Abstract
This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.
Highlights
Developing countries in sub-Saharan Africa and Asia account for close to 80% of the global TB burden [1]
We focus on variables that are included in TB screening protocols and best practices, and use uni- and bivariate analysis of these variables to describe the levels of the quality of TB screening
For South Africa, TB screening protocols used at a primary healthcare (PHC) level comply with the South African National TB Management Guidelines (SANTMG) which is derived from the World Health Organization’s TB guidelines
Summary
Developing countries in sub-Saharan Africa and Asia account for close to 80% of the global TB burden [1]. It is unsurprising that South Africa, a high-burden TB country, struggles with this pandemic which remains the main driver of morbidity and mortality [2]. Within this context, local and international research highlighting gaps and weaknesses in TB protocol implementation [3,4,5,6,7,8] and a global call for shifts towards quality improvement [9,10,11] motivated us to consider the quality of TB screening in South Africa. Our study adds to the literature in the quality of care space
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