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Enhancing TB/HIV Co-Infected Patient Retention in Uganda Through Quality Improvement

This study focused on utilizing Continuous Quality Improvement methods to identify and implement facility-based innovations aimed at increasing the retention of TB/HIV co-infected patients on treatment in Uganda. By training providers in TB/HIV co-management and applying QI approaches, significant improvements were achieved in patient retention. Lessons learned include the importance of provider involvement in performance measurement and the need for sustained efforts to maintain improvements.

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Enhancing TB/HIV Co-Infected Patient Retention in Uganda Through Quality Improvement

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  1. Using Continuous Quality Improvement approaches to identify facility-based innovations to increase retention of TB/HIV co-infected patients on treatment in Uganda Authors: K. Mutesasira, D. Murdoch, N. Tumwesigye, A. Muhwezi, A. Musisi, M. Irige, H.Mutabarura, E. Alunguru, S. Muchuro Presenter: Kenneth Mutesasira 3 July 2013

  2. Objective: To improve TB treatment completion towards the National target of 85% Methods Quality Improvement Model • Trained providers in basic TB/HIV co-management and application of continuous quality improvement (QI) approaches • Supported TB process improvement team formation and application of QI methods using onsite QI coaching and clinical mentorship approaches CQI training & team formation Integrated clinical mentoring and QI coaching Quarterly mentorship & QI coaching Orientation on indicator definitions and reporting tools

  3. Implemented change package and results TB care providers measure and track performance Regular team review and updating of patient records Capturing of patient phone numbers to enable patient tracking Initiation of regular cohort reviews to identify and track missing patients using telephone calls and in collaboration with the district TB supervisor Implementation of family-supported DOT Patient referral to treatment facilities closer to home CQI training & team formation Integrated clinical mentoring and QI coaching Orientation on indicator definitions and reporting tools Quarterly mentorship & QI coaching

  4. Lessons and Implications • Improvements in retention of TB/HIV patients on treatment can be achieved through simple, routine facility-based interventions identified and implemented using QI approaches • Provider involvement in performance measurement enhances ownership and motivation for implementation of improvement changes • Integrating clinical mentorship and QI coaching facilitates rapid improvements • More work remains to uphold the improvements gained from application of QI approaches

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