Improving tuberculosis screening and isoniazid preventive therapy in an HIV clinic in Addis Ababa, Ethiopia

Int J Tuberc Lung Dis. 2013 Nov;17(11):1396-401. doi: 10.5588/ijtld.13.0315.


Background: The World Health Organization (WHO) recommends active tuberculosis (TB) case finding among people living with human immunodeficiency virus (HIV) in resource-limited settings using a symptom-based algorithm; those without active TB disease should be offered isoniazid preventive therapy (IPT).

Objective: To evaluate rates of adherence to WHO recommendations and the impact of a quality improvement intervention in an HIV clinic in Addis Ababa, Ethiopia.

Design: A prospective study design was utilized to compare TB symptom screening and IPT administration rates before and after a quality improvement intervention consisting of 1) educational sessions, 2) visual reminders, and 3) use of a screening checklist.

Results: A total of 751 HIV-infected patient visits were evaluated. The proportion of patients screened for TB symptoms increased from 22% at baseline to 94% following the intervention (P < 0.001). Screening rates improved from 51% to 81% (P < 0.001) for physicians and from 3% to 100% (P < 0.001) for nurses. Of the 281 patients with negative TB symptom screens and eligible for IPT, 4% were prescribed IPT before the intervention compared to 81% after (P < 0.001).

Conclusions: We found that a quality improvement intervention significantly increased WHO-recommended TB screening rates and IPT administration. Utilizing nurses can help increase TB screening and IPT provision in resource-limited settings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ambulatory Care Facilities / standards*
  • Antitubercular Agents / therapeutic use*
  • Checklist / standards
  • Coinfection*
  • Ethiopia / epidemiology
  • Female
  • Guideline Adherence / standards
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology
  • HIV Infections / therapy*
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility / standards
  • Humans
  • Isoniazid / therapeutic use*
  • Male
  • Mass Screening / nursing
  • Mass Screening / standards*
  • Middle Aged
  • Patient Education as Topic / standards
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards*
  • Predictive Value of Tests
  • Primary Prevention / standards*
  • Prospective Studies
  • Quality Improvement / standards
  • Quality Indicators, Health Care / standards
  • Reminder Systems / standards
  • Tuberculosis / diagnosis*
  • Tuberculosis / epidemiology
  • Tuberculosis / prevention & control*
  • World Health Organization


  • Antitubercular Agents
  • Isoniazid