Impact of organizational factors on adherence to laboratory testing protocols in adult HIV care in Lusaka, Zambia

Deo, Sarang, Topp, Stephanie M., Westfall, Andrew O., Chiko, Matimbo M., Wamulume, Chibesa S., Morris, Mary, and Reid, Stewart (2012) Impact of organizational factors on adherence to laboratory testing protocols in adult HIV care in Lusaka, Zambia. BMC Health Services Research, 12 (106). pp. 1-9.

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Abstract

Background: Previous operational research studies have demonstrated the feasibility of large-scale public sector ART programs in resource-limited settings. However, organizational and structural determinants of quality of care have not been studied.

Methods: Using data on 13 urban HIV treatment facilities in Zambia, we use multivariate regression models to assess the impact of structural determinants on health workers' adherence to national guidelines for conducting laboratory tests such as CD4, hemoglobin and liver function and WHO staging during initial and follow-up visits as part of Zambian HIV care and treatment program.

Results: CD4 tests were more routinely ordered during initial history and physical (IHP) than followup(FUP) visits (85.5 % vs. 93.0 %; p < 0.01). More physical space, higher staff turnover and greater facility experience with ART was associated with greater odds of conducting tests. Higher staff experience decreased the odds of conducting CD4 tests in FUP (OR 0.93; p <0.05) and WHO staging in IHP visit (OR 0.90; p < 0.05) but increased the odds of conducting hemoglobin test in IHP visit (OR 1.05; p < 0.05). Higher staff burnout increased the odds of conducting CD4 test during FUP (OR 1.14; p < 0.05) but decreased the odds of conducting hemoglobin test in IHP visit (0.77; p < 0.05) and CD4 test in IHP visit (OR 0.78; p < 0.05).

Conclusion: Physical space plays an important role in ensuring high quality care in resource-limited setting. In the context of protocolized care, new staff members are likely to be more diligent in following the protocol verbatim rather than relying on memory and experience thereby improving adherence. Future studies should use prospective data to confirm the findings reported here.

Item ID: 39616
Item Type: Article (Research - C1)
ISSN: 1472-6963
Additional Information:

© 2012 Deo et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Funders: Elizabeth Glaser Pediatric AIDS Foundation, Centers for Disease Control and Prevention (CDCP), Northwestern University
Projects and Grants: CDCP President's Emergency Fund for Aid's Relief, CDCP U62/CCU12354
Date Deposited: 30 Jul 2015 04:09
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 50%
15 COMMERCE, MANAGEMENT, TOURISM AND SERVICES > 1503 Business and Management > 150312 Organisational Planning and Management @ 50%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 40%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 60%
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