{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T23:22:01Z","timestamp":1785367321165,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013986","name":"Government of the United Kingdom","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013986","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The adverse effects of the COVID\u201019 pandemic on tuberculosis (TB) detection have been well documented. Despite shared symptoms, guidance for integrated screening for TBand COVID\u201019 are limited, and opportunities for health systems strengthening curtailed by lockdowns. We partnered with a high TB burden district in KwaZulu\u2010Natal, South Africa, to co\u2010develop an integrated approach to assessing COVID\u201019 and TB, delivered using online learning and quality improvement, and evaluated its performance on TB testing and detection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a mixed methods study incorporating a quasi\u2010experimental design and process evaluation in 10 intervention and 18 control clinics. Nurses in all 28 clinics were all provided access to a four\u2010session online course to integrate TB and COVID\u201019 screening and testing, which was augmented with some webinar and in\u2010person support at the 10 intervention clinics. We estimated the effects of exposure to this additional support using interrupted time series Poisson regression mixed models. Process evaluation data comprised interviews before and after the intervention. Thematic coding was employed to provide explanations for effects of the intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Clinic\u2010level support at intervention clinics was associated with a markedly higher uptake (177 nurses from 10 intervention clinics vs. 19 from 18 control clinics). Lack of familiarity with online learning, and a preference for group learning hindered the transition from face\u2010to\u2010face to online learning. Even so, any exposure to training was initially associated with higher rates of GeneXpert testing (adjusted incidence ratio [IRR] 1.11, 95% confidence interval 1.07\u20131.15) and higher positive TB diagnosis (IRR 1.38, 1.11\u20131.71).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These results add to the knowledge base regarding the effectiveness of interventions to strengthen TB case detection during the COVID\u201019 pandemic. The findings support the feasibility of a shift to online learning approaches in low\u2010resource settings with appropriate support and suggest that even low\u2010intensity interventions are capable of activating nurses to integrate existing disease control priorities during pandemic conditions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13860","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T08:45:04Z","timestamp":1675845904000},"page":"324-334","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A health systems intervention to strengthen the integration of tuberculosis and <scp>COVID<\/scp>\u201019 detection: Outcomes of a quasi\u2010experimental study in a high burden tuberculosis district in <scp>KwaZulu<\/scp> Natal, South Africa"],"prefix":"10.1111","volume":"28","author":[{"given":"Robyn","family":"Curran","sequence":"first","affiliation":[{"name":"Knowledge Translation Unit, Department of Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Murdoch","sequence":"additional","affiliation":[{"name":"School of Life Course and Population Sciences, Department of Social Science and Health King's College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 J.","family":"van Rensburg","sequence":"additional","affiliation":[{"name":"Centre for Rural Health, School of Nursing and Public Health University of KwaZulu Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Bachmann","sequence":"additional","affiliation":[{"name":"Norwich Medical School, Faculty of Medicine and Health Science University of East Anglia  Norwich UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajibola","family":"Awotiwon","sequence":"additional","affiliation":[{"name":"Knowledge Translation Unit, Department of Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christy\u2010Joy","family":"Ras","sequence":"additional","affiliation":[{"name":"Knowledge Translation Unit, Department of Medicine University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"Petersen","sequence":"additional","affiliation":[{"name":"Centre for Rural Health, School of Nursing and Public Health University of KwaZulu Natal  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Prince","sequence":"additional","affiliation":[{"name":"King's Global Health Institute, Department of Population Science King's College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Moultrie","sequence":"additional","affiliation":[{"name":"Centre for Tuberculosis National Institute for Communicable Diseases, Division of the National Health Laboratory Service  Sandringham South Africa"},{"name":"School of Pathology, Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercury","family":"Nzuza","sequence":"additional","affiliation":[{"name":"Department of Health Amajuba Health District  Newcastle South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Fairall","sequence":"additional","affiliation":[{"name":"Knowledge Translation Unit, Department of Medicine University of Cape Town  Cape Town South Africa"},{"name":"King's Global Health Institute, Department of Population Science King's College  London 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