Current Integration of Tuberculosis (TB) and HIV Services in South Africa, 2011

Abstract

SettingPublic Health Facilities in South Africa.ObjectiveTo assess the current integration of TB and HIV services in South Africa, 2011.DesignCross-sectional study of 49 randomly selected health facilities in South Africa. Trained interviewers administered a standardized questionnaire to one staff member responsible for TB and HIV in each facility on aspects of TB/HIV policy, integration and recording and reporting. We calculated and compared descriptive statistics by province and facility type.ResultsOf the 49 health facilities 35 (71%) provided isoniazid preventive therapy (IPT) and 35 (71%) offered antiretroviral therapy (ART). Among assessed sites in February 2011, 2,512 patients were newly diagnosed with HIV infection, of whom 1,913 (76%) were screened for TB symptoms, and 616 of 1,332 (46%) of those screened negative for TB were initiated on IPT. Of 1,072 patients newly registered with TB in February 2011, 144 (13%) were already on ART prior to Tb clinical diagnosis, and 451 (42%) were newly diagnosed with HIV infection. Of those, 84 (19%) were initiated on ART. Primary health clinics were less likely to offer ART compared to district hospitals or community health centers (p<0.001).ConclusionAs of February 2011, integration of TB and HIV services is taking place in public medical facilities in South Africa. Among these services, IPT in people living with HIV and ART in TB patients are the least available.

Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems

“…PEPFAR-supported activities fall within the WHOs’ framework for collaborative TB and HIV activities, including critical interventions to (1) develop organizational methods of collaboration across the two programs, (2) reduce the burden of HIV infection among patients with TB, and (3) reduce the burden of TB among persons with HIV infection or AIDS [41]. A 2010 report showed that PEPFAR and partners made important gains in coverage and scope of HIV testing, referral, and ART for patients with TB, but the authors called for the need to focus on increasing access to isoniazid preventive therapy and strengthening TB infection control in integrated programs [42].…”

“…We know that the quality of care of patients co-infected with TB and HIV can be compromised if health services are not provided in an integrated setting. In a study from a township in South Africa, delays in starting ART among TB patients were almost three times greater for patients who were referred between non-integrated TB services and ART clinics compared to those in whom TB was diagnosed in the ART clinic [41, 43, 44]. Those studies demonstrate the importance of TB/HIV service integration, and how the lack of integration compromises patient care and may even increase risk of mortality.…”

The politics of tuberculosis and HIV service integration in Ghana

“…Recent studies (Kerschberger et al, 2012;Chehab et al, 2013;Ikeda et al, 2014;Uyei et al, 2014) have provided evidence in support of at least the same clinical team delivering TB/HIV diagnosis and treatment services. Although Ghana is not one of the high burden TB/HIV countries in sub-Saharan Africa, the current paradigm in global public health on the effective treatment of TB/HIV makes it imperative to explore contextualised issues surrounding integration of TB/HIV control activities.…”

“…Probably, the apathy towards seamless integration as espoused by the WHO (2004WHO ( , 2012 in the country could be driven by the not-too-high comorbidity burden of the two diseases in the country. In South Africa for instance where the dual burden of TB/HIV is high, integration appears to be catching-up with service despite some inherent challenges (Chehab et al, 2013).…”

An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: results of the MERGE cluster randomised trial

“…This level of integration-co-location of services-was assumed sub-optimal with the one-stop-shop model-a model in which both TB and HIV services are provided by the same provider in the same consultation-considered ideal. [15] In addition, in the sub-district where the trial was implemented, there was an on-going TB/HIV health systems strengthening programme whose main activities were mentoring clinic nurses on ART and training on recording and reporting for TB and HIV. At the time of clinic randomization, South African national HIV treatment guidelines recommended ART for HIV positives with WHO Stage 3 or 4 disease, CD4 count < 200 cells/μl, TB disease or pregnancy with at CD4 counts < 350 cells/μl.…”