Early lessons from the integration of tuberculosis and HIV services in primary care centers in Lusaka, Zambia.
BACKGROUND
Zambia faces overlapping tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics; however, care for co-infected patients often occurs through separate, vertical programs.


OBJECTIVE
To establish a program to integrate TB and HIV services in Lusaka primary care centers.


METHODS
In collaboration with the Zambian Ministry of Health, TB-HIV integration activities began in December 2005 and were expanded to seven health centers by March 2007. Principal activities included developing staff capacity to manage co-infected patients, implementing HIV testing within TB departments and establishing referral systems between departments.


RESULTS
Using a provider-initiated approach, 2053 TB patients were offered HIV testing. Seventy-seven per cent agreed to be tested; 69% of those tested were HIV-infected. Of these, 59% were enrolled in HIV care. The proportion of antiretroviral treatment (ART) program enrollees who were TB-HIV co-infected increased by 38% after program implementation. The median CD4 count among co-infected patients was 161 cells/microl, with 88% eligible for ART.


CONCLUSIONS
Integration of HIV testing and referral services into urban primary care centers identified many co-infected patients and significantly increased the proportion of TB patients among people accessing HIV care. Ongoing challenges include maximizing the number of patients accepting HIV testing and overcoming barriers to enrollment into HIV care.
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. Jennie.Harris@cidrz.org
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Harris
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Hatwiinda
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Randels
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Kancheya
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Samungole
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Cantrell
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D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D003153:Community Health Services; D015897:Comorbidity; D003695:Delivery of Health Care; D019033:Delivery of Health Care, Integrated; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D009313:National Health Programs; D011320:Primary Health Care / Q000458:organization & administration*; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D015024:Zambia
D019380:Anti-HIV Agents; D000995:Antitubercular Agents