scholarly journals Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Lisa M. Puchalski Ritchie ◽  
Monique van Lettow ◽  
Austine Makwakwa ◽  
Ester C. Kip ◽  
Sharon E. Straus ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Treatment Adherence ◽  
Health Workers ◽  
Controlled Trial ◽  
Demographic Data ◽  
Treatment Success ◽  
Randomized Controlled ◽  
Tb Treatment ◽  
Adherence Intervention ◽  
Cluster Randomized

Abstract Background With the global shortage of skilled health workers estimated at 7.2 million, outpatient tuberculosis (TB) care is commonly task-shifted to lay health workers (LHWs) in many low- and middle-income countries where the shortages are greatest. While shown to improve access to care and some health outcomes including TB treatment outcomes, lack of training and supervision limit the effectiveness of LHW programs. Our objective was to refine and evaluate an intervention designed to address common causes of non-adherence to TB treatment and LHW knowledge and skills training needs. Methods We employed a pragmatic cluster randomized controlled trial. Participants included 103 health centres (HCs) providing TB care in four districts in Malawi, randomized 1:1 stratified by district and HC funding (Ministry of Health, non-Ministry funded). At intervention HCs, a TB treatment adherence intervention was implemented using educational outreach, a point-of-care reminder tool, and a peer support network. Clusters in the control arm provided usual care. The primary outcome was the proportion of patients with successful TB treatment (i.e., cure or treatment completion). We used a generalized linear mixed model, with district as a fixed effect and HC as a random effect, to compare proportions of patients with treatment success, among the trial arms, with adjustment for baseline differences. Results We randomized 51 HCs to the intervention group and 52 HCs to the control group. Four intervention and six control HCs accrued no eligible patients, and 371 of 1169 patients had missing outcome, HC, or demographic data, which left 74 HCs and 798 patients for analysis. Randomization group was not related to missing outcome, however, district, age, and TB type were significantly related and included in the primary analysis model. Among the 1153 patients with HC and demographic data, 297/605 (49%) and 348/548 (64%) in the intervention and control arms, respectively, had treatment success. The intervention had no significant effect on treatment success (adjusted odds ratio 1.35 [95% confidence interval 0.93–1.98]). Conclusion We found no significant effect of the intervention on TB treatment outcomes with high variability in implementation quality, highlighting important challenges to both scale-up and sustainability. Trial registration ClinicalTrials.gov NCT02533089. Registered August 20, 2015.

scholarly journals A mixed-methods evaluation of a cluster randomized controlled trial on simulation-based low-dose, high-frequency plus mobile mentoring training versus traditional group-based training of health workers in Ebonyi and Kogi States, Nigeria

2019 ◽  
Author(s):  
EMMANUEL UGWA ◽  
Mark Kabue ◽  
Emmanuel Otolorin ◽  
Gayane Yenokyan ◽  
Adetiloye Oniyire ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
High Frequency ◽  
Low Dose ◽  
Health Workers ◽  
Controlled Trial ◽  
Traditional Group ◽  
Knowledge And Skills ◽  
Randomized Controlled ◽  
Simulation Based ◽  
Cluster Randomized

Abstract Background: There are few studies from low- and middle-income countries on learning outcomes among health workers who have been trained on day of birth care using onsite, simulation-based, low-dose, high frequency (LDHF) training plus mobile (m) mentoring. The aim of this study was to compare their knowledge and skills competencies with those of health workers trained using the traditional offsite, group-based training (TRAD) approach in Kogi and Ebonyi states, Nigeria, over a 12-month period. Methods: We conducted a prospective cluster randomized controlled trial, enrolling 299 health workers in 60 health facilities in Kogi and Ebonyi states, randomized to either LDHF/m-mentoring (intervention, n=30 facilities) or traditional group-based training (TRAD, n=30 facilities) control arm. Health workers in both arms received basic emergency obstetric and newborn care training with simulated practice using anatomic models and role-plays. The control arm participants were trained offsite while the intervention arm were trained onsite where they work. Mentorship was done through telephone calls and reminder text messages. The multiple choice questions and objective structured clinical examinations mean scores were compared; p-value <0.05 was considered statistically significant. Qualitative data were collected and analyzed along themes of interest. Results: The mean knowledge scores between the two arms at months 3 and 12 post-training were equally high; no statistically significant differences. Both arms showed improvements in composite scores for assessed BEmONC clinical skills from around 30% at baseline to 75% and above at endline (p <0.05). Overall, the observed improvement and retention of skills was higher in intervention arm compared to the control arm at 12 months post-training, (p<0.05). Some LDHF/m-mentoring approach trainees reported that mentors’ support improved their acquisition and maintenance of knowledge and skills, which may have led to reductions in maternal and newborn deaths in their facilities. Conclusion: The LDHF/m-mentoring intervention is more effective than TRAD approach in improving health workers’ skills acquisition and retention. Health care managers should have the option to select the LDHF/m-mentoring learning approach, depending on their country’s priorities or context, as it ensures health workers remain in their place of work during training events thus less disruption to service delivery.

scholarly journals Simulation-based low-dose, high-frequency plus mobile mentoring versus traditional group-based trainings among health workers in Nigeria; a cluster randomized controlled trial

2020 ◽  
Author(s):  
EMMANUEL UGWA ◽  
Mark Kabue ◽  
Emmanuel Otolorin ◽  
Gayane Yenokyan ◽  
Adetiloye Oniyire ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
High Frequency ◽  
Low Dose ◽  
Health Workers ◽  
Controlled Trial ◽  
Traditional Group ◽  
Knowledge And Skills ◽  
Randomized Controlled ◽  
Simulation Based ◽  
Cluster Randomized

Abstract Background: The aim of this study was to compare health workers knowledge and skills competencies between those trained using the onsite simulation-based, low-dose, high frequency (LDHF) training plus mobile (m) mentoring and the ones trained using the traditional offsite, group-based training (TRAD) approach in Kogi and Ebonyi states, Nigeria, over a 12-month period. Methods: A prospective cluster randomized controlled trial was conducted by enrolling 299 health workers in 60 health facilities in Kogi and Ebonyi states, randomized to either LDHF/m-mentoring (intervention, n=30 facilities) or traditional group-based training (TRAD, n=30 facilities) control arm. These health workers in both arms received basic emergency obstetric and newborn care training with simulated practice using anatomic models and role-plays. The control arm was trained offsite while the intervention arm was trained onsite where they worked. Mentorship was done through telephone calls and reminder text messages. The multiple choice questions and objective structured clinical examinations mean scores were compared; p-value <0.05 was considered statistically significant. Qualitative data were collected and content analysis was done. Results: The mean knowledge scores between the two arms at months 3 and 12 post-training were equally high; no statistically significant differences. Both arms showed improvements in composite scores for assessed BEmONC clinical skills from around 30% at baseline to 75% and above at endline (p <0.05). Overall, the observed improvement and retention of skills was higher in intervention arm compared to the control arm at 12 months post-training, (p<0.05). Some LDHF/m-mentoring approach trainees reported that mentors’ support improved their acquisition and maintenance of knowledge and skills, which may have led to reductions in maternal and newborn deaths in their facilities. Conclusion: The LDHF/m-mentoring intervention is more effective than TRAD approach in improcquisition and retention. Health care managers should have the option to select the LDHF/m-mentoring learning approach, depending on their country’s priorities or context, as it ensures health workers remain in their place of work during training events thus less disruption to service delivery.

scholarly journals The Effect of Family Psychoeducation on Tuberculosis Treatment Adherence of Children in Indonesia

2022 ◽  
Vol 5 (S2) ◽  
pp. 44-49
Author(s):  
Yuni Kusmiyati ◽  
Suherni ◽  
Yuliasti Eka Purnamaningrum ◽  
Sih Rini Handajani ◽  
Agung Jaya Endranto ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Health Workers ◽  
Controlled Trial ◽  
Primary Caregivers ◽  
Control Group ◽  
P Value ◽  
Family Psychoeducation ◽  
Randomized Controlled ◽  
Tb Treatment ◽  
End Of Treatment

Tuberculosis (TB) is an infectious disease leading cause of death in the world but treatment adherence the most underrated and understudied factor affecting the outcome of TB therapy. The aim of this study was to determine the effect of family psychoeducation on TB treatment adherence of children. The study used a randomized controlled trial (RCT). The sample was 40 pairs of primary caregivers and children who received TB treatment and experienced no side effects of anti-TB drugs in Wonosari Hospital Indonesia in 2019. The treatment group was given psychoeducation by trained health personnel psychoeducators, while the control group was given education by health workers. Psychoeducation was carried out individually, 3 meetings in the first week of the study. Adherence was measured at the sixth month which was the end of treatment period, using a questionnaire. Data were analyzed by using multiple logistic regression. The results showed that family psychoeducation had a significant effect on TB treatment adherence in children after controlling for mother’s knowledge (P-value 0.05 ≤ 0.05). Family psychoeducation is a preventive factor for non-adherence to TB treatment. It is important that psychoeducation is provided to all TB patients to reduce psychological problems that can lead to treatment non-adherence.

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