Tuberculosis case finding in a public healthcare setting in South Africa: using QI worksheets and a social network learning platform for rapid data-driven improvement

Abstract

Abstract Background The Coronavirus 2019 (COVID-19) pandemic diverted attention and resources away from tuberculosis (TB) and other non-COVID services and decreased clinic attendance. Objective The objective was to rapidly restore TB case finding to pre-pandemic levels using a data-driven, quality improvement (QI) approach, adapted to constraints of the pandemic. Method A mixed-methods assessment of a QI intervention in 129 health facilities from five rural health districts in KwaZulu-Natal province was performed. Eight worksheets guided clinical teams, using QI principles, to improve routine data quality and implement preselected change ideas for TB case finding in Human Immunodefiency Virus-positive clinic subpopulations. Facility teams shared data and learnings and were coached in person and via a social media platform and virtual encounters. Results We observed high rates of engagement by district TB managers and facility teams (94% of facilities posted worksheets on WhatsApp each month). The number of worksheets posted, TB investigations undertaken, and TB cases confirmed increased rapidly over time. Facility data quality improved significantly over time (median 40% errors at start vs 5% errors at end). Conclusion The Sprint initiative showed that a novel simplified QI intervention that integrated clinical protocols and data tracking was rapidly adopted and improved TB case finding despite the constraints of the COVID-19 pandemic. Two key innovations—a simplified set of data-focused QI worksheets and a social engagement and learning platform—were used to drive a focused QI effort. The approach should be considered for improving gaps in focused health system priorities in low- and middle-income country settings beyond the pandemic.