Integrating HIV/TB care in Uganda improves ART start, TB outcomes
Integrating care of tuberculosis and HIV infection, as recommended by the World Health Organization (WHO), improved TB treatment outcomes and antiretroviral therapy (ART) initiation in a 712-person comparison in an urban Ugandan HIV clinic.
Sub-Saharan Africa shoulders 80% of the world’s HIV/TB
coinfection burden. To ease this burden, WHO formulated a
strategic framework for collaborative TB/HIV care (click on
link below).
In December 2008 an outdoor integrated HIV/TB clinic began
operation at a large HIV clinic in Kampala, Uganda. This study
aimed to compare TB and HIV treatment outcomes before and
after the integrated clinic opened its doors. To do so,
researchers merged clinical, pharmacy, and lab data with (1)
TB clinic data for patients who began TB therapy in 2009 and
(2) TB register data for patients who started therapy in
2007.
The analysis focused on 346 people who began TB treatment in
2007 and 366 who started in 2009. Median CD4 count at TB
diagnosis did not differ significantly between the two groups.
From 2007 to 2009, TB treatment cure or completion rates rose
from 62% to 68%, while death or default (dropout) rates fell
from 33% to 25% (P < 0.001).
Fewer antiretroviral-naive TB patients started ART in 2009
than in 2007 (57% versus 66%, P = 0.031). But people
with a CD4 count above 250 cells/µL accounted for this
lower rate (19% versus 48%, P = 0.003).
Compared with 2007, more people started ART during TB
treatment in 2009 (94% versus 78%, P < 0.001). And
more people in 2009 than in 2007 started ART during the
intensive phase of TB therapy (60% versus 23%, P <
0.001).
“Complete integration of TB and HIV care in our urban
HIV clinic contributed to an increase in the proportion of
patients who completed TB treatment alive and to a decrease in
treatment default,” the authors conclude.
“It also led to earlier and more prioritized ART
initiation in ART-naive HIV-infected patients diagnosed with
TB with a decrease in the time to initiation of ART,
especially in patients with a CD4 count <100 cells per
cubic millimeter who are most likely to benefit from timely
ART initiation.”
These researchers believe their findings “support the
rollout of a fully integrated TB/HIV service delivery model
throughout high prevalence TB and HIV settings.”
Source:
Sabine M. Hermans, Barbara Castelnuovo, Catherine Katabira,
Peter Mbidde, Joep M.A. Lange, Andy I.M. Hoepelman, Alex
Coutinho, Yukari C. Manabe. Integration of HIV and TB services
results in improved TB treatment outcomes and earlier
prioritized ART initiation in a large urban HIV clinic in
Uganda. JAIDS. 2012; 60: e29-e35.
For the complete article
For the WHO policy on collaborative TB/HIV activities
IAS
http://www.iasociety.org/Default.aspx?pageId=5&elementId=14546
