The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.

<h4>Background</h4>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...

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Autores principales:	Bernhard Kerschberger, Katherine Hilderbrand, Andrew M Boulle, David Coetzee, Eric Goemaere, Virginia De Azevedo, Gilles Van Cutsem
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/027cb82c4e3d482ead8452c79c8e7370
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spelling	oai:doaj.org-article:027cb82c4e3d482ead8452c79c8e73702021-11-18T08:13:01ZThe effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.1932-620310.1371/journal.pone.0046988https://doaj.org/article/027cb82c4e3d482ead8452c79c8e73702012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23071690/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methodology/principal findings</h4>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.<h4>Conclusions/significance</h4>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.Bernhard KerschbergerKatherine HilderbrandAndrew M BoulleDavid CoetzeeEric GoemaereVirginia De AzevedoGilles Van CutsemPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 10, p e46988 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bernhard Kerschberger Katherine Hilderbrand Andrew M Boulle David Coetzee Eric Goemaere Virginia De Azevedo Gilles Van Cutsem The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.
description	<h4>Background</h4>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.<h4>Methodology/principal findings</h4>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.<h4>Conclusions/significance</h4>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.
format	article
author	Bernhard Kerschberger Katherine Hilderbrand Andrew M Boulle David Coetzee Eric Goemaere Virginia De Azevedo Gilles Van Cutsem
author_facet	Bernhard Kerschberger Katherine Hilderbrand Andrew M Boulle David Coetzee Eric Goemaere Virginia De Azevedo Gilles Van Cutsem
author_sort	Bernhard Kerschberger
title	The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.
title_short	The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.
title_full	The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.
title_fullStr	The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.
title_full_unstemmed	The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.
title_sort	effect of complete integration of hiv and tb services on time to initiation of antiretroviral therapy: a before-after study.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/027cb82c4e3d482ead8452c79c8e7370
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The effect of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before-after study.

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