T D Ledibane1, S C Motlhanke2, A Rose1, W H Kruger1, N R T Ledibane3, M M Claassens4. 1. Department of Community Health, University of the Free State, Bloemfontein, South Africa. 2. Free State Department of Health, Bloemfontein, South Africa. 3. School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa. 4. Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Abstract
BACKGROUND: South Africa has the second worst tuberculosis-human immunodeficiency virus (TB-HIV) syndemic in the world: in 2011, the TB-HIV co-infection rate was estimated at 65%. Integration of TB and HIV health-care services was implemented to increase antiretroviral treatment (ART) uptake among eligible patients. AIM: To evaluate whether integrated TB and HIV facilities had better ART uptake among eligible patients compared to non-integrated facilities. METHODS: A cross-sectional study using routine TB programme data from January to December 2010. ART eligibility was defined as a CD4+ cell count <350 cells/μl. RESULTS: Respectively 2761 (86.8%) and 3611 (84.7%) patients were eligible for ART at integrated and non-integrated facilities (P < 0.001). The proportion of patients started on ART at integrated facilities did not differ significantly from that of non-integrated facilities (35.9% vs. 37.1%, P = 0.340), but the proportion with unknown HIV status (31.8% vs. 24.5%, P < 0.001) and unknown CD4+ cell count (40.9% vs. 30.4%, P < 0.001) did. CONCLUSION: Integration of TB and HIV services in the Free State (2009-2010) was not associated with improved ART uptake. The reasons why are not clear. Of concern are the high proportions of unknown HIV status and CD4+ cell count results, especially at integrated facilities, and the small proportion of patients on ART, which may indicate poor implementation of integration.
BACKGROUND: South Africa has the second worst tuberculosis-human immunodeficiency virus (TB-HIV) syndemic in the world: in 2011, the TB-HIV co-infection rate was estimated at 65%. Integration of TB and HIV health-care services was implemented to increase antiretroviral treatment (ART) uptake among eligible patients. AIM: To evaluate whether integrated TB and HIV facilities had better ART uptake among eligible patients compared to non-integrated facilities. METHODS: A cross-sectional study using routine TB programme data from January to December 2010. ART eligibility was defined as a CD4+ cell count <350 cells/μl. RESULTS: Respectively 2761 (86.8%) and 3611 (84.7%) patients were eligible for ART at integrated and non-integrated facilities (P < 0.001). The proportion of patients started on ART at integrated facilities did not differ significantly from that of non-integrated facilities (35.9% vs. 37.1%, P = 0.340), but the proportion with unknown HIV status (31.8% vs. 24.5%, P < 0.001) and unknown CD4+ cell count (40.9% vs. 30.4%, P < 0.001) did. CONCLUSION: Integration of TB and HIV services in the Free State (2009-2010) was not associated with improved ART uptake. The reasons why are not clear. Of concern are the high proportions of unknown HIV status and CD4+ cell count results, especially at integrated facilities, and the small proportion of patients on ART, which may indicate poor implementation of integration.
Authors: Helena Legido-Quigley; Catherine M Montgomery; Palwasha Khan; Rifat Atun; Ade Fakoya; Haileyesus Getahun; Alison D Grant Journal: Trop Med Int Health Date: 2012-12-10 Impact factor: 2.622
Authors: S Phiri; P Y Khan; A D Grant; D Gareta; H Tweya; M Kalulu; T Chaweza; L Mbetewa; H Kanyerere; R Weigel; C Feldacker Journal: Trop Med Int Health Date: 2011-08-02 Impact factor: 2.622
Authors: David Coetzee; Katherine Hilderbrand; Eric Goemaere; Francine Matthys; Marleen Boelaert Journal: Trop Med Int Health Date: 2004-06 Impact factor: 2.622
Authors: M Gasana; G Vandebriel; G Kabanda; S J Tsiouris; J Justman; R Sahabo; D Kamugundu; W M El-Sadr Journal: Int J Tuberc Lung Dis Date: 2008-03 Impact factor: 2.373
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