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.
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