Stockouts among obstacles to TB/HIV treatment monitoring, training evaluation finds

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Training may have supported care outcome improvements

In South Africa, where in 2014 an estimated 6,8 million people were living with HIV, and where an estimated 450,000 people became sick with tuberculosis that year, healthcare providers equipped to meet their needs are stretched thin, and training to help nurses manage patients who are infected with both diseases is critical to treatment access.

An evaluation of a five-day training in integrating treatment for the two diseases for workers in 76 health centers, however, highlighted additional hurdles to both streamlining and ensuring effective care for coinfected patients.

The evaluation, reported in Open Forum Infectious Diseases, sought to measure the impact of training on treatment monitoring with appropriate testing after intervals of treatment. For  HIV patients that meant comparing the numbers receiving viral load tests after six months of antiretroviral treatment before  health workers underwent training and after. For tuberculosis patients that meant looking at the number of patients whose sputum was tested at the end of the intensive phase of treatment, before and after health worker training. By both measures, the training did not appear to have an effect. But, authors led by Sean Galagan of the University of Washington note, stock-outs of necessary supplies may have been among the reasons. Supplies used to monitor treatment progress, but reported to have run out before replacements arrived at 20 percent of the facilities, authors note, included HIV tests, specimen containers for blood, sputum containers and dried blood spot forms.

In addition, evaluators reported a challenge to piecing together information on the overall effectiveness of patient monitoring in continuing record-keeping gaps that made distinguishing between missing data entry and missing services impossible.

Still, evaluators noted improvements on important fronts over the time period they examined — both potentially attributable to the training and unrelated, with significantly more patients whose viral loads were tested showing undetectable viral loads, and more patients with HIV referred for preventive isoniazid treatment to protect them from becoming sick with tuberculosis.

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