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Author Notes:

Sandra Zaeh, MS, Emory University School of Medicine, Address: 522 Ladson Court, Decatur, GA 30033, Phone Number: (908) 938-0981, sezaeh@gmail.com, Admasu Tenna, MD, Addis Ababa University, Addis Ababa, Ethiopia, kadmasen@gmail.com

Sandra Zaeh contributed to study design and execution, data collection and entry, and drafted the manuscript; Russell Kempker contributed to study design, data analysis, and revisions of the final manuscrip; Edward Stenehjem assisted with study design and revisions of the final manuscript; Henry M. Blumberg assisted with study design and the manuscript revisions; Obsie Temesgen contributed to data collection and manuscript revisions; Ighovwerha Ofotokun provided project mentorship, contributed to study design, and assisted with revisions to the final manuscript; Admasu Tenna contributed to the study design, execution of the project, assisted with revisions to the final manuscript and provided mentorship.

All authors report no conflicts of interest.


Research Funding:

Supported in part from the Emory University School of Medicine; the American Society of Tropical Medicine and Hygiene’s Kean Fellowship (to SZ); the Infectious Diseases Society of America Medical Scholars Program (to SZ); and the Emory Global Health Institute.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Infectious Diseases
  • Respiratory System
  • quality improvement
  • implementation science
  • checklists
  • task shifting
  • CARE
  • COST

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


Journal Title:

International Journal of Tuberculosis and Lung Disease


Volume 17, Number 11


, Pages 1396-1401

Type of Work:

Article | Post-print: After Peer Review


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 symptombased 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.

Copyright information:

© 2013 The Union.

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