Effect of TB/HIV Integration on TB and HIV indicators in Rural Ugandan Health Facilities

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  BURNETT, Sarah M ; ZAWEDDE-MUYANJA, Stella ; HERMANS, Sabine M ; WEAVER, Marcia R ; COLEBUNDERS, Robert ; MANABE, Yukari C
• Description:
  Background
  
  WHO recommends integrating services for patients co-infected with TB and HIV. We assessed the effect of TB/HIV integration on ART initiation and TB treatment outcomes among TB/HIV co-infected patients using data collected from 14 rural health facilities during two previous TB and HIV quality of care studies.
  
  Methods
  
  A facility was considered to have integrated TB/HIV services if TB/HIV patients had combined treatment for both illnesses by one provider or care team at one treatment location. We analyzed the effect of integration by conducting a cross-sectional analysis of integrated and non-integrated facility periods comparing performance on ART initiation and TB treatment outcomes. We conducted logistic regression, with the patient as the unit of analysis, controlling for other intervention effects, adjusting for age and gender, and clustering by health facility.
  
  Results
  
  From January 2012-June 2014, 996 TB patients were registered, 97% were tested for HIV and 404 (42%) were HIV positive. Excluding transfers, 296 patients were eligible for analysis with 117 and 179 from non-integrated and integrated periods, respectively. Being treated in a facility with TB/HIV integration was associated with lower mortality (adjusted odds ratio [aOR]=0.38, 95% confidence interval [CI]=0.18–0.77), but there was no difference in the proportion initiating ART (aOR=1.34, 95% CI=0.40–4.47), with TB treatment success (aOR=1.43, 95% CI=0.73–2.82), lost to follow-up (aOR=1.64, 95% CI=0.53–5.04), or failure (aOR=1.21, 95% CI=0.34–4.32).
  
  Conclusion
  
  TB/HIV service integration was associated with lower mortality during TB treatment even in settings with suboptimal proportions of patients completing TB treatment and starting on ART.
  
  
• Keywords:
  Adult Africa Anti-HIV Agents Anti-retroviral Therapy Initiation Antitubercular Agents Coinfection Cross-Sectional Studies Delivery Of Health Care Female Health Facilities HIV HIV Infections Humans Male Mortality Retrospective Studies Rural Population South Of The Sahara Survival Analysis Treatment Outcome Tuberculosis Tuberculosis/HIV Co-infection Tuberculosis Treatment Outcomes Uganda

  More +
• Source:
  J Acquir Immune Defic Syndr. 79(5):605-611
• Pubmed ID:
  30383587
• Pubmed Central ID:
  PMC6422342
• Document Type:
  Journal Article
• Funding:
  D43 TW009771/TW/FIC NIH HHSUnited States/ ; U01 GH000527/GH/CGH CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/
• Place as Subject:
  Uganda
• Volume:
  79
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1ce49549a41b543fa738ba0cdd60057ccb45b32ad2f7950f89c4515837e6f49d
• Download URL:
  https://stacks.cdc.gov/view/cdc/76961/cdc_76961_DS1.pdf
• File Type:
  [PDF - 335.32 KB ]