Clinical Guidelines for Managing Hearing Loss as a Complication of Drug-Resistant Tuberculosis Treatment: An Evaluation of Implementation fidelity in Kano, Nigeria

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Abstract Background: Nigeria has a high burden of Tuberculosis (TB) including Drug-resistant Tuberculosis (DR-TB) and hearing lossObjective: To measure the implementation fidelity of management guidelines for hearing loss resulting from DR-TB treatment and to identify its determinants Method: A questionnaire-based cross-sectional study was conducted at the Infectious Disease Hospital, Kano. Implementation fidelity of the Programmatic Management guidelines for the treatment of Drug-resistant Tuberculosis was measured under the four domains of content, coverage, duration and frequency. The determinants examined are intervention complexity, facilitation strategies, quality of delivery and participant responsiveness as proposed by the Carroll et al framework. Other determinants used are age, sex, professional cadre and work experience of healthcare providers.Results: The Implementation fidelity score ranged from 40 - 64% with a mean of 47.6%. Quality of delivery, intervention complexity, participants’ responsiveness, and being a medical doctor exerted a positive effect on implementation fidelity while facilitation strategy, age and work experience exerted a negative effect on implementation fidelity. Conclusion: The implementation fidelity of management guidelines for hearing loss resulting from DR-TB treatment was low. Implementation fidelity should be assessed early and at intervals in the course of implementing the PMDT guideline and indeed, in the implementation of any intervention.

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