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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The Effect of Complete Integration of HIV and TB Services on Time to Initiation of Antiretroviral Therapy: A Before-After Study
PLoS ONE, Volume 7, No. 10, Article e46988, Year 2012
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Description
Background: Studies have shown that early ART initiation in TB/HIV co-infected patients lowers mortality. One way to implement earlier ART commencement could be through integration of TB and HIV services, a more efficient model of care than separate, vertical programs. We present a model of full TB/HIV integration and estimate its effect on time to initiation of ART. Methodology/Principal Findings: We retrospectively reviewed TB registers and clinical notes of 209 TB/HIV co-infected adults with a CD4 count <250 cells/μl and registered for TB treatment at one primary care clinic in a South African township between June 2008 and May 2009. Using Kaplan-Meier and Cox proportional hazard analysis, we compared time between initiation of TB treatment and ART for the periods before and after full, "one-stop shop" integration of TB and HIV services (in December 2009). Potential confounders were determined a priori through directed acyclic graphs. Robustness of assumptions was investigated by sensitivity analyses. The analysis included 188 patients (100 pre- and 88 post-integration), yielding 56 person-years of observation. Baseline characteristics of the two groups were similar. Median time to ART initiation decreased from 147 days (95% confidence interval [CI] 85-188) before integration of services to 75 days (95% CI 52-119) post-integration. In adjusted analyses, patients attending the clinic post-integration were 1.60 times (95% CI 1.11-2.29) more likely to have started ART relative to the pre-integration period. Sensitivity analyses supported these findings. Conclusions/Significance: Full TB/HIV care integration is feasible and led to a 60% increased chance of co-infected patients starting ART, while reducing time to ART initiation by an average of 72 days. Although these estimates should be confirmed through larger studies, they suggest that scale-up of full TB/HIV service integration in high TB/HIV prevalence settings may shorten time to ART initiation, which might reduce excess mortality and morbidity. © 2012 Kerschberger et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3465310/bin/pone.0046988.s001.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3465310/bin/pone.0046988.s002.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3465310/bin/pone.0046988.s003.pdf
Authors & Co-Authors
Kerschberger, Bernhard
Switzerland, Geneva
Medecins Sans Frontieres
Hilderbrand, Katherine
Switzerland, Geneva
Medecins Sans Frontieres
South Africa, Cape Town
Faculty of Health Sciences
Boulle, Andrew
South Africa, Cape Town
Faculty of Health Sciences
Coetzee, David John
South Africa, Cape Town
Faculty of Health Sciences
Goemaere, Eric
South Africa, Johannesburg
South African Medical Unit
de Azevedo, Virginia
South Africa, Cape Town
City of Cape Town
Van Cutsem, Gilles
Switzerland, Geneva
Medecins Sans Frontieres
South Africa, Cape Town
Faculty of Health Sciences
Statistics
Citations: 62
Authors: 7
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pone.0046988
e-ISSN:
19326203
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study