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SAMJ: South African Medical Journal

versión On-line ISSN 2078-5135

Resumen

SCOTT, Vera; AZEVEDO, Virginia  y  CALDWELL, Judy. Improving access and quality of care in a TB control programme. SAMJ, S. Afr. med. j. [online]. 2012, vol.102, n.11, pp. 837-840. ISSN 2078-5135.

OBJECTIVES: To use a quality improvement approach to improve access to and quality of tuberculosis (TB) diagnosis and care in Cape Town. METHODS: Five HIV/AIDS/sexually transmitted infections/TB (HAST) evaluations were conducted from 2008 to 2010, with interviews with 99 facility managers and a folder review of over 850 client records per evaluation cycle. The data were used in a local quality improvement process: sub-district workshops identified key weaknesses and facility managers drew up action plans. Lessons learnt and successful strategies were shared at quarterly district-wide HIV/TB meetings. RESULTS: Geographical access was good, but there were delays in treatment commencement times. Access for high-risk clients improved significantly with intensified TB case finding made routine in both the HIV counselling and testing and antiretroviral treatment (ART) services (p<0.01 for both). Access for children in contact with an infectious case has improved but is still low (42% investigated and treated). Quality of care was mostly high at baseline (adherence to treatment protocols 95%). Measurement of body mass index improved from 20% to 62%. The assessment of contraception improved from 27% to 58%. Care for co-infected clients showed improved use of customised HIV stationery and increased assessment for ART eligibility. CONCLUSIONS: The HAST audit contributed to the improved TB cure rates by supplementing routine information and involving sub-district managers, facility managers and facility staff in a quality improvement process that identified local opportunities for programme strengthening.

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