Physical activity interventions implemented for older people in sub-Saharan Africa: protocol for a scoping review.

INTRODUCTION: The global population of older people (OP) is on an upward trajectory, with predictions that the number of OP would surpass the population of younger people by 2050. In sub-Saharan Africa (SSA), death from infectious diseases in the younger population and lower fertility rates are influencing a double burden contributing to an exponential growth in the ageing population. Non-communicable diseases (NCDs) are the leading cause of mortality and disability in the population of OP in SSA. Physical activity (PA) has been proven to have positive benefits in reducing the prevalence of NCDs in OP. The objective of this scoping review is to summarise the evidence on the feasibility and effectiveness of PA interventions that have been implemented among OP to address PA levels, blood pressure, blood glucose levels, cognitive function, quality of life and body mass index in SSA. METHODS AND ANALYSIS: The Joanna Briggs Insitute (JBI) methodology will be followed for this scoping review. An electronic search of PubMed, EBSCOhost (Academic Search Premier AfricaWide Information, CINAHL, Health Sources Premier Academic/Nursing), Scopus and ProQuest (grey literature) will be done from 2010 onwards to identify reports of randomised controlled studies published in English using relevant keywords. 2010 was selected as the cut-off point for inclusion in order to focus only on relatively recent evidence, as it is more likely to remain relevant and applicable to present-day settings. The searches will be performed by the primary reviewer in conjunction with a senior librarian. Full independent review of the uploaded articles will be done by two reviewers, by title and abstract, and thereafter by full text, based on specified inclusion and exclusion criteria. The reference list of included articles will be scanned for additional relevant articles. Disagreements will be arbitrated by a third reviewer. Results will be presented in a descriptive form as well as in tabular, graphical and diagrammatic formats, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. ETHICS AND DISSEMINATION: The review will be extracting and reporting on data from published literature so there is no requirement for ethics approval. The findings of the review will be submitted for publication in a peer-reviewed journal.

A cluster-randomized controlled trial to improve the quality of integrated HIV-tuberculosis services in primary healthcareclinics in South Africa.

INTRODUCTION: Tuberculosis (TB) remains the most common cause of death among people living with HIV. Integrating HIV and TB services reduces mortality but is sub-optimally implemented. Quality improvement (QI) methods offer a low-cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV-TB care in rural South African primary healthcare (PHC) clinics. METHODS: Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on-site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study-appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing. RESULTS: The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02-1.38; p=0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02-2.72; p=0·044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05; p=0.448), initiated on ART (91.7 vs. 95.5; RR=0.96; p=0.172) and VL testing (72.2% vs. 72.8%; RR=0.99; p=0.879) was similar in both groups. CONCLUSIONS: QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV-TB service delivery and increase the success of future QI scale-up activities.