Table 1 Definition and measurement of organizational contextual factors
Organizational contextual factors (OCFs) | Definition | Allocation of scores | Max score per clinic | Method | Completed by | Survey used |
|---|---|---|---|---|---|---|
Physical Infrastructure | Refers to availability, utilization, and cleanliness of spaces, rooms, and facilities that are required for patient care, consultation rooms, waiting areas, designated cough booth, designated pharmacy, privacy for patients, vitals assessment* room, and ablution facilities. | 1 point allocated to each area for each attribute of availability, utilization, and cleanliness Availability = 7 Utilization = 7 Cleanliness = 7 | 21 | Key areas were directly observed and scored. | Jointly completed by study staff and facility manager or designee | Physical infrastructure is a sub-scale located in the CPT |
Key staff | Refers to frontline healthcare workers that are considered key personnel in providing patient care and monitoring delivery of healthcare services at the clinic level. Key staff included: - Facility manager - NIMART nurse - PN trained to initiate and manage TB treatment - Lay counsellors - Data capturer - Enrolled nurses | 1 point allocated if key staff post was filled at the time of completing the survey | 6 | Data received directly from facility manager or designee | Jointly completed by study staff and facility manager or designee | Key staff is a sub-scale located in the CPT |
Flexibility of clinic hours | Refers to the operating hours of clinics as a proxy measure for the extent to which clinic services are available to the community. Normal hours were defined as Monday to Friday from 07:00 to 16:00. Flexibility is defined as normal hours plus any hours on either side of normal hours or normal hours plus weekends or public holidays | Availability of clinic services during normal working hours = 1 point; extended hours = 2 points; weekends, extended hours, and public holiday = 3 points | 3 | Data received directly from facility manager or designee | Jointly completed by study staff and facility manager or designee | Flexibility of clinic hours is a sub-scale located in the CPT |
Leadership support * | Refers to leadership support visits from the DMT conducted within the last 6 months. Key DMT staff considered were: TB manager, HAST manager, QA manager, M&E manager. Frequency with which the facility manager** was off-site for meetings was considered and combined with the leadership visits score. | 1 point allocated to each of the 4 DMT members who visited the clinic even once in the last 6 months plus Frequency facility manager is off-site: Weekly = 1 Bi-monthly = 2 Monthly = 3 Quarterly = 4 | 8 | Data received directly from facility manager or designee and confirmed with the Clinic Visitor’s logbook | Jointly completed by study staff and facility manager or designee | Leadership support is a sub-scale of the CPT |
Monitoring data for improvement (MDI) | Refers to the extent to which clinic teams have accessed and utilized integrated HIV and TB electronic databases, met to discuss performance, and monitors HIV and TB programme outcomes. | Key systems in place for MDI allocated 1 point each and evidence of implementation allocated 1 point each: - Team information meetings—2 - -Ability to generate reports from the patient electronic database—2 - HIV-TB mortality data reviewed—2 - Single electronic system for HIV and TB—2 - Data quality assurance systems in place and implemented—2 - Clinic improvement team available and functional—2 | 12 | Data received directly from facility manager or designee Team meetings verified by meeting minutes. Direct observation of integrated electronic and patient file system Data quality assurance plans observed on file | Jointly completed by study staff and facility manager or designee | Monitoring data for improvement is a sub-scale located in the CPT |
Supportive contexts for change | Refers to clinic staff perceptions of the extent to which their work environment was supportive to making changes. | The COACH survey scored as per developers’ guidance which was to calculate the mean of all sub-scale means | Mean of 5 | Survey administered to clinic staff volunteers by a trained study staff member | Clinic staff who volunteered and agreed to sign the informed consent | COACH tool |
The degree of integrated TB and HIV services | Validated survey that assessed the perceptions of healthcare workers in the extent to which staff and clinic processes were organized and coordinated toward integrated HIV-TB services | Degree of integrated TB and HIV survey as per developer’s guidance which was to calculate the mean of all sub-scale means | Mean of 5 | Survey administered to clinic staff volunteers by a trained study staff member | Clinic staff who volunteered and agreed to sign the informed consent | Degree of integrated TB and HIV survey |