PDA's and Direct Observation Play Role in Tuberculosis Treatment

By working with private health facilities, the five year PC4 Project in Ethiopia contributed to increased access to affordable, high-quality HIV/AIDS and tuberculosis (TB) prevention and care services. The goal of the USAID-funded project, which ended in September 2009, was to improve TB detection and treatment in the context of HIV/AIDS, a frequent coinfection. IntraHealth led the clinical aspects of the project by introducing innovative tools for effective supportive supervision and training health workers according to national standards and in the WHO-recommended method of TB treatment.

Supportive supervision played a critical part in improving health worker performance at private facilities. The introduction of hand-held personal digital assistants (PDAs) increased the efficiency of the supervision and our staff’s response to problems identified at facilities. Health care supervisors used the PDAs to collect and aggregate data on health worker performance at many clinical sites. After each supervisory visit, PDA data were downloaded to the Addis Ababa headquarters’ system for analysis; when problems were discovered, supervisors could take appropriate and immediate action. Yonas Yilma, the project’s TB/HIV program coordinator, said, “Using the PDAs, we can now easily identify sites where staff are leaving and who is left and can immediately see where training is needed. Overall improvement in data quality is being observed since using the PDAs.”

The project supported the Tesfa Medium Clinic to increase its adherence to national TB diagnosis standards. After working with the project, the clinic showed a 9.2% improvement in smear positive rates (an important TB test). The Regional Laboratory External Quality Assurance report on the clinic’s work showed results 100% concordant with national standards.

“Here, everybody is serious,” said Tamrat Wolde, the clinic’s head nurse and TB focal person. “Clinical assessment is performed in a conscientious manner, and all true pulmonary suspects are sent to the laboratory.” Wolde follows up with his town’s public health office to make sure all TB patients referred by the clinic receive treatment.

The project also improved TB health care quality by training health care staff at Dr. Amir Higher Clinic in TB-DOTS (tuberculosis directly observed treatment, short course—the WHO-recommended method of treating TB). Through DOTS, health care providers observe TB patients taking their medication, ensuring compliance. The facility established a TB/HIV room and coordinated with the nearby government health office to ensure a steady drug supply. The clinic’s TB focal person explained how he ensured patients receive appropriate treatment: “I will not register TB patients far from the clinic,” Ato Alemayehu Tesfaye said. “Rather I advise them to start their drug in the nearby [government-run] health facility. Intensive phase drugs are administered [on a] daily basis; in case there are patients who are not able to follow [treatments] daily, I will go to their home to provide their drug.”

The PC4 Project was led by PSP-One.