Assessing Implementation Fidelity of Targeted Universal Testing for Tuberculosis at Primary Care Facilities in Johannesburg 2024-2025
1
Epidemiology and Biostatistics, Wits University, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Targeted Universal Testing for Tuberculosis (TUTT) was introduced for testing asymptomatic high-risk individuals for tuberculosis in South Africa without assessing the implementation fidelity of TUTT. This study assessed health providers’ fidelity to the TUTT standard operating procedure in three Johannesburg sub-districts.
METHODS:
A cross-sectional survey with 88 health providers across 22 clinics assessed fidelity. Linear regression with robust standard errors was used to determine the association between fidelity scores and moderating factors (TUTT complexity, quality of TUTT delivery [e.g., sputum collection], facilitation strategies [e.g., training], patient responsiveness) and sociodemographic characteristics.
RESULTS:
Median fidelity score was 93.2% (IQR: 88.8 – 97.7%). TUTT complexity was negatively associated with fidelity (β = -0.50), while quality of delivery (β = 0.66), facilitation strategies (β = 0.23) and participant responsiveness (β = 0.55) were positively associated. Only participant responsiveness was statistically significant in the adjusted model (β = 0.55, 95% CI: 0.06–1.05, p = 0.03).
CONCLUSIONS:
Health providers showed high TUTT implementation fidelity. Training and sputum collection support are recommended to sustain the high fidelity.
Targeted Universal Testing for Tuberculosis (TUTT) was introduced for testing asymptomatic high-risk individuals for tuberculosis in South Africa without assessing the implementation fidelity of TUTT. This study assessed health providers’ fidelity to the TUTT standard operating procedure in three Johannesburg sub-districts.
METHODS:
A cross-sectional survey with 88 health providers across 22 clinics assessed fidelity. Linear regression with robust standard errors was used to determine the association between fidelity scores and moderating factors (TUTT complexity, quality of TUTT delivery [e.g., sputum collection], facilitation strategies [e.g., training], patient responsiveness) and sociodemographic characteristics.
RESULTS:
Median fidelity score was 93.2% (IQR: 88.8 – 97.7%). TUTT complexity was negatively associated with fidelity (β = -0.50), while quality of delivery (β = 0.66), facilitation strategies (β = 0.23) and participant responsiveness (β = 0.55) were positively associated. Only participant responsiveness was statistically significant in the adjusted model (β = 0.55, 95% CI: 0.06–1.05, p = 0.03).
CONCLUSIONS:
Health providers showed high TUTT implementation fidelity. Training and sputum collection support are recommended to sustain the high fidelity.
| eISSN: | 2654-1459 |
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