Partner organizations: Indlela, Gauteng Department of Health, and Anova Health Institute
Study objectives:
- To evaluate the effect of behavioural interventions aimed at increasing TB testing at the facility level.
- To assess the use, feasibility, and acceptability of behavioural interventions within routine PHC settings.
Intervention description: This intervention idea stemmed from a Nudgeathon, conducted in collaboration with the Anova Health Institute in October 2024. The target statement for the Nudgeathon was: “Healthcare providers investigating TB among PLHIV at their annual ART clinic visit for VL testing”. The intervention was subsequently refined after feedback sessions with healthcare workers in Sedibeng and Johannesburg districts.
The intervention comprises three complementary visual components designed to increase TB testing among HIV/ART clients at selected public health facilities in Gauteng Province. These include:
- Staff Provider Badges: Clinic staff badges that act as visible cues to prompt and encourage conversations with clients about TB testing, creating subtle opportunities to raise awareness and encourage testing during routine interactions,
- Client File Stickers: These stickers were placed on HIV/ART client folders to prompt healthcare workers to consider and discuss TB testing when reviewing client files, and
- Client-facing posters: These posters displayed the message “Remember to ask your healthcare worker about TB Testing”, which was intended to remind clients to ask about TB testing and encourage conversations with healthcare workers.
Together, these three interventions provided prompts to both healthcare workers and clients, integrating TB testing into routine HIV/ART consultations and encouraging greater attention to TB testing during routine care.
The interventions were developed through a behavioural science and human-centred co-design process facilitated in collaboration with all partners. This co-design process ensured that the interventions were relevant to the local context, included voices of healthcare workers and clients, with buy-in from the Department of Health to support integration of the intervention into existing HIV/ART service delivery and workflows.
Evaluation description: The intervention is being evaluated alongside the Department of Health using a mixed methods approach. The Department of Health programme rolled out the interventions within the selected facilities as part of routine service delivery. We are extracting quantitative data from routine clinic records to assess changes in TB testing among HIV/ART clients before and after implementation of the intervention. We are also conducting qualitative interviews with healthcare workers across Sedibeng and Johannesburg to explore implementation experiences, perceptions of the intervention, and factors influencing its use within participating facilities.
Study site: Healthcare facilities in Johannesburg and Sedibeng districts
Target population:
Inclusion criteria for clients (Quantitative component)
For the quantitative analysis, we are extracting data for the following eligible clients:
- HIV/ART clients attending the selected facilities and eligible for TB screening and testing according to national guidelines
- Clients who have been enrolled in HIV care
Inclusion criteria for healthcare workers (Qualitative component)
- HCWs employed at participating public health facilities in City of Johannesburg and Sedibeng Districts
- HCWs involved in HIV/ART clinical care during the study implementation
- Willingness to provide informed consent to participate in interviews
Sample size: 20 healthcare workers from the 20 sampled primary healthcare facilities
Duration: 9 months
