (HIV) positive. Screening for TB and provision of Isoniazid to those who screen negative for TB are recommended in HIV positive people. Fidelity is defined as the extent to which an intervention is being implemented as it was intended by the programme developers. This study assessed the fidelity of implementing TB prevention guidelines for people living with HIV in Zambia.

Objective The main objective of this study was to assess the extent of fidelity (adherence) of healthcare workers to the implementation of guidelines for Intensified Case Finding (ICF) and Isoniazid Preventive Therapy (IPT) for prevention of active TB infection among People living with HIV/AIDS in Zambia. Materials and Methods The research project consisted of secondary analysis of data from patient’s medical records from four clinics in which the extent of implementation fidelity to TB prevention by healthcare workers in Zambia was studied. We adopted and constructed a conceptual framework based on Carroll’s conceptual framework for measuring implementation fidelity. The explanatory variable were healthcare worker training, profession, gender and geographical location of the clinic. The outcome variables were ICF and IPT fidelity scores. Analysis of variance was conducted to compare the mean ICF score between the different health centres and the patient v

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visits. Univariable and multivariable logistic regression were used to model the explanatory variables against the outcome of achieving an ICF score of 3 or less versus achieving an ICF score of 4.

Results The overall health workers ICF adherence fidelity mean score was found to be low 2.40 (50%). There was a significant difference in ICF fidelity by gender of healthcare worker for the first visit but no significant difference for the other visits. There was also a difference in ICF fidelity score for the health centres. The providers’ training and profession did not affect their ICF adherence fidelity score for all the visits. The fidelity score obtained for IPT was zero.

Conclusion and Recommendations Low implementation fidelity scores for TB prevention were obtained in all facilities. Rural facilities had the lower fidelity scores compared to urban facilities. Even after undergoing training as provided by training records and provided with guidelines, ICF fidelity was still low. More studies are needed that will investigate the providers perception of the intervention.