Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda

Olivie C. Namuju; Proscovia M. Namuwenge; Richard Kwizera; Emmanuel Obuya; Paul Kirumira; Rose Naluyima; Cynthia Ahimbisibwe; Jane Francis Ndyetukira; Hawa Nakato; Robert Kirungi; Jane Gakuru; Samuel Junju; Edwin Nuwagira; Morris Rutakagirwa; Sara Nsibirwa; Vennie Nabitaka; Elizabeth Nalintya; Edward Mpoza; Conrad K. Muzoora; Abdu K. Musubire; David R. Boulware; David B. Meya

doi:10.1371/journal.pone.0284165

Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda

Olivie C. Namuju, Proscovia M. Namuwenge, Richard Kwizera, Emmanuel Obuya, Paul Kirumira, Rose Naluyima, Cynthia Ahimbisibwe, Jane Francis Ndyetukira, Hawa Nakato, Robert Kirungi, Jane Gakuru, Samuel Junju, Edwin Nuwagira, Morris Rutakagirwa, Sara Nsibirwa, Vennie Nabitaka, Elizabeth Nalintya, Edward Mpoza, Conrad K. Muzoora, Abdu K. MusubireDavid R. Boulware, David B. Meya

Medicine - Infectious Disease and International

Research output: Contribution to journal › Article › peer-review

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Abstract

Introduction Health workers’ failure to adhere to guidelines for screening, diagnosis and management of HIV-associated cryptococcal meningitis (CM) remains a significant public health concern. We aimed to assess adherence to the standards of care and management of HIV patients at risk of CM per the MoH guidelines and assess stock management of CM supplies in the period of January to June 2021 at selected public health facilities (HFs) in Uganda. Methods The study employed an observational cross-sectional design to assess the level of adherence of health workers to standards of clinical care and management of HIV positive patients at risk of CM as per the clinical guidelines for Uganda, and stock management of CM supplies in the period of January to June 2021in selected public health facilities. The study team used a survey guide designed by MoH to assess and score the screening, diagnosis and management practices of Health Facilities towards CM. Scoring was categorized as red (< 80%), light green (80%-95%), and dark green (>95%) in the order from worst to best adherence. The data was transcribed into a spread sheet and analysed using STATA–v15. Results The study team visited a total of 15 public health facilities including 5 general hospitals, 9 regional referral hospitals (RRHs) and 1 National Referral hospital (NRH). The mean score for adherence to screening and management of CM for all the combined facilities was 15 (64.7%) classified as red. 10 (66.7%) HFs had not performed a baseline CD4 test for eligible patients within 2 weeks of ART initiation. With regards to treatment, 9 (60%) of the HFs were scored as light green on knowledge of the procedure for reconstituting intravenous Liposomal Amphotericin B. None of the HFs visited had potassium chloride tablets in stock. Conclusion Major MoH guidelines are generally not being adhered to by health workers while managing cryptococcal meningitis. It is vital that government and implementing partners regularly support HFs with training, mentorship, and support supervision on CM management to improve adherence to CM screening and treatment guidelines.

Original language	English (US)
Article number	e0284165
Journal	PloS one
Volume	18
Issue number	4 April
DOIs	https://doi.org/10.1371/journal.pone.0284165
State	Published - Apr 2023

Bibliographical note

Funding Information:
The Study was funded by CLINTON HEALTH ACCESS INITIATIVE AND NIH GRANT (K 43 TW010718-02). We thank the institutional support from the CHAI, MOH, IDI and the Meningitis team at IDI- Kampala and Mbarara Regional Referral Hospital. We also thank Hawa Nakate (MOH), Directors and staffs (National Referral Hospital, General Hospitals and Regional Referral Hospitals).

Publisher Copyright:
© 2023 Namuju et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Namuju, O. C., Namuwenge, P. M., Kwizera, R., Obuya, E., Kirumira, P., Naluyima, R., Ahimbisibwe, C., Ndyetukira, J. F., Nakato, H., Kirungi, R., Gakuru, J., Junju, S., Nuwagira, E., Rutakagirwa, M., Nsibirwa, S., Nabitaka, V., Nalintya, E., Mpoza, E., Muzoora, C. K., ... Meya, D. B. (2023). Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda. PloS one, 18(4 April), Article e0284165. https://doi.org/10.1371/journal.pone.0284165

Namuju, OC, Namuwenge, PM, Kwizera, R, Obuya, E, Kirumira, P, Naluyima, R, Ahimbisibwe, C, Ndyetukira, JF, Nakato, H, Kirungi, R, Gakuru, J, Junju, S, Nuwagira, E, Rutakagirwa, M, Nsibirwa, S, Nabitaka, V, Nalintya, E, Mpoza, E, Muzoora, CK, Musubire, AK, Boulware, DR & Meya, DB 2023, 'Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda', PloS one, vol. 18, no. 4 April, e0284165. https://doi.org/10.1371/journal.pone.0284165

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abstract = "Introduction Health workers{\textquoteright} failure to adhere to guidelines for screening, diagnosis and management of HIV-associated cryptococcal meningitis (CM) remains a significant public health concern. We aimed to assess adherence to the standards of care and management of HIV patients at risk of CM per the MoH guidelines and assess stock management of CM supplies in the period of January to June 2021 at selected public health facilities (HFs) in Uganda. Methods The study employed an observational cross-sectional design to assess the level of adherence of health workers to standards of clinical care and management of HIV positive patients at risk of CM as per the clinical guidelines for Uganda, and stock management of CM supplies in the period of January to June 2021in selected public health facilities. The study team used a survey guide designed by MoH to assess and score the screening, diagnosis and management practices of Health Facilities towards CM. Scoring was categorized as red (< 80%), light green (80%-95%), and dark green (>95%) in the order from worst to best adherence. The data was transcribed into a spread sheet and analysed using STATA–v15. Results The study team visited a total of 15 public health facilities including 5 general hospitals, 9 regional referral hospitals (RRHs) and 1 National Referral hospital (NRH). The mean score for adherence to screening and management of CM for all the combined facilities was 15 (64.7%) classified as red. 10 (66.7%) HFs had not performed a baseline CD4 test for eligible patients within 2 weeks of ART initiation. With regards to treatment, 9 (60%) of the HFs were scored as light green on knowledge of the procedure for reconstituting intravenous Liposomal Amphotericin B. None of the HFs visited had potassium chloride tablets in stock. Conclusion Major MoH guidelines are generally not being adhered to by health workers while managing cryptococcal meningitis. It is vital that government and implementing partners regularly support HFs with training, mentorship, and support supervision on CM management to improve adherence to CM screening and treatment guidelines.",

author = "Namuju, {Olivie C.} and Namuwenge, {Proscovia M.} and Richard Kwizera and Emmanuel Obuya and Paul Kirumira and Rose Naluyima and Cynthia Ahimbisibwe and Ndyetukira, {Jane Francis} and Hawa Nakato and Robert Kirungi and Jane Gakuru and Samuel Junju and Edwin Nuwagira and Morris Rutakagirwa and Sara Nsibirwa and Vennie Nabitaka and Elizabeth Nalintya and Edward Mpoza and Muzoora, {Conrad K.} and Musubire, {Abdu K.} and Boulware, {David R.} and Meya, {David B.}",

note = "Funding Information: The Study was funded by CLINTON HEALTH ACCESS INITIATIVE AND NIH GRANT (K 43 TW010718-02). We thank the institutional support from the CHAI, MOH, IDI and the Meningitis team at IDI- Kampala and Mbarara Regional Referral Hospital. We also thank Hawa Nakate (MOH), Directors and staffs (National Referral Hospital, General Hospitals and Regional Referral Hospitals). Publisher Copyright: {\textcopyright} 2023 Namuju et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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T1 - Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda

AU - Namuju, Olivie C.

AU - Namuwenge, Proscovia M.

AU - Kwizera, Richard

AU - Obuya, Emmanuel

AU - Kirumira, Paul

AU - Naluyima, Rose

AU - Ahimbisibwe, Cynthia

AU - Ndyetukira, Jane Francis

AU - Nakato, Hawa

AU - Kirungi, Robert

AU - Gakuru, Jane

AU - Junju, Samuel

AU - Nuwagira, Edwin

AU - Rutakagirwa, Morris

AU - Nsibirwa, Sara

AU - Nabitaka, Vennie

AU - Nalintya, Elizabeth

AU - Mpoza, Edward

AU - Muzoora, Conrad K.

AU - Musubire, Abdu K.

AU - Boulware, David R.

AU - Meya, David B.

N1 - Funding Information: The Study was funded by CLINTON HEALTH ACCESS INITIATIVE AND NIH GRANT (K 43 TW010718-02). We thank the institutional support from the CHAI, MOH, IDI and the Meningitis team at IDI- Kampala and Mbarara Regional Referral Hospital. We also thank Hawa Nakate (MOH), Directors and staffs (National Referral Hospital, General Hospitals and Regional Referral Hospitals). Publisher Copyright: © 2023 Namuju et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2023/4

Y1 - 2023/4

N2 - Introduction Health workers’ failure to adhere to guidelines for screening, diagnosis and management of HIV-associated cryptococcal meningitis (CM) remains a significant public health concern. We aimed to assess adherence to the standards of care and management of HIV patients at risk of CM per the MoH guidelines and assess stock management of CM supplies in the period of January to June 2021 at selected public health facilities (HFs) in Uganda. Methods The study employed an observational cross-sectional design to assess the level of adherence of health workers to standards of clinical care and management of HIV positive patients at risk of CM as per the clinical guidelines for Uganda, and stock management of CM supplies in the period of January to June 2021in selected public health facilities. The study team used a survey guide designed by MoH to assess and score the screening, diagnosis and management practices of Health Facilities towards CM. Scoring was categorized as red (< 80%), light green (80%-95%), and dark green (>95%) in the order from worst to best adherence. The data was transcribed into a spread sheet and analysed using STATA–v15. Results The study team visited a total of 15 public health facilities including 5 general hospitals, 9 regional referral hospitals (RRHs) and 1 National Referral hospital (NRH). The mean score for adherence to screening and management of CM for all the combined facilities was 15 (64.7%) classified as red. 10 (66.7%) HFs had not performed a baseline CD4 test for eligible patients within 2 weeks of ART initiation. With regards to treatment, 9 (60%) of the HFs were scored as light green on knowledge of the procedure for reconstituting intravenous Liposomal Amphotericin B. None of the HFs visited had potassium chloride tablets in stock. Conclusion Major MoH guidelines are generally not being adhered to by health workers while managing cryptococcal meningitis. It is vital that government and implementing partners regularly support HFs with training, mentorship, and support supervision on CM management to improve adherence to CM screening and treatment guidelines.

AB - Introduction Health workers’ failure to adhere to guidelines for screening, diagnosis and management of HIV-associated cryptococcal meningitis (CM) remains a significant public health concern. We aimed to assess adherence to the standards of care and management of HIV patients at risk of CM per the MoH guidelines and assess stock management of CM supplies in the period of January to June 2021 at selected public health facilities (HFs) in Uganda. Methods The study employed an observational cross-sectional design to assess the level of adherence of health workers to standards of clinical care and management of HIV positive patients at risk of CM as per the clinical guidelines for Uganda, and stock management of CM supplies in the period of January to June 2021in selected public health facilities. The study team used a survey guide designed by MoH to assess and score the screening, diagnosis and management practices of Health Facilities towards CM. Scoring was categorized as red (< 80%), light green (80%-95%), and dark green (>95%) in the order from worst to best adherence. The data was transcribed into a spread sheet and analysed using STATA–v15. Results The study team visited a total of 15 public health facilities including 5 general hospitals, 9 regional referral hospitals (RRHs) and 1 National Referral hospital (NRH). The mean score for adherence to screening and management of CM for all the combined facilities was 15 (64.7%) classified as red. 10 (66.7%) HFs had not performed a baseline CD4 test for eligible patients within 2 weeks of ART initiation. With regards to treatment, 9 (60%) of the HFs were scored as light green on knowledge of the procedure for reconstituting intravenous Liposomal Amphotericin B. None of the HFs visited had potassium chloride tablets in stock. Conclusion Major MoH guidelines are generally not being adhered to by health workers while managing cryptococcal meningitis. It is vital that government and implementing partners regularly support HFs with training, mentorship, and support supervision on CM management to improve adherence to CM screening and treatment guidelines.

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Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda

Abstract

Bibliographical note

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UN SDGs

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