Assessment of accessibility and use of a tuberculosis screening tool among health care workers in HIV care and treatment clinics in Dar es salaam region.

Abstract

Background: The World Health Organization recommends countries to embark on intensified Tuberculosis case finding among People Living with HIV/AIDS (PLHA) by using a simplified clinical algorithm for Tuberculosis (TB) screening tool. Tanzania adopted the use of the screening tool in 2007. However, there is scant information on the extent of use and availability of the tool among health care workers who are using it to screen PLHA.

Objective: To assess the extent of use and accessibility of Tuberculosis screening tool in health facilities in detecting Tuberculosis cases among People Living with HIV/AIDS in Care and Treatment Clinics in Dar-es-Salaam.

Methodology: Explorative cross-sectional study was conducted among health care workers providing services to PLHA in Care and Treatment Clinics (CTCs). A total of 208 health care workers were enrolled in the study. A total of 200 patient’s records files registered into HIV CTCs for the past 6 months prior the commencement of the study were assessed for correctness, completeness and consistency of filling TB screening tool, CTC2 card and patient clinical notes. Data was collected using structured face-to-face questionnaires; patients’ files were also assessed using a check list.

Results: There was no statistically significant association between the respondents level of education (p=0.62), their professions (p=0.91) and working experiences (p=0.88) with the use of TB screening tool respectively. However training on the use of TB screening tool, those who are aware and respondents who were supervised all three yielded a strong relationship of using TB screening tool with statistical significant level of (p = 0.001). Majority of respondents (87 percent) reported that the TB screening tool was always accessible when they wanted to use it. About (75 percent) of those who reported to have had missed the tool, had missed it more than once. About (43 percent) of the respondents were not aware of the existence of an ordering system in the health facility. More than 85 percent of respondents reported to have had been supervised at least once. Despite the supervision, (72 percent) of the respondents reported to had received feedback on the gaps in filling the tool. However a significant number of TB screening tools were not filled at all (135 out of 200).

Conclusions and recommendations The tool has been used by the majority of the health care workers and in most cases has been accessible. Continual training to increase awareness and supportive supervision should be emphasized to improve the use of the TB screening tool to improve the detection rate of TB among PLHAs. More studies should be conducted to find a way of integrating the TB screening tool with the CTC2 cards, in order to reduce the amount of time spent on paper work.