Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana.

<h4>Introduction</h4>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 th...

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Autores principales:	Solomon A Narh-Bana, Mary Kawonga, Esnat D Chirwa, Latifat Ibisomi, Frank Bonsu, Tobias F Chirwa
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bbbec40c4dc7498194692745a4941197
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spelling	oai:doaj.org-article:bbbec40c4dc7498194692745a49411972021-12-02T20:14:32ZFidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana.1932-620310.1371/journal.pone.0257486https://doaj.org/article/bbbec40c4dc7498194692745a49411972021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257486https://doaj.org/toc/1932-6203<h4>Introduction</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Solomon A Narh-BanaMary KawongaEsnat D ChirwaLatifat IbisomiFrank BonsuTobias F ChirwaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257486 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Solomon A Narh-Bana Mary Kawonga Esnat D Chirwa Latifat Ibisomi Frank Bonsu Tobias F Chirwa Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana.
description	<h4>Introduction</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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	article
author	Solomon A Narh-Bana Mary Kawonga Esnat D Chirwa Latifat Ibisomi Frank Bonsu Tobias F Chirwa
author_facet	Solomon A Narh-Bana Mary Kawonga Esnat D Chirwa Latifat Ibisomi Frank Bonsu Tobias F Chirwa
author_sort	Solomon A Narh-Bana
title	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_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_sort	fidelity of implementation of tb screening guidelines by health providers at selected hiv clinics in ghana.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/bbbec40c4dc7498194692745a4941197
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Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana.

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