推广异烟肼预防疗法的干预措施对领导和管理能力的影响。

IF 1.3 Q4 RESPIRATORY SYSTEM Public Health Action Pub Date : 2024-06-01 DOI:10.5588/pha.24.0002

C Christian, E Kakande, V Nahurira, L B Balzer, A Owaraganise, J R Nugent, W DiIeso, D Rast, J Kabami, J J Peretz, C S Camlin, S B Shade, M R Kamya, D V Havlir, G Chamie

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引用次数: 0

摘要

背景：在撒哈拉以南非洲地区，中层医疗管理人员负责监督国家指导方针的实施。目前仍不清楚领导力和管理培训能否改善人口健康结果：我们试图评估参与 SEARCH-IPT 随机试验的乌干达地区级医疗管理人员的领导力/管理技能，该试验旨在促进艾滋病毒感染者（PWH）的异烟肼预防性治疗（IPT）。干预措施包括对管理人员进行年度领导力/管理培训，从而提高了 IPT 的使用率。我们在试验结束时对管理人员的领导力/管理技能进行了横断面调查。调查评估了领导力/管理工具的自我报告使用情况和一般领导力/管理情况。我们对提供者进行了抽样调查，以了解干预措施的影响。我们采用了基于目标最小损失估计（TMLE）的方法来比较试验组之间的反应：在参与 SEARCH-IPT 试验的 163 名管理人员中，有 119 人（73%）完成了调查。与对照组管理人员相比，干预组管理人员更经常使用干预课程中教授的领导力/管理工具（+3.64，95% CI 1.98-5.30，P <0.001）。与对照组相比，干预组在自我报告的领导技能方面没有明显差异。在服务提供者中，干预组与对照组相比，所报告的指导和监督的平均质量明显更高（+1.08，95% CI 0.63-1.53，P = 0.001）：领导力与管理培训干预措施提高了中层管理人员对领导力/管理工具的使用率，并使乌干达干预地区与对照地区的医疗服务提供者认为监督质量更高。这些研究结果表明，在 SEARCH-IPT 试验的干预地区，管理人员领导力/管理水平的提高有助于提高 PWH 使用 IPT 的比例。

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The effect of an intervention to promote isoniazid preventive therapy on leadership and management abilities.

Background: Across sub-Saharan Africa, mid-level healthcare managers oversee implementation of national guidelines. It remains unclear whether leadership and management training can improve population health outcomes.

Methods: We sought to evaluate leadership/management skills among district-level health managers in Uganda participating in the SEARCH-IPT randomised trial to promote isoniazid preventive therapy (IPT) for persons with HIV (PWH). The intervention, which led to higher IPT rates, included annual leadership/management training of managers. We conducted a cross-sectional survey assessing leadership/management skills among managers at trial completion. The survey evaluated self-reported use of leadership/management tools and general leadership/management. We conducted a survey among a sample of providers to understand the intervention's impact. Targeted minimum loss-based estimation (TMLE) was used to compare responses between trial arms.

Results: Of 163 managers participating in the SEARCH-IPT trial, 119 (73%) completed the survey. Intervention managers reported more frequent use of leadership/management tools taught in the intervention curriculum than control managers (+3.64, 95% CI 1.98-5.30, P < 0.001). There were no significant differences in self-reported leadership skills in the intervention as compared to the control group. Among providers, the average reported quality of guidance and supervision was significantly higher in intervention vs control districts (+1.08, 95% CI 0.63-1.53, P = 0.001).

Conclusions: A leadership and management training intervention increased the use of leadership/management tools among mid-level managers and resulted in higher perceived quality of supervision among providers in intervention vs control districts in Uganda. These findings suggest improved leadership/management among managers contributed to increased IPT use among PWH in the intervention districts of the SEARCH-IPT trial.

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.