Missed opportunities for accessing HIV care among Tshwane tuberculosis patients under different models of care

G. Louwagie*, B. Girdler-Brown, R. Odendaal, T. Rossouw, S. Johnson, M. Van Der Walt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

OBJECTIVE: To compare access to human immunodeficiency virus (HIV) care for tuberculosis (TB) patients in settings with antiretroviral treatment (ART) and TB care under one roof ('semi-integrated sites') and in settings with geographically separately rendered care in Tshwane, South Africa. METHODS: Historical cohort study of patients registered with TB at 46 TB treatment points, with follow-up until the end of anti-tuberculosis treatment. ART initiation for HIV-positive TB patients was established through linkage of TB register patient identifiers to the electronic ART register. Data analysis entailed univariate and multi-variate competing risk analysis. RESULTS: The records of 636 and 1297 patients for semi-integrated and separate facilities, respectively, were reviewed. Cotrimoxazole prophylactic therapy and recording of CD4 count were lower in semi-integrated than in separate facilities, but the reverse was true for referral to HIV-related care. A higher percentage of patients started ART in the semi-integrated than in the separate facilities (70.5% vs. 44.6%, P < 0.001). In competing risk analysis (with death and lost to follow-up as competing risks), attending a semi-integrated facility (sub-hazard ratio [SHR] 2.49, 95%CI 1.06-5.88) and TB case load > 401 (SHR 1.45, 95%CI 1.04-2.03) were associated with increased ART initiation. CONCLUSIONS: ART and TB treatment under one roof appears to facilitate ART initiation for HIV-positive TB patients.

Original languageEnglish
Pages (from-to)1052-1058
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume16
Issue number8
DOIs
Publication statusPublished - 1 Aug 2012
Externally publishedYes

Keywords

  • Antiretroviral treatment
  • Integration
  • Tuberculosis

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