CLUSTER RCT of A MID-LEVEL MANAGER INTERVENTION to PROMOTE IPT UPTAKE in UGANDA
Topics in Antiviral Medicine
; 30(1 SUPPL):27, 2022.
Article
in English
| EMBASE | ID: covidwho-1880410
ABSTRACT
Background:
Despite longstanding guidelines endorsing isoniazid preventive therapy (IPT) for persons with HIV, uptake is low across sub-Saharan Africa. Mid-level health managers oversee IPT programs nationally;interventions aimed at this group have not been tested.Methods:
We conducted a cluster randomized trial in Uganda among district-level health managers from 2017-2021. The unit of randomization was groups of 4-7 managers. Our intervention convened managers into mini-collaboratives facilitated by Ugandan TB/HIV experts and provided business leadership/management training, SMS platform access, and data feedback. The primary outcome was IPT initiation rates among adults with HIV in health facilities overseen by participants over 2 years (2019-2021). We compared incidence rates using cluster-level targeted minimum loss-based estimation. We conducted pre-specified analyses that excluded Q3-2019 to understand intervention effects independent of a national "100-day push" of IPT tied to a financial contingency during Q3-2019. Qualitative interviews were analyzed to ascertain mechanisms of intervention action.Results:
Managers from 82/82 eligible districts (61% of Uganda's 135 districts) were enrolled and randomized 43 districts to intervention, 39 to control. After one year, in 5-point-Likert quantitative surveys, intervention-group managers demonstrated greater increases in familiarity with IPT (by +0.47 points (95%CI0.14-0.80)) and knowledge of IPT efficacy (+0.59 points (95%CI0.06-1.12)) as compared to control. Intervention-group managers reported improved within-district communication and inter-district collaboration and feeling empowered to better manage frontline providers, in contrast to control, in qualitative interviews. Over two years, the IPT initiation rate was 0.74 vs. 0.65 starts/person-year in intervention vs control incidence rate ratio (IRR)=1.14 (95%CI0.88-1.46;p=0.16). Excluding Q3-2019, IPT initiation was higher in intervention vs control 0.32 vs. 0.25 starts/person-year (IRR=1.27, 95%CI1.00-1.61, p=0.03;Figure).Conclusion:
Though overall IPT initiation rates were not significantly higher with the mid-level manager intervention in this cluster randomized trial, rates were significantly higher compared to control when excluding the massive MoH-led "100-day IPT push" in both arms. The higher rates were sustained during the COVID-19 pandemic, suggesting benefits of targeted leadership and management training for mid-level health managers.
isoniazid; adult; clinical article; conference abstract; controlled study; coronavirus disease 2019; female; health care facility; human; Human immunodeficiency virus; incidence; interview; leadership; male; manager; nonhuman; outcome assessment; pandemic; prophylaxis; randomization; randomized controlled trial; TB [Human] cell line; Uganda
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Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Experimental Studies
Language:
English
Journal:
Topics in Antiviral Medicine
Year:
2022
Document Type:
Article
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