Scaling Up the Uptake of Tuberculosis Preventative Therapy among HIV Positive Clients at Okahao Clinic, Northern Namibia; A Quality Improvement Capstone Project

Globally over 10.4 million people fell ill with TB, of which 1.7 million died from the disease in 2016. And in the same year, 40% of HIV deaths were due to TB. 95% of TB deaths occur in low- and middle-income countries, and Namibia has one of the highest case notification rates (CNR) of TB in the world. Tuberculosis Presumptive Therapy (TPT) treats latent TB infection, and this reduces the likelihood that active TB disease will develop. Whereas Namibia adopted TPT use for PLHIV in 2005, the national coverage has remained low and was estimated to be 35% in June 2018, and specifically at 42% for Okahao, ART Clinic. We therefore designed a quality improvement project to scale up the uptake of TPT at this clinic. We used both quantitative and qualitative methods. We conducted health education sessions daily for 15 minutes, and patients were taught about TPT. Three categories of clients were registered according to those who suggested TPT initiation. Category one (C1) were those where a clinician suggested TPT, Category two (C2) by the client themselves and category three (C3) by data administrators. We analyzed data using simple excel spread sheets as either trend graphs or pie charts. Category two had more clients started on TPT (n=1,609, 58.3%). TPT coverage within the backlog cohort improved from 42% to 94%, and for the new cohort, coverage increased from 81% to 100%. 13 clients (64%) reported skin related manifestations as side effects. Daily health education about TPT in HIV care settings improves uptake. Keywords: TB Presumptive Therapy (TPT), Uptake, HIV positive, Quality improvement project.