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Table 4 List of Implementation Strategies and Outcomes Produced in each Study (n = 61)

From: Implementation strategies for infection prevention and control promotion for nurses in Sub-Saharan Africa: a systematic review

No. Author/ Year EVB IPC intervention Implementation strategy* Implementation outcome for the EBP* Implementation outcome for the Implementation strategy*
1 Allegranzi et al. [32] Hand hygiene/washing 1. PLAN: (conducted local consensus discussions with senior managers, WHO staff, ward staff, pharmacists; recruit, designate, trained for leadership-task-shifted roles of hospital staff; assess for readiness and identified barriers, conducted needs assessment)
2. RESTRUCTURE: (revise profession roles—pharmacist became study coordinator and an additional pharmacist and medical student became trainers; change physical structure and equipment—supplied hand-rub to HCWs)
3. EDUCATE: (training on HH, distributed educational materials; made training dynamic—slide show, training film, and presentations)
4. FINANCIAL (fund and contract for clinical innovation—hand rub production)
5. QUALITY MGMT: (audit and provide feedback to HCWs)
1. FEASIBILITY: Reduction in HAI from baseline (18.7%) to follow-up (15.3%) (p = .453) observed using the WHO HH toolkit 1. FEASIBILITY: WHO HH improvement strategy was successfully implemented
2. COST: Economic production of alcohol hand rub was produced
3. PENETRATION: 224 HCWs were trained
4. ACCEPTIBILITY: HCW perceptions on some HH indicators improved (i.e. system change, education, providing feedback, etc.)
2 Brown et al. [50] HIV prevention/safe conception practices associated with HIV prevention 1. EDUCATE: (Development of educational materials, HIV counseling guide, counseling messages to prevent HIV, brochures for HIV couples on safe conception practices and avoidance of HIV infection; Educational materials were distributed to providers and patients; Training was given to providers on all developed materials and on how to best counsel patients) 1. ACCEPTIBILITY: self- reported provider confidence in HIV/safer conception counseling and testing
2. FEASIBILITY: Providers stated that integrating counseling into HIV patient care was doable
3. SUSTAINABILITY: Increased confidence in HIV prevention/safe conception knowledge/practice sustained three weeks post-training (self-reported by providers)
1. PENETRATION: After counseling, patients (74%) were able to identify HIV treatment and viral suppression as effective strategies for safer contraception compared to pre-counseling (33%); Pre-training, only 10% of providers could identify the fertile period during a women’s menstrual cycle compared to 70% post-training; Pre training, only 66% of providers could identify safer contraception strategies to prevent HIV compared to 100% post-training; 116 potential participants screened to enroll in intervention—response rate for those who agreed to enroll was 42% for discordant couples, 34% for HIV+ women, and 100% for HCWs; No lost to follow-up among HCWs or patients
2. APPROPRIATENESS: self-report from HCWs that educational toolkit materials are culturally appropriate
3 Brown et al. [51] Immunization 1. EDUCATE: (conduct training, make training dynamic: used PP, pictures, demonstrations, videos, and group discussions) None 1. PENETRATION: 69 eligible HCWs could have participated in study; 69 did participate in study; 1 HCW was lost to follow-up; knowledge of HCWs increased immediately after the intervention, but then declined at 3 and 6 months; For the intervention group, overall knowledge scores increased significantly compared to non-intervention counterpart scores (p < .001)
2. FEASIBILITY: Factors identified as influencing HCW knowledge were assessed
4 Courtenay-Quirk et al. [52] Post-exposure prophylaxis (PEP) 1. PLAN: (stakeholder buy-in and information sessions; visit different sites in the 3 countries; conducted an assessment of PEP barriers and BPE rates)
2. EDUCATE: (conducted training sessions on PEP; educational materials were distributed through the healthcare facilities)-posters, calendars, key chains
3. QUALITY MGMT: (update PEP operational plans)
1. FEASIBILITY: Formative research conducted at 9 health facilities prior to intervention to access potential challenges/barriers to PEP implementation; Factors hindering PEP were identified; BPE rates were high in HCWs, yet under-reported; PEP management not sufficient given low report of BPE incidences; Within the last 6 months, roughly 2073 (69%) of HCWs stated having a BPE. Of these HCWs who stated having a BPE, roughly 35.6% were not reported. 1. PENETRATION: (number of HCWs who attended training (n-2852)/compared to total HCWs who could have attended the training N = 4667)
2. APPROPRIATENESS: (HCW and healthcare management stated that tailoring each intervention to specific facility needs, HCW cadres needs, or messaging needs to be incorporated into intervention
5 Dahinten et al. [53] ART (HIV therapy) 1. EDUCATE: (trained HCWs on “Pratt pouch”) 1. ADOPTION: (Pratt pouch was often used as a “bridge” until women could get to a healthcare facility, such that 73% of mothers used at least 3 pouches and 88% of mothers used less than 7 pouches;
2. FEASIBILITY: 90% of women who gave birth at home were able to use the Pratt pouch within three days of delivery
3. ACCEPTIBILITY: (26/30 mothers who gave birth at home stated that the pouch was easy to use or understanding the instructions of the pouch)
4. PENETRATION: Pratt pouch increased access to ARVs went from 35% to 94% (p < 05); 169 HIV+ pregnant women were surveyed. Of which, 160 enrolled in study)
1. PENETRATION: 41 HCWs from 8 different facilities were trained
2. SUSTAINABILITY: Three months after training, 8 nurses and 11 community-health workers were re-assessed and training knowledge was identified as retained
6 Durrheim et al. [54] Surveillance/screening 1. PLAN: (stakeholder buy-in on surveillance system)
2. EDUCATE (develop effective educational materials (manual/training materials), trainings, and create a learning collaborative for nurses)
3. QUALITY MGMT: (audit and feedback-assessment for flaccid paralysis from hospital records, develop and organize quality monitoring systems for the surveillance system)
4. RESTRUCTURE: (Revise professional roles-nurses involved in active surveillance)
1. FIDELITY: During two year period, 14 cases of meningococcal disease occurred. All but one was notified and contained within 48-h period 1. SUSTAINABILITY: monthly meetings among nurses, networking, and feedback were identified as important mechanisms keeping the surveillance system on-going
7 Elnour et al. [39] Waste management and proper disposal 1. EDUCATE: (training for HCWs on proper waste management; made training dynamic—used PP, group discussions, videos, demos, and health talks) 1. PENETRATION: Within the intervention group, self-reported practices (among those reporting good practice) rose from 42% to 55%. Similar increases in practice were self-reported for waste management practice indicators collected (ie safe waste separation) None
8 Farley et al. [55] MDR-TB treatment/monitoring 1. PLAN: (assessed for readiness via a SWOT analysis to identify strengths, weaknesses, opportunities, and threats in the current MDR-TB and HIV treatment model; Recruited, designated, and trained for leadership—one nurse case manager; Developed a formal implementation blueprint using the PRECEDE-PROCEED model; Conducted educational and ecological assessment, as well as, administrative and policy assessments for intervention
2. RESTRUCTURE: (revised professional roles via the introduction of nurse case manager role)
3. EDUCATE: (trained case manager on 6 proximal outcomes of interest associated with MDR-TB treatment management)
1. ADOPTION: 40 MDR-TB patients enrolled in the intervention and followed for the 6-month intervention period (aka to be followed by the nurse case manage
2. PENETRATION: 24% increased occurred between Cotrimoxazole preventative therapy at baseline to post-intervention; Active surveillance for adverse drug reactions increased by 75% from baseline to post-intervention.
1. PENETRATION: No lost to follow-up during 6-month intervention period of 40 patients; In terms of MDR-TB and HIV medical record concordance, nurse case manager identified 44% of the documented ART regimens were discordant between the medical records at baseline compared to post-intervention concordance, which was 100% between MDR-TB and HIV medical records
9 Fatti, G [56]. PMTCT (HIV therapy) 1. RESTRUCTURE: (revise professional roles via the use of a quality nurse mentor—whose responsibility is to build staff capacity and clinical management skills, ensure proper application of PMTCT guidelines)
2. QUALITY MGMT: (visit sites every two weeks and audit patient records with facility registers; address any data gaps, conduct re-fresher trainings for nurses if gaps exist)
1. PENETRATION: Estimated HIV testing in children increased 2-fold: 12.4% to 22.9% (p < 0001) Proportion of infant tested for HIV 6-weeks after birth increased: 68.7% to 76.7%(p < .0001); Repeat HIV testing at 32 weeks went from 38.5% to 46.4% (p < .0001); Zudovidine uptake increased from 80.9% to 88.1% (p < .0001); Of 27,458 pregnant women who could have been included in intervention, 4981 (18%) were included 1. PENETRATION: Nurse restructuring and quality management activities were introduced into 31 sites
10 Gous et al. [57] Point-of-care testing (POCT) 1. EDUCATE: (senior level nurses trained how to use and evaluate POCT devices)
2. RESTRUCTURE: (senior level nurses at 2 clinic facilities are asked to task-shift duties to include POCT; new POCT devices are introduced into clinical system)
3. QUALITY MGMT: (POCT verification processes were undertaken through the study; Laboratory confirmation of POCT tests was also performed)
1. ACCEPTIBILITY: Nurses stated no difficulties in in performing POCT
2. FEASIBILITY: 70% of patients required 3+ POCT; On average, if CD4 counts were needed for the POCT, testing took roughly 1 h and 47 min; If CD4 was not needed, for 3 tests was 6 min; A total of 6% and 4.3% error rates for the POCT platforms were obtained in the two study sites
1. PENETRATION: 793 HIV+ patients were asked to enroll and 793 did
2. ACCEPTIBILITY: nurses stated a preference for quick reference charts as quick aids over longer training sessions
3. FEASIBILITY: POCT was implemented into 2 ART clinics; All POCT platforms passed verification; POCT did add to nurses’ already busy scope of practice
11 Holmen et al. [58] Hand hygiene (hand washing) 1. PLAN: (stake holder buy-in established prior to intervention roll-out with hospital leadership; Ensuring procurement of alcohol hand rub both for HCWs and patient rooms in facility)
2. EDUCATE: (nurses and physicians attended HH training; posters and educational materials were placed in facility wards)
3. RESTRUCTURE: (providing HCWs personal alcohol hand rub)
4. QUALITY MGMT: (pre- intervention HH quality assessment via observations; audit and feedback given to facility administrators on HH compliance among HCWs post-intervention)
1. FIDELITY: Disparities among HH existed for both nurses and physicians pre-/post- intervention, with physicians being more compliant than nurses 1. PENETRATION: (9 out of 12 physicians and 54 out of 54 nurses attended the HH training: Knowledge increased among HCWs from 41.3% at baseline to 78.45(p < .001) post-intervention
12 Holmen et al. [33] Hand hygiene (hand washing) 1. QUALITY MGMT: (purposeful re-examination of the HH intervention by conducting another post-intervention assessment via HH observation and interviews among nurses and physicians; performed audit/observation assessment of medical and nursing students in 2016) 1. SUSTAINABIITY: (Among all HCWs, HH compliance declined from the 2015 assessment to the current 2016 assessment from 68.9% to 36.8%(p < .001); Nurse-specific compliance decreased by 20.8%; physician compliance was reduced in 4/5 HH indications, nurse compliance reduced in 2/5; Similar to 2015, physician compliance was higher than nurse compliance, however, the difference had decreased by 9.7%; In 2016 assessment, there was no difference in HH compliance between medical or nursing students 1. FEASIBILITY: Production of alcohol hand gel that was provided to HCWs in 2015 assessment was no longer being made by the local pharmacist and distributed to HCWs
13 Howard et al. [59] IPT (TB therapy) 1. PLAN: (engaged local government stakeholders before study to gain feedback and buy-in on intervention)
2. EDUCATE: (trained nurses on IPC protocols; distributed educational materials throughout clinics as reminders of IPC protocols)
3. RESTRUCTURE: (introduced new tools to capture patient data, such as a Family Care Enrollment form to screen family members for TB/HIV; Patients were reimbursed for clinic visits, provided mobile phones, airtime, and sent reminder SMS messages to them)
4. QUALITY MGMT: (tools were developed for intervention monitoring)
1. ADOPTION: IPT initiation rates
2. PENETRATION: IPT completion rates; IPT adherence rates; ART adherence rates; changes in CD4 counts; retention in HIV care
1. ACCEPTABILITY: Majority of patients and HCWs stated that IPT combination intervention was agreeable
14 Imani et al. [60] Screening, diagnosis, therapy 1. EDUCATE: (trained HCWs on childhood infectious diseases: TB, HIV, malaria, and others, specifically on the diagnosis and therapy components of these diseases
2. QUALITY MGMT: (on-site supervision was provided for 9-months to HCWs, whereby mentorship and extra training were provided)
1. FEASIBILITY: Relative risk ratios comparing intervention to control relative risk showed no difference in improvements in screening, diagnosis, and therapy initiation None
15 Jere et al. [61] Universal precautions AND HIV prevention associated with universal precautions 1. EDUCATE: (provided training for HCWs on universal precautions and HIV preventions; trainings were made dynamic in that they incorporated rehearsal of key skills with feedback)
2. QUALITY MGMT: (developed tools for intervention monitoring, which included pre-/post- assessments and observations
None 1. FEASIBILITY: At baseline, overall universal precautions knowledge was higher in the control group
16 Jones et al. [62] Standard Precautions/UP 1. PLAN: (a collaboration of stake- holders was established between the MOH and the Global Health Alliance of Western Australia (GHAWA) to better understand why clinical practice had not changed among HCWs after an infectious disease training; An IPC needs assessment was performed by GHAWA; conducted healthcare facility visits to gain a sense of IPC challenges and cultural contexts)
2. EDUCATE: (developed an IPC course to fill in some of the gaps from previous courses/trainings; received stakeholder feedback and modified the course based on local context; training was made dynamic via role-plays and Glitterbug!)
1. FEASIBILITY: Health facilities lacked running water, lack of resources, storage for IPC materials 1. ACCEPTABILITY: HCWs reported they thought the training was useful and informative
17 Jones-Konneh et al. [63] Standard precautions and transmission- based precautions for EVD prevention 1. PLAN: (a collaboration of stake-holders was established to be able to cover all training needs, partners included: IOM, COMHAS, MOH, and RSLAF
2. EDUCATE: (HCWs were trained on the relevant standard precautions and transmission-based precautions to provide patient care and to maintain their own safety; Training was made dynamic—mock ETU were used, skills stations, clinical cases, and lectures)
None 1. PENETRATION: 6206 HCWs were trained
2. FEASIBILITY: Anxiety associated with providing care to EVD patients decreased after training
18 Kaponda et al. [64] Universal precautions AND HIV prevention associated with universal precautions 1. EDUCATE: (provided training for HCWs on universal precautions and HIV preventions; trainings were made dynamic in that they incorporated rehearsal of key skills with feedback)
2. QUALITY MGMT: (developed tools for intervention monitoring, which included pre-/post- assessments and observations
None 1. ACCEPTABILITY: HIV patients were asked about if HCWs had discussed any of the training materials with them AND how they felt about the material delivered; At baseline, only 28% of HCWs had discussed HIV prevention with patients compared to37% post-intervention(p < .01)
19 Karari et al. [65] ART (HIV therapy) 1. PLAN: (established an academic partnership to initiate Uliza; a publicity meeting was conducted introducing Uliza to HCWs)
2. EDUCATE: (promoting Uliza vai educational sessions to HCWs)
3. QUALITY MGMT: (reminded HCWs of Uliza via text messages; introduced Uliza: telephone consultation service to improve HIV care/ART; tools/surveys developed to evaluate the implementation of Uliza; chart audits at healthcare facilities were reviewed to assess if Uliza advice was actually implemented by HCWs)
None 1. PENETRATION: 296 calls from 79 different HCWs used Uliza within the first year of its implementation; 58.4% of HCWs made 2+ calls; 69% of calls came from district hospitals or healthcare centers
2. ACCEPTABILITY: Among users of Uliza, all most all (94+%) agreed that the service helped them with providing better patient care, met their expectations, convenient, and timely.
3. FEASIBILITY: two important barriers to implementation success: cell phone coverage in certain rural areas, and delayed response from Uliza consultants; Nonusers stated they did not use the service because they did not know about it, did not have questions, or used other resource materials available to them
20 Kerrigan et al. [66] TB screening/active case finding 1. PLAN: (Focus group discussions and in-depth interviews with key stakeholders (HCWs, patients, and family members) was performed to identify which active case finding method for TB (clinic-based, home-based, or incentive-based) would be the best option for a future trial) None 1. ACCEPTABILITY: All study participants stated the all three strategies would be acceptable, yet each method had its pros and cons, and some methods may be better targeted to specific patient populations. For example, patients stated clinic-based methods were generally acceptable and not out of the ordinary, however, they want to ensure patients were not being stigmatized. Thus, they suggested that ALL patients (not just some patients, like HIV+) be screened; HCWs stated they favored incentive-based system best
2. FEASIBILITY: Clinic costs and transportation times were also listed as issues that might inhibit this strategy’s successful implementation; Some TB patients stated they liked the home-based method better, as it allowed patients to feel more comfortable, less costs, but it did have the potential to create stigma; In terms of the material-based method, many participants stated food and money were good incentives, yet they questioned if the government would be able to implement this form of incentive system. Additional concerns related to this method were around if this method was sustainable.
21 Kunzmann et al. [67] “Best Care Always:” an evidence- based HCAI prevention bundle 1. PLAN: (consensus from local stakeholders agreed that a VAP bundle needed to be implemented on PICUs)
2. RESTRUCTURE: (task-shifting via the creation of a “VAP champion” role for nurses; nurse teams of 5 members were created to implement the VAP bundle; doctors required to complete VAP identification screening form; VAP Coordinator position was created)
3. EDUCATE: (all staff involved in the implementation of the VAP bundle were trained on the bundle; one-to-one teaching sessions occurred between VAP Coordinator and nursing staff; educational materials were made available throughout the PICU)
4. QUALITY MGMT: (new tool adapted to screen for VAP; regularly VAP monitoring for VAP introduced)
None 1. ACCEPTABILITY; Full-time VAP Coordinator, whose duties would not be clinical, was well received by healthcare facility administration (this newly created position would not cause senior nursing staff to be pulled away from the bedside)
2. FEASIBILITY: Initial implementation of VAP bundle was not successful; Resources shortages, limited number of nurses all contributed to implementation challenges; Upon initial implementation, many challenges arose that required changing the implementation approach of the VAP bundle intervention. For example, within first 4 months, data collection was unreliable, compliance low, 5-member nurse team had little time to teach and monitor staff on bundle, resistance from nurse staff in wanting to implement the VAP bundle, and PICU team buy-in was challenging-no sense of urgency to change
3. SUSTAINABILITY: After the VAP Coordinator position was eliminated, the intervention continued for 3 months
22 Labhardt et al. [68] PMTCT (HIV therapy) 1. RESTRUCTURE: (HIV kits, pocket guides for HIV ART distributed to 70 health care facilities)
2. QUALITY MGMT: (Throughout study, HIV kit inventories were captured; staff knowledge was assessed on ART; Senior nurses developed an inventory tracking tool for ART resources at the facility level)
3. EDUCATE: (HCWs were provided HIV/ART training, training was made dynamic via the use of lectures, demonstrations, teach-backs, interactive plenary sessions; on-site supervision occurred after training as well)
None 1. PENETRATION: HIV materials to deliver ART was distributed to 70 facilities; (44 healthcare facilities (63%) contained full equipment for HIV testing; 16 (23%) had stocked PMTCT drugs; Only 14 (20%) had both
2. FEASIBILITY: Physicians confirmed that PMTCT drugs had reached district-level facilities; yet materials and funds for training had not
23 Levy et al. [69] Standard precautions and transmission- based precautions for EVD prevention 1. PLAN: (coalition established between MOH and CDC, NGOs; some partners procured PPE, others organized logistics associated with training in the district PHUs)
2. EDUCATE: (IPC curriculum, training materials, and health promotion materials were produced; on-site PHU training occurred for all staff; Train-the-trainer strategy used to educate staff in 1200 PHUs nationwide)
3. COST: (funding for intervention strategies was provided from a variety of international, external sources)
4. QUALITY MGMT: (district teams performed initial PHU assessments, made recommendations, and returned a week later to perform quantitative assessment of the PHU; Additional feedback and training was provided at this time)
None 1. PENETRATION: 4264 HCWs trained in 14 districts; over 94% of PHUS received training/PPE supplies
24 Lewin et al. [70] TB therapy 1. EDUCATE: (training materials produced that incorporated a lot of staff self-reflection on TB care, addressing barriers to care, and empowering staff to implement system changes; training on the newly produced materials was carried out) 1. PENETRATION: rates for successful completion of treatment improved more in the intervention clinics than in the control clinics, yet these differences were not statistically significant) 1. FEASIBILITY: Training was successfully conducted in all clinics, except for 1; complete pre-and post-intervention data were obtained for all clinics, except 1; all clinic-based records matched 100% of the laboratory records
2. ACCEPTIBILITY: Clinic staff stated that they generally approved and liked the intervention
25 Liautaud et al. [71] HIV/TB IPC 1. FIANANCE: (University of Free State received funding for this program from Canada’s Global Health Research Initiative)
2. EDUCATE: (HCWs were trained on HIV/TB IPC; training was made dynamic—via the use of collaborative projects that had to address a specific HIV/TB IPC challenge at the HCWs place of work; HCWs had to develop proposals, initiate research models, and collect data)
1. FEASIBILITY: Barriers to intervention implementation were identified: not enough time, lack of resources, logistical challenges, and institutional capacity; Lack of computer skills to develop HIV/TB IPC materials for research/data collection was a barrier to many HCWs 1. ACCEPTIBILITY: HCWs stated that this intervention program was good, eye-opening, and substantial; HCWs felt they had learned a lot about research that they previously had no exposure to
26 Liu et al. [72] Ebola ETU safe design/layout for patient isolation and infection reduction; standard precautions; transmission-based precautions 1. RESTRUCTURE: (facilities to care for EVD patients was completely physically re-designed to adhere to IPC guidelines; cameras install into EVD units for close patient monitoring; Initiating a buddy-system for EVD patient care)
2. EDUCATE: (new EVD guidelines were developed; new tools for donning/doffing were produced—41 step PPE wearing guide was developed; training for EVD IPC provided to all HCWs working with EVD patients)
3. QUALITY MGMT: (strict supervision and inspection of all staff’s PPE prior to ETU entry was required; site inspections occurred regularly with video surveillance; Feedback was immediately provided to HCWs if PPE errors were observed)
None 1. PENETRATION: 1520 individuals were trained in EVD IPC; 80 local HCWs were trained in EVD IPC
2. FEASIBILITY: EVD facilities were constructed
27 Mahomed et al. [73] IPC Practices (including standard precautions and transmission-based precautions) 1. RESTRUCTURE: (trained nurses were used to fill out ICATs for given IPC assessment areas, like hand hygiene or isolation/quarantine)
2. EDUCATE: (nurses were trained on the ICAT tool)
3. QUALITY MGMT: (introduction of the ICAT tool to assess how well IPC is being implemented in ICUS)
None 1. PENETRATION: IPC practices associated with study were carried out in 6 public and 5 private ICUs
2. FEASIBILITY: Nurses successfully completed ICAT assessments
28 Miceli et al. [74] HIV prevention/ART, TB screening/therapy, malaria screening/therapy 1. EDUCATE: (implemented the Integrated Management of Infectious Disease training program; made training dynamic via case studies, group discussions, and small group work; On-site support and continuing education for HCWs was provided throughout 9-month study period)
2. QUALITY MGMT: (performed observations of HCWs practice for a total of 20 observations; assessed site performance via a surveillance system; assessment of population outcomes)
None 1. PENETRATION: 72 HCWs trained on IMID; HCWs applied complex clinical reasoning concepts by: analyzing 40–50 cases, discussing 20–30 presentations from their peers, 36 h of clinical placement, and discussing with 20 physicians
29 Mbombo & Bimerew [75] PMTCT (HIV therapy) 1. EDUCATE: (trainings performed in both midwifery and PMTCT for nursing students: training was dynamic via skills lab, visualization processes, guided practice, and independent practice) 1. PENETRATION: Of 154 students, 107 (69.5%) provided intrapartum ARV prophylaxis to pregnant women; Of 116 students, 75.3% conducted neonatal ARV prophylaxis, (23 or 14.5%) performed 15 neonatal ARV prophylaxis procedures 1. PENETRATION: 134 students performed the HIV pre-testing counseling competency (only 119 or 77.3%) completed the required 10 pre-test cases; 132 students completed the post-test counseling competency (only 115 or 74.7%) completed the required 10 post-test cases; Of the 144 student who submitted their competencies, 135 (87.7%) performed the required 7 rapid fingersticks for HIV testing; 121 (78%) of students provided dual ARV therapy (74 or 48.1%) competed the required 10 dual therapy sessions;
30 Ogoina et al. [76] Standard precautions and transmission-based precautions for EVD prevention 1. PLAN: (established partnerships between the Niger Delta University Teaching Hospital (NDUTH) and the Bayelsa State Ebola Task Force, the MOH, and international partners, like WHO; appraisal of the hospital’s EVD preparedness was assessed via the WHO Ebola checklist)
2. RESTRUTURE: (EVD response team was created at hospital; Facility altered to include isolation/quarantine space)
3. EDUCATE: (sensitization EVD workshops were provided to all HCWs)
4. FINANCIAL (funds from the state allowed for an isolation ward to be designed and built)
5. QUALITY MGMT: (assessments performed to assess HCW EVD knowledge, fears, myths; continuous IPC evaluations were performed throughout epidemic
1. PENETRATION: 3 EVD “alarms” were reported, which turned out to be false/non-EVD cases
2. SUSTAINABILITY: a significant outcome of this study is associated with sustainability. Once the EVD outbreak was over in Nigeria, the IPC activities were not sustained
1. PENETRATION: Among 500 HCWs, 189 completed the survey on EVD; 3-false alarms of EVD were reported
2. FEASIBILITY: Some HCWs were reluctant to be a part of the EVD team—some asked for stipends and life insurance to participate in EVD team; many HCWs refused to work in an isolation ward; Among 189 HCWs, 82% believed the misconception that EVD can be prevented by avoiding crowds; 56% of HCWs believed the misconception that patients with a fever should be treated like an EVD case; Hand gloves, sanitizers, and hand soap quickly ran out upon initiation of the intervention
3. ADOPTION: an isolation ward was established; hospital procured PPE, alcohol hand gel, established the use of an incinerator
31 Otu et al. [77] Standard precautions and transmission-based precautions for EVD prevention 1. PLAN: (partnerships between the national government, cell phone companies, and other partners were established)
2. EDUCATE: (HCWs were provided an Ebola Awareness Tutorial (EAT); EAT was designed and developed by Information Control Technology and IPC experts)
3. QUALITY MGMT: (Pilot testing of EAT to assess diagnostic and management responses to EVD; pre- and post-intervention assessments performed to evaluate EAT)
1. ACCEPTIBILITY: Positive response to using PPE to prevent the spread of EVD. None
32 Parker et al. [78] Safe Water System (Hand hygiene) 1. PLAN: (partnerships between the CDC, CARE International, PSI, and the Maternal and Child Health Clinic in Homa Bay)
2. EDUCATE: (training in SWS and proper hand washing technique were provided to all nurses; educational materials post training were also provided nurses)
None 1. PENETRATION: All 11 nurses received the SWS and hand-washing training; Post-training, 7 nurses scored 100% of the post-test assessment, 3 scored 91%, and 1 scored 62%; 10(91%) of nurses reported using hand hygiene and SWS materials to teach clients using materials from the trainings they received
33 Richards et al. [79] “Best Care Always:” an evidence- based HCAI prevention bundle 1. PLAN: (coalition established between private hospital groups (Netcare), healthcare professionals, and the National Department of Health; ICU staff were familiarized with the bundle)
2. RESTRUCTURE: (CLABSI bundle implemented; On-going monitoring was integrated into ICU nurses’ roles and responsibilities)
3. EDUCATE: (multiple regional learning sessions about BCA campaign and CLABSI bundle were provided for nurses; guidelines were given to nurses; educational materials were made available)
4. FINANCE: (BCA campaign implemented using funds from private hospital nursing budgets or the overall hospital budget)
5. QUALITY MGMT: (Central-line bundle checklist were implemented for intervention monitoring; audits were regularly conducted; staff kept engaged via regular audit and surveillance data provided in visual forms, like run charts and team meetings
None 1. FEASIBILITY: CLABSI bundle successfully implemented in 43 healthcare facilities; Overall study recorded 1,119,558 central-line-days
34 Samuel et al. [80] Hand hygiene (hand washing) 1. PLAN: (strong support and buy-in form government regarding intervention; multi-disciplinary infection prevention committee was initiated)
2. QUALITY MGMT: (feedback from healthcare workers and patients obtained regarding hand washing practices; direct hand washing observations were carried out to ensure quality practice: data triangulation and quality checks were performed; immediate feedback was given and correct hand washing practice demonstrated whenever requested during weekly facilitation and couching visits; Post-intervention workshops were carried out to engage hospital management team and HCWs in problem solving sessions)
3. EDUCATE: (In-service training on hand washing was provided to all HCWs; Facilitation and coaching visits were made weekly)
4. RESTRUCTURE: (HCWs provided hand towels and soap; portable water tap for hand washing was placed on wards)
None 1. FEASIBILITY Lack of resources (soap and towels) stated by HCWs; soap, towels, and water taps were made available to HCWs on the wards; Observations conducted assessed that all wards had running water, 60% had functioning and conveniently located sinks)
35 Schmitz et al. [81] Hand hygiene/washing 1. PLAN: Hospital leadership was involved in the design, conception, and implementation of project; Baseline evaluations/observation were conducted
2. RESTRUCTURE: Alcohol, soap, and personalized bottles of hand gel were made available to HCWs; New roles were established called “Hand Hygiene Champions, who were hospital leaders who supported HH changes at the facility)
3. EDUCATE: HCWs were trained using WHO HH strategies; Posters and visual aids were put around the facility; Informal teaching sessions were provided HCWs during daily rounding)
4. QUALITY MGMT: Monitoring and feedback on HH practices was given to HCWs; A post-intervention evaluation was conducted; HCWs were asked to complete a survey focused on HCW acceptance of the WHO campaign
None 1. FEASIBILITY All 11 patient wards at hospital had functioning sinks with a 1:4.6 patient/bed ratio; Only 20% of the sinks had soap
2. PENETRATION: 212 HCWs were approached to complete the post-intervention survey, and 161 HCWs completed; Among the HCWs who attended the training, 85.4% (111/130) and 80.8% (104/130) stated that the training increased their knowledge of HH and impacted their practice respectively
3. ACCEPTIBILITY: 64.0% of HCWs stated that they preferred hand gel to soap, and hand gel would improve their HH practice
36 Shumbusho et al. [82] ART (HIV therapy) 1. PLAN: (partnership established between MOH, FHI (NGO), and 3 health center nurse staff)
2. EDUCATE: (nurses were trained by an FHI physician; on-going physician support with weekly supervision and mentoring at each PHC)
3. RESTRUCTURE: (ART management tools were modified for nurse use during task-shifted roles)
4. QUALITY MGMT: (created checklist were created to aid nurses to collect and assess patient data)
1. PENETRATION: Of the 1076 patient enrolled in the study, 435 (40)% were initiated on ART by nurses; CD4 counts pre-ART to 6-month follow-up changed from 97 to 128 cells/ul; CD4 count from 6-months to 24-months changed from 79 to 129 cells; Mean weight gained within the first 6 months of ART initiation was 1.8 to 4.3 kg; In the last 6 months, mean weight increases were 0.5 to 1.7 kg 1. PENETRATION: 3 nurses received ART training
2. FEASIBILITY: Task-shifting successfully implemented
37 Speare et al. [83] Surveillance/screening 1. PLAN: (collaboration established between RSA provincial government, RSA universities, and Australia)
2. RESTRUCTURE: (RSA provincial government established communicable district control coordinator (CDCC)
3. EDUCATE: (nurses were trained to conduct epidemiological field surveys)
None 1. PENETATION: 16 out of 20 nurses were trained in the CDCC curriculum; 2 nurses were able to present research they conducted while in their CDCC role at a conference; some nurses also co-authored manuscripts
2. ACCEPTIBILITY: 15 of the 20 nurses stated the training materials/sessions were appropriate for their needs
38 Tillerkeratne et al. [84] CAUTI Infection Prevention and Control 1. PLAN: (pre-intervention surveillance was performed to obtain baseline data on CAUTI rates and practices)
2. EDUCATE: (training was performed for HCWs to address correct catheter placement/management; Reminder signs were placed over patient beds to act as visual HCW reminders; Training was made dynamic via videos, lectures, demonstrations; Discussions had on HH, sterile gloves, and antisepsis)
3. QUALITY MGMT: (Nurse matrons performed weekly infection prevention rounds on catheterized patients to assess if catheters were still needed for said patients; Post-intervention, surveillance conducted to assess CAUTI rates)
1. FEASIBILITY: Limited hospital supplies reported: bed-pans/urinals stated as reasons for catheter-placement during pre-intervention phase of study 1. PENETRATION: 125 patients received catheters during this study; 82 in the pre-intervention phase AND 43 in the post-intervention phase
39 Uneke et al. [34] Hand hygiene/washing 1. PLAN: (consultations/advocacy meetings were conducted between the Research team and stakeholders: Chief Resident Doctors and Heads of Nursing Services) before study commencement
2. EDUCATE: (training sessions on HH were conducted; HH reminders were placed within the wards/hospital)
3. RESTRUCTURE: (Alcohol-based hand gel was made available on all the wards)
4. QUALITY MGMT: (pre- and post-intervention observations were performed to assess for HH compliance)
1. FEASIBILITY: Inadequate water supply, limited access to soap and towels, lack of awareness of HH, insufficient number of HCWs, and absent guidelines for HH were all listed as reasons for limited HH compliance) 1. PENETRATION: 202 HCWs were trained
40 Uneke et al. [85] Disinfection (of medical equipment) 1. PLAN: (pre-intervention assessments were performed to assess HCWs KAP of stethoscope handling and maintenance; Microbiological assessment were performed on HCW’s stethoscopes; Baseline compliance of stethoscope disinfection practices of HCWs was performed; FGD were conducted to assess factors with limited stethoscope compliance among HCWs)
2. EDUCATE: (training In workshops on stethoscope disinfection practices were provided to HCWs)
3. RESTRUCTURE: (Alcohol-based hand gel was procured and placed on wards)
4. QUALITY MGMT: (post-assessments performed on stethoscope disinfection practices and microbiological assessments)
1. FEASIBILITY: Reasons by HCWs for non- compliance with stethoscope disinfection were provided)
2. PENETRATION: Pre-intervention assessments revealed that no doctors regularly disinfected their stethoscopes after seeing patients, yet 39.2% of nurses did; Post-intervention, 89 stethoscopes were microbiologically tested for bacteria, roughly 20.2% of them were contaminated with bacterial agents; Following the intervention, stethoscope contamination was reduced by 58.3% compared to pre-intervention rates; Post-intervention, 100% of HCWs cleaned their stethoscopes after each patient
1. PENETRATION: 202 HCWs were trained in a series of workshops; Post-intervention, 89 HCWs were asked to provide their stethoscopes for microbiological assessment, and 100% of them did
41 Van Rie et al. [86] HIV Counseling/Testing AND TB Prophylaxis 1. EDUCATE: (nurses received HIV counseling and testing training for 2 weeks)
2. RESCTRUCTURE: (HIV counseling and testing services were provided to patients utilizing three different delivery models: referral to a free-standing VCT clinic, Referral to counseling/testing center to which the TB clinic belongs, or TB nurse offered to patient and provide HIV counseling/testing
1. PENETRATION: Cotrimoxazole prophylaxis was initiated in 89.9% of HIV co-infected patients with TB 3. SUSTAINABILITY: Of those who initiated the CTX at the TB clinic, 88.4% were still on it at the end of 8-months of TB treatment or until time of death. 1. ACCEPTIBILITY: The proportion of patients accepting HIV counseling/testing was significantly lower (68.5%) at the clinic that referred patients to a free-standing VCT center compared to 94.8% acceptance rate at the clinic with on-site referral and 97.7% at the clinic where counseling/testing was conducted by a TB nurse (p < 001)
2. ADOPTION: 3 TB clinics implemented the intervention
3.FEASIBILITY: 1238 (99.4%) of the 1246 patients registered at the 3 TB clinics had available data
4. PENETRATION: 10 nurses trained on HIV counseling/testing and TB prophylaxis
42 Wanyu et al. [87] PMTCT (HIV therapy) 1. PLAN: (Study supervisory staff met with village health committee and educated them about HIV and PMTCT; If committee agreed to participate in study, local trained birth attendants would be sent for additional training)
2. EDUCATE: (Trained birth attendants were further trained in PMTCT protocols, including HIV counseling, peripartum administration of Nevirapine to mother and baby, and HIV testing)
1. PENETRATION: Trained birth attendants counseled 2331 women; Of the 2331 women counseling, 2310 (99.1%) agreed to initial HIV testing using OraQuick; Of the 42 women who delivered at the primary health centers, 37 (88.1%) received Nevarapine prophylaxis is; Of the 42 newborns delivered by trained birth attendants, 36 (85.7%) were treated with Nevarapine after birth; Of the children whose mother’s had a positive Ora Quick test, 14 were tested for HIV at 15 months) 1. PENETRATION: 30 trained birth attendants agreed and received training
43 Welty et al. [88] PMTCT (HIV therapy) 1. EDUCATE: (Nurses and trained birth attendants were trained how to conduct HIV counseling/testing and provide Nevarapine prophylaxis)
2. COST: (A variety of stakeholders provided financial support for this intervention, such as the Elizabeth Glaser Pediatric AIDS Foundation, Axios Foundation, Boehringer Ingleheim Pharmaceutical Company
1. PENETRATION: 68,635 women received pre-test counseling; 63,094 (91.9%) of women were screened for HIV; Of those screened for HIV, 5550 (8.7%) were HIV positive; Of those who were HIV positive, 5433 (97%) were provided Nevarapine 1. PENETRATION: 690 nurses, nurse aids, and trained birth attendants were trained to provide PMTCT in 115 facilities in 6 out of ten provinces in Cameroon
44 White et al. [89] IPC Practices during surgeries (disinfection of equipment, decontamination of equipment, disinfection of environment) 1. EDUCATE: (3 different training methods were used to promote the use of the WHO Surgical checklist—nurses were only trained in one method (the team method: an intra-professional training modality)
2. QUALITY MGMT: (Training effectiveness was measured post-training once HCWs returned back to their home healthcare facilities. Only 3 out of the 4 WHO areas of patient care were assessed—Measurement of Surgical services was not conducted)
1. APPROPRIATE: Upon returning to their home healthcare facilities, all HCWs who trained on board or in the team modalities, but none who trained only in the classroom, stated the checklist improved infection control
2. ADOPTION: HCWs stated they felt improvement in decontamination and washing of surgical instruments, using bleach solutions, not picking instruments off the floor, and cleaning up blood as soon as it hits the floor)
1. ACCEPTIBILITY: For those HCWs in the “team modality,” they all felt that these way of training was good and improved infection control in their hospitals
2. FEASIBILITY: Implementing the checklist in it’s entirety was not achieved
45 Xi et al. [90] PPE use 1. PLAN: (To prevent Ebola infection in HCWs, video cameras were installed in the ETU to perform surveillance of HCWs as they doffed their PPE)
2. EDCUATE: (nurses were trained to supervise HCWs as they doffed their PPE via video surveillance to ensure that each step of doffing process was successfully performed by HCWs)
3. QUALITY MGMT: (Nurses monitored HCWs during the doffing process; gave real-time feedback during the process of mistakes were made via a communication system installed in the ETU; Nurses would also record any mistakes and discuss these with HCWs after doffing; Nurses made a standardize table of all of the required doffing steps to be used during surveillance activities)
1. FIDELITY: 1797 inappropriate doffing actions were identified and corrected; In the first week, the error rates for each doffing step was between 0.60% to 50.60%; In the second, third, fourth, and fifth weeks, the error rates were 0–19.05%, 0–0.89%, 0–1.19%, and 0–0.89% respectively. 1. PENETRATION: 8 nurses were trained in required PPE doffing procedures; A total of 1680 counts of doffing PPE were recorded
46 Zaeh et al. [91] TB screening/IPT Prophylaxis 1. PLAN: (pre-intervention assessments were performed to collect baseline data see if HIV+ patients at the health facility had been screen for TB and/or been put on IPT)
2. EDUCATE: (HCWs were trained on TB screening and IPT; Reminder posters were posted throughout the HIV clinic)
3. QUALITY MGMT: (The WHO TB screening checklist was added to each patients’ chart to help HCWs remember to complete it; Post-intervention assessments were conducted to address any change after the intervention)
1. PENETRATION: 751 HIV+ patients were evaluated during the study; Post-intervention, 94% of HIV+ patients were screening for TB compared to only 22% pre-intervention; Nurses originally screened 3% of patients, yet after the intervention, they screened 100% (p < 001); Among the patients with a negative symptom screen who were eligible for IPT, 81% were put on IPT compared to only 4% (p < 001) pre-intervention; Nurses initiated 90% of HIV+ patients on IPT post-intervention compared to only 17% (p < 001) pre-intervention) 1. PENETRATION: 2 nurses trained in TB screening/ IPT
47 Bedelu et al. [92] ART (HIV therapy) 1. PLAN: (Partnership established with MSF to deliver ART using a task-shifting approach and de-centralized HIV care)
2. EDUCATE: (Nurses and CHWs were provided training on HIV management, including ART, PMTCT, and TB diagnosis)
3. RESTRUCTURE: (Task-shifting was utilized to have HIV ART be nurse-initiated instead of physician-initiated)
4. QUALITY MGMT: (All clinics with task-shifted nurses received support from physicians via a mobile visit; Intervention evaluation was conducted by a quality control team (consisting of one physician and one nurse) on a quarterly basis)
1. PENETRATION Post-intervention, 2200 people were receiving ART; Pre-intervention, 50% of service users at the hospital and 40% at the clinics arrived with CD4 counts less than 50 cells/mm. Post-intervention, the number of patients with CD4 counts less than 50 cells/mm had decreased to 16& at both facility types
2. SUSTAINABILITY: Cohort analysis of people who received ART treatment for longer than 12 months showed satisfactory immunological recovery and viral suppression;
1. FEASIBILITY: Closer proximity and acceptability of services at the clinic level (compared to hospital level) led to faster enrollment of people on ART and better patient retention
2. PENETRATION: Only 2% of people were lost to follow up
48 Elden et al. [38] TB screening/intensive case finding 1. EDUCATE: (nurses and HIV counselors attended a 2-day training course on TB screening tool and intensive case finding)
2. RESTRUCTURE: (Transportation systems were introduced to allow for the more effective delivery of sputum samples; One full time nurse and one TB/HIV Coordinator were hired to coordinate intervention)
3. QUALITY MGMT: (TB intensive case finding screening tool was developed and used to monitor intervention progress; Monthly supervisory visits were made to the hospital and clinics to ensure use of the new ICP tool; an MEQ system was implemented to assess patient treatment initiation if TB positive)
4. COST: (Nurse coordinator, outreach coordinator, and TB coordinator all received cellular phones with monthly credit; Clinics were given month cellular telephone credit to call hospitals)
1. PENETRATION: During 3 month study period, 1467 HIV+ patients were screened for TB (1129 from hospital; 338 from clinics); Of those screened, 365 (25%) were identified at TB suspects; Using 1467 as the denominator, 28 (2%) of HIV+ patients were identified as TB positive 1. ADOPTION: Proportion of HIV+ patients screened was higher in the clinics than in the hospital—potentially due to staff motivation or rigorous application of the screening tool (p < 001); 53% of patient did not return their TB specimens for testing—potentially due to financial and geographical barriers, difficulty producing sputum, and patients not prioritizing testing)
2. FEASIBILITY: Overall, ICP was implemented into the hospital and clinics successfully)
49 Charalambous et al. [93] ART (HIV therapy) TB screening/INH therapy 1. PLAN: (Stakeholder buy-in and informational sessions were conducted with primary health service nurses, mine management, union representatives to address any potential concerns/issues with the introduction of the new HIV clinic on-site at the mines)
2. RESTRUCTURE: (a new HIV clinic was proposed to be located and operationalize for HIV+ miners; Staff were recruited to service the new HIV clinic, including a professional nurse and two enrolled nurses)
3. EDUCATE: (All staff involved in patient care at the HIV clinic received training in HIV management (ART) and TB screening and prophylaxis)
4. QUALITY MGMT: (Regular meetings were held with nurses to discuss issues concerning monitoring and supply of preventative therapy; A liaison nurses visited the primary care nurses to monitor record keeping and to provide additional education to staff about preventative therapy)
1. PENETRAION: Of the 1773 new HIV clinic attendees, 48 (3.7%) were found to have TB upon screening; 1190 (67%) of clinic attendees were eligible for INH, 966 (82%) initiated INH. 1. PENETRATION: 1773 patients attended the new HIV clinic; Of the 1773 patients who attended the clinic, 1270 (72%) were still active attendees over a 29-month period; This framework was used to establish two other similar clinics at mining companies in RSA
2. ACCEPTIBILITY: Patients attending the clinic had positive feelings about the preventative therapy and were confident about the benefits of attending the clinic; Clinic attendees were very enthusiastic about ART initiation
3. FEASIBILITY: new HIV clinic was established at mining facility for miners
50 Fairall et al. [40] ART (HIV therapy) 1. EDUCATE: (Nurses received HIV training sessions about prescribing ART and potential side effects, as well as, the PALSA PLUS guidelines, which provide care for respiratory disorders, like TB; Nurse managers would provide additional educational sessions to intervention nurses)
2. QUALITY MGMT: (24 physicians would mentor and support nurses initiating ART to patients at the intervention clinics)
3. RESTRUCTURE: (Physician roles were task-shifted to nurses to initiate ART for patients)
1. ADOPTION: (All 16 clinics were able to implement phase 2, re-initiating ART in patients who are already taking it 1. PENETRATION: 103 nurses trained in ART; All 16 intervention clinics were able to successfully implement 2 out 3 phases of the intervention
2. FEASIBILITY: Task-shifting ART to nurses in a large-scale public sector program did not improve survival of patient not yet taking ART with CD4 counts of 350 cell/mm or less, but it did in patients with CD4 counts of 201–350 cell/mm, although the difference was not significant; 2 clinics could not implement phase 3 due to difficulties with staff and drug distribution
51 Harrison et al. [94] STD Syndromic case management 1. EDUCATE: (Nurses received STD case management training, including STD drugs, counseling, condom protection, contact tracing, and syndrome packets that have STD specific treatment, condoms, partner cards, and patient information leaflet; Nurses also participated in problem-solving exercises to define objectives to improve the quality of STD management)
2. QUALITY MGMT: (Three follow- up sessions were held at each intervention clinic; monthly follow-up visits to the clinic by the district STD team provided continued STD management support)
3. RESTRUCTURE: (Nurses were asked to implement the use of syndrome packets to patients; Simulated patients were used to assess training. Simulated patients were come to the intervention clinics and use a standard script, presenting as a patient with an STD)
None 1. PENETRATION: 5 nurses were trained on STD management and syndrome packets; Post-intervention, the intervention is now being implemented within the 5 control clinics
2. ACCEPTABILITY: syndrome packets were well received by patients and nurses—they are now the standard of care in the intervention clinics
3. FEASIBILITY: Program was demonstrated by its integration within primary healthcare services
52 Naidoo et al. [95] TB diagnosis, treatment, and treatment monitoring 1. EDUCATE: (HCWs were trained in TB diagnosis, treatment, DOTS, drug management, etc.) None 1. PENETRATION: Of the 818 HCWs who were invited to participate in the training, 585 (71.0%) participated in at least part of the training program; Of the 818 HCWs, 267 (46%) attended the training and completed both the pre- and post- training knowledge assessments; For the 267 HCWs, percentage of correct answers on assessments rose from 59.9% pre- training to 66.5% post-training; Nurses had the lowest knowledge scores post- training—their scores were the lowest in TB patient management and TB program monitoring; Though nurses scored the lowest on the assessments, their improvements post training compared to pre-training were significant (p < 001)
53 Morris et al. [96] ART (HIV therapy) 1. EDUCATE: (Clinical officers were trained to prescribe ART, manage toxicities and opportunistic infections; Nurses were trained in triage, which ensured that all assessed patients were prioritized for care based on clinical need)
2. QUALITY MGMT: (Nurses received continued mentorship at the clinics post-training; Evaluation of clinical care via charts were reviewed monthly, feedback was provided in the event of poor site performance; and an exchange clinic system was initiated, whereby good performing clinic staff would assist poor performing clinics)
3. RESTRUCTURE: (Task-shifting was used to train CO in traditional physician skills, nurses in CO skills, and peer educators in nursing skills)
None 1. PENETRATION: 174 Clinical officers and 333 nurses were trained in HIV care and treatment; 131 CO and 120 nurses were trained in pediatric HIV care and treatment; 91 nurses were trained in triage
2. FEASIBILITY: Task-shifting was successfully implemented at healthcare facility
54 Perez et al. [97] PMTCT (HIV therapy) 1. RESTRUCTURE: (PMTCT services were initiated at a rural healthcare facility)
2. EDUCATE: (Nurses and midwives were trained to provide NVP to pregnant mothers, provide HIV counseling, and HIV testing)
3. QUALITY MGMT: (Audits and regular monitoring were performed during intervention)
1. PENETRATION: 220 women received NVP tablet to take home; 2298 (93%) women benefitted from pre-test counseling; 93% of counseled women accepted HIV testing; Of the 159 deliveries at the facility, 111 reported taking NVP during labor and 114 reported their children receiving NVP; Only 16 HIV+ women refused follow-up at discharge
2. FEASIBILITY: Reasons for refusing testing were desire to consult partner first)
1. FEASIBILTY: PMTCT program was implemented in rural health facility
2. PENETRATION: 20 nurses and mid- wives were trained in Nevarapine delivery and HIV counseling; More specifically, 2 midwives and three PMTCT staff were trained in HIV testing)
55 Sanne et al. [98] ART (HIV therapy) 1. EDUCATE: (HCWs received training on ART) 2. RESTRUCTURE: (Task-shifting ART therapy from physicians to nurses) 1. PENETRATION: Primary study end- point was reached by 371 (45.7%) of patients; 192 (48%) were in the nurse arm, 179 (44%) were in the physician-arm; CD4 counts increased in both nurses and physician arms, but was slightly higher in nurse-arm at end of 2-year study; Baseline CD4 was 155 cells and 158 cells for nurses and physicians respectively, whereas, 239 cells and 220 cells for nurse and physicians was assessed at the study’s end
2. FEASIBILTY: Non-inferiority of nurse-initiated ART was assessed
1. PENETRATION: 812 patients enrolled in trail: 408 in nurses arm; 404 in physician arm; 2 nurses trained in ART
56 Ssekabira et al. [99] Malaria screening, diagnosis, treatment 1. PLAN: (Ugandan Malaria Surveillance Project (UMSP) and the Malaria Control Program (MCP) established a surveillance system in 2006 to capture patient data; Malaria training materials were developed via a joint partnership between Joint Uganda Malaria Training Program (JUMP), UMSP, and Infectious Disease Institute (IDI) of Mekerer University)
2. EDUCATE: (HCWs were trained in malaria screening, diagnostics, and treatment; Training materials were developed via joint partnerships)
3. RESTRUCUTRE: (Malaria surveillance system was established)
1. PENETRATION: Post-training, the proportion of patients suspected of having malaria referred for microscopy increased by 50%; Proportions of patients with a negative blood smear prescribed antimalarials decreased by 60%; The proportion of decrease in inadequate antimalarial prescribing resulted in 8151 fewer prescriptions among the 67,705 patients over the 120 days after training 1. PENETRATION: 170 HCWs were trained in malaria screening, diagnostics, and treatment
57 Sserwanga et al. [100] Malaria screening/surveillance/ intensive case finding 1. PLAN: (Partnership established among UMSP, MOH, and the Ungandan National Malaria Control Program (NMCP) to initiate the implementation of a malaria surveillance system)
2. EDUCATE: (HCWs were trained in malaria screening/surveillance; Training materials were developed via joint partnerships)
3. RESTRUCUTRE: (Malaria surveillance system was established and implemented at 6 sites; A UMSP team would visit sites every 1–2 months to ensure adequate supply of resources for testing)
4. QUALITY MGMT: (UMSP team would also provide feedback to HCWs at sites during monthly visits)
1. PENETRATION: 166,278 patients underwent diagnostic testing for malaria during the study period; Proportion of suspected patients who underwent diagnostic testing increased from 39% during the first three months of surveillance to 97% in the last three months of surveillance 1. PENETRATION: 84 nurses trained in malaria screening/surveillance/intensive case finding
2. FEASIBILITY: Malaria surveillance system was successfully implemented
58 Stringer et al. [101] ART (HIV therapy) 1. PLAN: (A partnership among the Lusaka Urban Health District, the University Teaching Hospital, the Zambian National AIDS Council, and the Centre for Infectious Disease Research, and the University of Alabama was established)
2. RESTRUCTURE: (During 18-month study period, ART program was scale-up to 14 additional sites in Lusaka; Renovation of healthcare facilities to better be equipped to provide ART was undertaken; Form drive protocols were to be used during patient visits; EMR system was designed and implemented)
3. EDUCATE: (Training of non-physician clinicians occurred in ART; Clinical care oversight was provided to HCWs; Form-driven protocols were developed)
4. COST: (Non-physician clinicians were provided overtime; PEPFAR provided generous support for this study)
1. PENETRATION: Among 21,755 HIV+ treatment-naïve patients who were eligible for ART, 16,198 (74%) were started on ART; As of Nov. 2005, 11,591 (72%) of patients who had started ART remained alive and were continuing to take ART 1. PENETRATION: 29,998 HIV+ patients were evaluated; Using nurses in task-shifting capacities allowed the study/ART program to overcome the challenges of physician shortages, in short, nurse s helped get patients on ART; Rapid scale-up of ART was accomplished at 14 additional sites in Lusaka
2. ACCEPTABILITY: Zambian government provided substantial support of the scale-up ART strategy
3. COST: Significant funds from PEPFAR made this intervention possible
59 Umulisa et al. [102] Hand hygiene/washing 1. RESTRUCTURE: (In stalling locally made hand hygiene facilities at point of patient care; ensuring availability of water at hand hygiene facilities)
2. EDUCATE: (HCWs received a 2-h training on hand hygiene; Posters were placed on the wards to serve as HCW reminders to wash hands)
3. QUALITY MGMT: (pre- and post-training observations were conducted on hand hygiene etiquette among HCWs; Supportive supervision was provided throughout training to ensure hand hygiene compliance)
None 1. ADOPTION: Ensuring hand gel and water were available at point of patient care was implemented at facility
60 Driessche et al. [103] HIV Counseling/Testing AND TB testing/therapy 1. PLAN: (Stakeholder collaboration/partnership established for training development)
2.. EDUCATE: (Training materials were developed collaboratively by the DRC National HIV and TB Control Program officers, an education specialist, international TB experts, and HCWs; Trainings were conducted for HCWs on HIV/TB testing/counseling; Training was made dynamics via interactive Q&A sessions, case studies, group sessions, PP presentations, small breakout sessions)
3. QUALITY MGMT: (On-site supervisory visits and monthly follow-up meetings were used as a part of the training process; Feedback was provided during these supervisory sessions to HCWs; Revisions were made to the training manuals and materials post-intervention)
1. FEASIBILITY: Before training, the link between HIV and TB was unclear to some HCWs, such that only 67% of HCWs stated that there was a connection between the two diseases 1. ADOPTION: High rates of training participation were achieved (91% to 100%) for all training sessions
2. ACCEPTABILITY: Training received positive feedback from HCWs
61 Workneh et al. [104] ART (HIV therapy) 1. PLAN: (A Center of Excellence was established between Baylor University and Botswana; COE developed mentorship program for HCWs)
2. EDUCATE: (On-site mentorship was provided to HCWs; Didactic sessions that were focuses on pediatric HIV care and treatment was also conducted)
1. FEASIBILITY: 6 out of the 14 clinical HIV indicators (i.e., ART dosing) had significant documentation to report on 1. ADOPTION: High rates of training participation were achieved (91% to 100%) for all training sessions
2. ACCEPTABILITY: Training received positive feedback from HCWs
3. FEASIBILITY: Retrospective chart review was conducted on 374 charts at four of the mentored sites
  1. *Represents strategies that targeted nurses and/or measured outcomes associated with nurses