BACKGROUND: The combined tuberculosis (TB) and HIV epidemics in South Africa (SA) have created enormous operational challenges for a health service that has traditionally run vertical programmes for TB treatment and antiretroviral therapy (ART) in separate facilities. This is particularly problematic for TB/HIV co-infected patients who need to access both services. OBJECTIVE: To determine whether integrated TB facilities had better TB treatment outcomes than single-service facilities in Cape Town, SA. METHODS: TB treatment outcomes were determined for newly registered, adult TB patients (aged > or = 18 years) at 13 integrated ART/TB primary healthcare (PHC) facilities and four single-service PHC facilities from 1 January 2009 to 30 June 2010. A chi2 test adjusted for a cluster sample design was used to compare outcomes by type of facility. RESULTS: Of 13,542 newly registered patients, 10,030 received TB treatment in integrated facilities and 3,512 in single-service facilities. There was no difference in baseline characteristics between the two groups with HIV status determined for 9,351 (93.2%) and 3,227 (91.9%) patients, of whom 6 649 (66.3%) and 2,213 (63%) were HIV-positive in integrated facilities and single-service facilities, respectively. The median CD4+ count of HIV-positive patients was 152 cells/microl (interquartile range (IQR) 71-277) for integrated facilities and 148 cells/microl (IQR 67-260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p = 0.56) or for the sub-set of HIV-positive TB patients (p = 0.58) CONCLUSION: This study did not demonstrate improved TB treatment outcomes in integrated PHC facilities and showed that the provision of ART in the same facility as TB services was not associated with lower TB death and default rates.
BACKGROUND: The combined tuberculosis (TB) and HIV epidemics in South Africa (SA) have created enormous operational challenges for a health service that has traditionally run vertical programmes for TB treatment and antiretroviral therapy (ART) in separate facilities. This is particularly problematic for TB/HIV co-infectedpatients who need to access both services. OBJECTIVE: To determine whether integrated TB facilities had better TB treatment outcomes than single-service facilities in Cape Town, SA. METHODS: TB treatment outcomes were determined for newly registered, adult TB patients (aged > or = 18 years) at 13 integrated ART/TB primary healthcare (PHC) facilities and four single-service PHC facilities from 1 January 2009 to 30 June 2010. A chi2 test adjusted for a cluster sample design was used to compare outcomes by type of facility. RESULTS: Of 13,542 newly registered patients, 10,030 received TB treatment in integrated facilities and 3,512 in single-service facilities. There was no difference in baseline characteristics between the two groups with HIV status determined for 9,351 (93.2%) and 3,227 (91.9%) patients, of whom 6 649 (66.3%) and 2,213 (63%) were HIV-positive in integrated facilities and single-service facilities, respectively. The median CD4+ count of HIV-positive patients was 152 cells/microl (interquartile range (IQR) 71-277) for integrated facilities and 148 cells/microl (IQR 67-260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p = 0.56) or for the sub-set of HIV-positive TB patients (p = 0.58) CONCLUSION: This study did not demonstrate improved TB treatment outcomes in integrated PHC facilities and showed that the provision of ART in the same facility as TB services was not associated with lower TB death and default rates.
Authors: Sarah M Burnett; Stella Zawedde-Muyanja; Sabine M Hermans; Marcia R Weaver; Robert Colebunders; Yukari C Manabe Journal: J Acquir Immune Defic Syndr Date: 2018-12-15 Impact factor: 3.731
Authors: Don Mudzengi; Sedona Sweeney; Piotr Hippner; Tendesayi Kufa; Katherine Fielding; Alison D Grant; Gavin Churchyard; Anna Vassall Journal: Health Policy Plan Date: 2017-11-01 Impact factor: 3.344
Authors: Peter Bock; Karen Jennings; Redwaan Vermaak; Helen Cox; Graeme Meintjes; Geoffrey Fatti; James Kruger; Virginia De Azevedo; Leonard Maschilla; Francoise Louis; Colette Gunst; Nelis Grobbelaar; Rory Dunbar; Mohammed Limbada; Sian Floyd; Ashraf Grimwood; Helen Ayles; Richard Hayes; Sarah Fidler; Nulda Beyers Journal: J Acquir Immune Defic Syndr Date: 2018-01-01 Impact factor: 3.731
Authors: Beth Rachlis; Giorgos Bakoyannis; Philippa Easterbrook; Becky Genberg; Ronald Scott Braithwaite; Craig R Cohen; Elizabeth A Bukusi; Andrew Kambugu; Mwebesa Bosco Bwana; Geoffrey R Somi; Elvin H Geng; Beverly Musick; Constantin T Yiannoutsos; Kara Wools-Kaloustian; Paula Braitstein Journal: PLoS One Date: 2016-08-10 Impact factor: 3.240