Integrating tuberculosis and HIV care in the primary care setting in South Africa.
BACKGROUND
In many countries including South Africa, the increasing human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have impacted significantly on already weakened public health services. This paper reviews the scope, process and performance of the HIV and TB services in a primary care setting where antiretroviral therapy is provided, in Khayelitsha, South Africa, in order to assess whether there is a need for some form of integration.


METHODS
The scope and process of both services were assessed through observations of the service and individual and group interviews with key persons. The performance was assessed by examining the 2001-2002 reports from the health information system and clinical data.


RESULTS
The TB service is programme oriented to the attainment of an 85% cure rate amongst smear-positive patients while the HIV service has a more holistic approach to the patient with HIV. The TB service is part of a well-established programme that is highly standardized. The HIV service is in the pilot phase. There is a heavy load at both services and there is large degree of cross-referral between the two services. There are lessons that can be learnt from each service. There is an overlap of activities, duplication of services and under-utilization of staff. There are missed opportunities for TB and HIV prevention, diagnosis and management.


CONCLUSIONS
The study suggests that there may be benefits to integrating HIV and TB services. Constraints to this process are discussed.
Coetzee
David
D
Infectious Disease Research Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, South Africa. dcoetzee@cormack.uct.ac.za
Hilderbrand
Katherine
K
Goemaere
Eric
E
Matthys
Francine
F
Boelaert
Marleen
M
D003140:Communicable Disease Control / Q000379:methods / Q000458:organization & administration*; D003376:Counseling; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004196:Disease Outbreaks / Q000517:prevention & control; D015658:HIV Infections / Q000628:therapy*; D006291:Health Policy; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation; D013019:South Africa; D014376:Tuberculosis / Q000628:therapy*