A Single Centre Quality Improvement Project for Tuberculosis Preventive Therapy in People Living with HIV

Abstract

Persons living with HIV should receive tuberculosis preventive therapy at least once in their lifetimes. Current practice at the Matron Roberts Polyclinic II (Belize City, Belize) is of a six-month course of isoniazid in combination with pyridoxine. A medical records audit was conducted for April 2021 with the objective of analyzing the initiation and completion of tuberculosis preventive therapy for people living with HIV seen in the polyclinic. This study was inconclusive due to a lack of standardization of the tuberculosis screening methods used, varied duration of tuberculosis preventive therapy and inconsistencies found in the documentation of the progress and completion of tuberculosis preventive therapy. In order to address these areas, a quality improvement project was conducted utilizing the Plan, Do, Study, Act methodology. The objectives were standardizing the tuberculosis screening methodology, the duration of therapy and the documentation. The following measures were taken: 1) four-question screening was standardized as the method of choice for tuberculosis screening; 2) tuberculosis preventive therapy was established as a six-month duration of isoniazid and pyridoxine; and 3) a documentation insert was added to the clinical notes to document tuberculosis screening and the progress of tuberculosis preventive therapy, among other parameters. Of the targets measured during the three months of the project, the outcomes were: 1) an average usage rate of 74.4% of the documentation insert; and 2) an average rate of initiation or continuation of tuberculosis preventive therapy of 64.3% for persons living with HIV seen over the duration of the project.