Provider fidelity in tuberculosis screening practices among adolescents and adults living with HIV in public health facilities in Tanzania
Date
2025-11-19
Journal Title
Journal ISSN
Volume Title
Publisher
Frontiers Public Health
Abstract
Tuberculosis (TB) remains the leading cause of morbidity and mortality among
people living with HIV (PLHIV) in high-burden countries like Tanzania. Despite
national and global guidelines recommending routine TB screening at every clinical
encounter, missed and delayed TB case notifications persist, suggesting gaps in
screening practices. This study evaluated the implementation fidelity of the TB
screening algorithm and associated factors within routine HIV care in public health
facilities in Geita, Tanzania. A facility-based cross-sectional study was conducted,
involving the extraction of data from 423 client treatment records and observation
of 423 screening sessions. Simple random and systematic sampling methods
were employed to select the records and sessions, respectively. Descriptive and
inferential analyses were performed using Excel and Stata. Modified Poisson
regression with robust variance was used to estimate prevalence ratios (PRs)
to determine factors associated with two binary outcomes: (1) consistent TB
screening over 12-month period, and (2) correct utilization of the screening tool.
TB screening was documented in 82.8% of clinical encounters. Overall, 70.7%
of clients were screened at every encounter, and 75.4% screened at their most
recent visit. Laboratory investigations were recorded in 94% of presumptive cases,
with all confirmed TB cases initiated on treatment. Additionally, 80.6% of eligible
clients were initiated on TB preventive therapy (TPT). The WHO Four-Symptom
Screening (W4SS) was widely used (98.8%), and the tool was correctly administered
in 62% of the sessions observed. Factors associated with inconsistent screening
included age 40–49 years [Adjusted Prevalence Ratio (aPR) = 0.82; p = 0.046], age
≥50 years (aPR = 0.76; p = 0.025), suppressed viral load (aPR = 0.63; p < 0.001),
monthly drug refill model (aPR = 0.55; p = 0.006), refill by treatment supporter
(aPR = 0.09; p < 0.001), being traced back from a lost to follow up (aPR = 1.38;
p = 0.019), and absence of prior TB (aPR = 0.81; p = 0.001). The correct use of
the W4SS tool was less likely at PMTCT clinics (aPR = 0.55; p < 0.001). Although
TB screening is widely integrated into HIV care, fidelity to the screening algorithm
remains suboptimal in the initial stages of symptom screening. The completion
of the algorithm cascade was well-implemented. Fidelity at earlier stages of the
algorithm, such as the consistent and correct use of the W4SS, should be enhanced
by strengthening provider capacity and routine monitoring to improve adherence
to the protocol.
Description
Frontiers
Keywords
tuberculosis, TBHIV, screening, algorithm, fidelity, evaluation
Citation
APA