{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:41:37Z","timestamp":1763534497953,"version":"3.45.0"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    Tuberculosis (TB) remains the leading cause of morbidity and mortality among people living with HIV (PLHIV) in high-burden countries like Tanzania. Despite national and global guidelines recommending routine TB screening at every clinical encounter, missed and delayed TB case notifications persist, suggesting gaps in screening practices. This study evaluated the implementation fidelity of the TB screening algorithm and associated factors within routine HIV care in public health facilities in Geita, Tanzania. A facility-based cross-sectional study was conducted, involving the extraction of data from 423 client treatment records and observation of 423 screening sessions. Simple random and systematic sampling methods were employed to select the records and sessions, respectively. Descriptive and inferential analyses were performed using Excel and Stata. Modified Poisson regression with robust variance was used to estimate prevalence ratios (PRs) to determine factors associated with two binary outcomes: (1) consistent TB screening over 12-month period, and (2) correct utilization of the screening tool. TB screening was documented in 82.8% of clinical encounters. Overall, 70.7% of clients were screened at every encounter, and 75.4% screened at their most recent visit. Laboratory investigations were recorded in 94% of presumptive cases, with all confirmed TB cases initiated on treatment. Additionally, 80.6% of eligible clients were initiated on TB preventive therapy (TPT). The WHO Four-Symptom Screening (W4SS) was widely used (98.8%), and the tool was correctly administered in 62% of the sessions observed. Factors associated with inconsistent screening included age 40\u201349\u202fyears [Adjusted Prevalence Ratio (aPR)\u202f=\u202f0.82;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.046], age \u226550\u202fyears (aPR\u202f=\u202f0.76;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.025), suppressed viral load (aPR\u202f=\u202f0.63;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&amp;lt;\u202f0.001), monthly drug refill model (aPR\u202f=\u202f0.55;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.006), refill by treatment supporter (aPR\u202f=\u202f0.09;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&amp;lt;\u202f0.001), being traced back from a lost to follow up (aPR\u202f=\u202f1.38;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.019), and absence of prior TB (aPR\u202f=\u202f0.81;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.001). The correct use of the W4SS tool was less likely at PMTCT clinics (aPR\u202f=\u202f0.55;\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&amp;lt;\u202f0.001). Although TB screening is widely integrated into HIV care, fidelity to the screening algorithm remains suboptimal in the initial stages of symptom screening. The completion of the algorithm cascade was well-implemented. Fidelity at earlier stages of the algorithm, such as the consistent and correct use of the W4SS, should be enhanced by strengthening provider capacity and routine monitoring to improve adherence to the protocol.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2025.1688829","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:36:00Z","timestamp":1763534160000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Provider fidelity in tuberculosis screening practices among adolescents and adults living with HIV in public health facilities in Tanzania: a cross-sectional evaluation"],"prefix":"10.3389","volume":"13","author":[{"given":"Lucas L.","family":"Shilugu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrencia D.","family":"Mushi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mackfallen G.","family":"Anasel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"ref1","volume-title":"Tuberculosis in the WHO African region: 2023 progress update","year":"2023"},{"key":"ref2","volume-title":"WHO global lists of high burden countries for tuberculosis (TB), TB\/HIV and multidrug\/rifampicin-resistant TB (MDR\/RR-TB), 2021\u20132025 background document","year":"2021"},{"key":"ref3","volume-title":"Global tuberculosis report","year":"2024"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1177\/23259582221079154","article-title":"Undernutrition and associated risk factors among adult HIV\/AIDS patients attending antiretroviral therapy at public hospitals of bench Sheko zone, Southwest Ethiopia","volume":"21","author":"Shifera","year":"2022","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"ref5","volume-title":"The path that ends AIDS: UNAIDS Global AIDS","year":"2023"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s41182-020-00264-1","article-title":"Prevalence and incidence rate of tuberculosis among HIV-infected patients enrolled in HIV care, treatment, and support program in mainland Tanzania","volume":"48","author":"Majigo","year":"2020","journal-title":"Trop Med Health"},{"key":"ref7","first-page":"183","article-title":"Autopsy causes of death in HIV-positive individuals in sub-Saharan Africa and correlation with clinical diagnoses","volume":"12","author":"Cox","year":"2010","journal-title":"AIDS Rev"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s41182-020-00212-z","article-title":"Effect of tuberculosis infection on mortality of HIV-infected patients in northern Tanzania","volume":"48","author":"Mollel","year":"2020","journal-title":"Trop Med Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/1346104","article-title":"Prevalence and risk factors of active TB among adult HIV patients receiving ART in northwestern Tanzania: a retrospective cohort study","volume":"2018","author":"Gunda","year":"2018","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/4716151","article-title":"Increasing TB\/HIV case notification through an active case-finding approach among rural and mining communities in Northwest Tanzania","volume":"2022","author":"Abeid","year":"2022","journal-title":"J Trop Med"},{"key":"ref11","volume-title":"Fact sheet - world tuberculosis day 2022","year":"2022"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3389\/fpubh.2019.00404","article-title":"Performance of and factors associated with tuberculosis screening and diagnosis among people living with HIV: analysis of 2012\u20132016 routine HIV data in Tanzania","volume":"7","author":"Maokola","year":"2020","journal-title":"Front Public Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12879-021-06962-3","article-title":"Causes of death and associated factors over a decade of follow-up in a cohort of people living with HIV in rural Tanzania","volume":"22","author":"Mollel","year":"2022","journal-title":"BMC Infect Dis"},{"key":"ref14","volume-title":"WHO consolidated guidelines on tuberculosis. Module 2: Screening \u2013 Systematic screening for tuberculosis disease","year":"2021"},{"key":"ref15","volume-title":"Global tuberculosis report 2023","year":"2023"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1186\/s12879-016-1967-3","article-title":"Outcomes of TB treatment in HIV co-infected TB patients in Ethiopia: a cross-sectional analytic study","volume":"16","author":"Ali","year":"2016","journal-title":"BMC Infect Dis"},{"key":"ref17","volume-title":"Quality improvement for TB case detection; a toolkit for health facilities","year":"2021"},{"key":"ref18","volume-title":"Manual for the management of tuberculosis and Leprosy in Tanzania","year":"2020"},{"key":"ref19","volume-title":"Epidemiological review in the United Republic of Tanzania","year":"2023"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1186\/s13104-015-1452-x","article-title":"Adherence to anti-tuberculosis treatment and treatment outcomes among tuberculosis patients in Alamata District, Northeast Ethiopia","volume":"8","author":"Tesfahuneygn","year":"2015","journal-title":"BMC Res Notes"},{"key":"ref21","volume-title":"Operational handbook on tuberculosis module 2: Screening systematic screening for tuberculosis disease. Module 5: management of tuberculosis in children and adolescents","year":"2021"},{"key":"ref22","volume-title":"Tuberculosis and HIV","year":"2019"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1186\/s12879-024-09313-0","article-title":"Increased tuberculosis case detection in Tanzanian children and adults using African giant pouched rats","volume":"24","author":"Agizew","year":"2024","journal-title":"BMC Infect Dis"},{"key":"ref24","volume-title":"Report of the Tanzania mid-term review of the National Tuberculosis and leprosy Programme strategic plan VI, 2020\u20132025","year":"2023"},{"key":"ref25","volume-title":"WHO end TB strategy","year":"2015"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/1748-5908-2-40","article-title":"A conceptual framework for implementation fidelity","volume":"2","author":"Carroll","year":"2007","journal-title":"Implement Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1002\/nur.20373","article-title":"Implementation fidelity in community-based interventions","volume":"33","author":"Breitenstein","year":"2010","journal-title":"Res Nurs Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"34","DOI":"10.4103\/picr.PICR_154_18","article-title":"Study designs: Part 2 - descriptive studies","volume":"10","author":"Aggarwal","year":"2019","journal-title":"Perspect Clin Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"156","DOI":"10.5799\/jmid.vi.328861","article-title":"Process evaluation of quality in the diagnosis and treatment of tuberculosis in public health facilies of Southwes Ethiopia: cross sectional study","volume":"6","author":"Dabaro Dangiso","year":"2016","journal-title":"J Microbiol Infect Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.4314\/ahs.v19i3.5","article-title":"Levels and predictors of TB-HIV diagnostic service linkage and testing in government hospitals of southern zone of Tigray, northern Ethiopia","volume":"19","author":"Mitiku","year":"2019","journal-title":"Afr Health Sci"},{"key":"ref31","volume-title":"Tanzania HIV impact survey 2022\u20132023 (THIS 2022\u20132023): Final report 2024","year":"2024"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/6135482","article-title":"Dietary diversity and associated factors among HIV positive adult patients attending public health facilities in Motta town, east Gojjam zone, Northwest Ethiopia, 2017","volume":"2018","author":"Tesfaw","year":"2018","journal-title":"Adv Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1136\/oem.55.4.272","article-title":"Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: what is to be done?","volume":"55","author":"Thompson","year":"1998","journal-title":"Occup Environ Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"240","DOI":"10.5588\/ijtld.19.0416","article-title":"TB and TB-HIV care for adolescents and young adults","volume":"24","author":"Enane","year":"2020","journal-title":"Int J Tuberc Lung Dis"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1213\/ANE.0000000000002864","article-title":"Correlation coefficients: appropriate use and interpretation","volume":"126","author":"Schober","year":"2018","journal-title":"Anesth Analg"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e35","DOI":"10.3346\/jkms.2024.39.e35","article-title":"Data distribution: Normal or abnormal?","volume":"39","author":"Habibzadeh","year":"2024","journal-title":"J Korean Med Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"486","DOI":"10.5812\/ijem.3505","article-title":"Normality tests for statistical analysis: a guide for non-statisticians","volume":"10","author":"Ghasemi","year":"2012","journal-title":"Int J Endocrinol Metab"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"5730","DOI":"10.1002\/sim.7059","article-title":"Prevalence odds ratio versus prevalence ratio: choice comes with consequences","volume":"35","author":"Tamhane","year":"2016","journal-title":"Stat Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"193","DOI":"10.3389\/fvets.2017.00193","article-title":"Odds ratio or prevalence ratio? An overview of reported statistical methods and appropriateness of interpretations in cross-sectional studies with dichotomous outcomes in veterinary medicine","volume":"4","author":"Fonseca Martinez","year":"2017","journal-title":"Front Vet Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified Poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou","year":"2004","journal-title":"Am J Epidemiol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s12874-018-0519-5","article-title":"Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification","volume":"18","author":"Chen","year":"2018","journal-title":"BMC Med Res Methodol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.1371\/journal.pone.0292065","article-title":"Factors to determine the adoption of online teaching in Tanzania\u2019s universities during the COVID-19 pandemic","volume":"18","author":"Anasel","year":"2023","journal-title":"PLoS One"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12889-018-6334-4","article-title":"Screening and testing for tuberculosis among the HIV-infected: outcomes from a large HIV programme in western Kenya","volume":"19","author":"Owiti","year":"2019","journal-title":"BMC Public Health"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"S270","DOI":"10.1097\/QAI.0000000000000485","article-title":"TB screening among people living with HIV\/AIDS in resource-limited settings","volume":"68","author":"Date","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1186\/s12889-016-3239-y","article-title":"Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set","volume":"16","author":"Mueller-Using","year":"2016","journal-title":"BMC Public Health"},{"key":"ref46","volume-title":"National Guidelines for the management of HIV and AIDS","year":"2019"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1186\/s12913-022-08295-6","article-title":"Factors influencing the implementation of TB screening among PLHIV in selected HIV clinics in Ghana: a qualitative study","volume":"22","author":"Narh-Bana","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"100278","DOI":"10.1016\/j.jctube.2021.100278","article-title":"Gaps related to screening and diagnosis of tuberculosis in care cascade in selected health facilities in East Africa countries: a retrospective study","volume":"25","author":"Mnyambwa","year":"2021","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"100427","DOI":"10.1016\/j.jctube.2024.100427","article-title":"Missed opportunities for TB diagnostic testing among people living with HIV in Zimbabwe: cross-sectional analysis of the Zimbabwe population-based HIV impact assessment (ZIMPHIA) survey 2015-16","volume":"35","author":"Takamiya","year":"2024","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"key":"ref50","volume-title":"National Guidelines for the management of HIV and AIDS","year":"2019"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1016\/S1473-3099(23)00372-9","article-title":"Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews","volume":"23","author":"Litvinjenko","year":"2023","journal-title":"Lancet Infect Dis"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"e47533","DOI":"10.1371\/journal.pone.0047533","article-title":"Tuberculosis and poverty: why are the poor at greater risk in India?","volume":"7","author":"Oxlade","year":"2012","journal-title":"PLoS One"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"888","DOI":"10.3390\/jcm10245888","article-title":"Tuberculosis in the elderly","volume":"10","author":"Caraux-Paz","year":"2021","journal-title":"J Clin Med"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1186\/s12879-020-05515-4","article-title":"Risk factors for recurrent tuberculosis after successful treatment in a high burden setting: a cohort study","volume":"20","author":"Cudahy","year":"2020","journal-title":"BMC Infect Dis"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"e0003896","DOI":"10.1371\/journal.pgph.0003896","article-title":"Mortality and loss to follow-up among tuberculosis patients on treatment in Meru County, Kenya: a retrospective cohort study","volume":"5","author":"Ngari","year":"2025","journal-title":"PLoS Glob Public 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