{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:47:46Z","timestamp":1786978066573,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>: Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub\u2010optimally implemented. Quality improvement (QI) methods offer a low\u2010cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV\u2010TB care in rural South African primary healthcare (PHC) clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on\u2010site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study\u2010appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510\/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02\u20131.38;\n                      <jats:italic>p<\/jats:italic>\n                      =0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02\u20132.72;\n                      <jats:italic>p<\/jats:italic>\n                      =0\u00b7044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05;\n                      <jats:italic>p<\/jats:italic>\n                      =0.448), initiated on ART (91.7 vs. 95.5; RR=0.96;\n                      <jats:italic>p<\/jats:italic>\n                      =0.172) and VL testing (72.2% vs. 72.8%; RR=0.99;\n                      <jats:italic>p<\/jats:italic>\n                      =0.879) was similar in both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV\u2010TB service delivery and increase the success of future QI scale\u2010up activities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.25803","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T02:42:45Z","timestamp":1631155365000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["A cluster\u2010randomized controlled trial to improve the quality of integrated HIV\u2010tuberculosis services in primary healthcareclinics in South Africa"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2890-7248","authenticated-orcid":false,"given":"Santhanalakshmi","family":"Gengiah","sequence":"first","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA)  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre M.","family":"Barker","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Improvement  Cambridge Massachusetts USA"},{"name":"Department of Maternal and Child Health Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nonhlanhla","family":"Yende\u2010Zuma","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA)  Durban South Africa"},{"name":"MRC\u2010CAPRISA HIV\u2010TB Pathogenesis and Treatment Research Unit Doris Duke Medical Research Institute University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mduduzi","family":"Mbatha","sequence":"additional","affiliation":[{"name":"Department of Health  Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Department of Health  Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myra","family":"Taylor","sequence":"additional","affiliation":[{"name":"School of Nursing and Public Health University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Loveday","sequence":"additional","affiliation":[{"name":"MRC\u2010CAPRISA HIV\u2010TB Pathogenesis and Treatment Research Unit Doris Duke Medical Research Institute University of KwaZulu\u2010Natal  Durban South Africa"},{"name":"HIV Prevention Research Unit South African Medical Research Council  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesuli","family":"Mhlongo","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA)  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clark","family":"Jackson","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Improvement  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Nunn","sequence":"additional","affiliation":[{"name":"Medical Research Council Clinical Trials Unit at University College London (UCL)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesri","family":"Padayatchi","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA)  Durban South Africa"},{"name":"MRC\u2010CAPRISA HIV\u2010TB Pathogenesis and Treatment Research Unit Doris Duke Medical Research Institute University of KwaZulu\u2010Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4986-2133","authenticated-orcid":false,"given":"Salim S. 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