title: Provider-initiated HIV testing increases access of patients with HIV-associated tuberculosis to antiretroviral treatment.
abstract: BACKGROUND
  Timely initiation of antiretroviral treatment (ART) is a critical component of the case management of patients with HIV-associated tuberculosis (TB) and advanced immunodeficiency. We sought to determine the impact of the introduction of provider-initiated HIV-testing in TB clinics in 2005 on subsequent referrals of patients with HIV-associated TB at a community-based ART service in Cape Town.
  
  
  METHODS
  Retrospective analysis of an ART cohort database (2002 - 2008) stratified by calendar periods.
  
  
  RESULTS
  Between 2002 and 2008, 3 770 ART-naive adults enrolled in the ART service. Overall, 27.4% of these patients had been referred from TB clinics with a diagnosis of HIV-associated TB. This proportion increased from 16.0% of referrals in the period 2002 - 2005 prior to the introduction of provider-initiated HIV testing, to 34.7% in 2007 - 2008 (p<0.001). The median duration of TB treatment completed prior to referral decreased from 3 months to 1 month (p<0.001) and patients enrolled with higher median CD4 cell counts (71 cells/microl v. 95 cells/microl; p<0.001). Moreover, the proportion with recurrent TB epiSodes decreased from 8.6% to 3.2% (p<0.001).
  
  
  CONCLUSIONS
  Introduction of provider-initiated HIV testing by the TB control programme was temporally associated with a major increase in referrals of patients with HIV-associated TB to this ART service, a progressive decline in referral delay, improvements in baseline CD4 cell counts, and fewer recurrent TB episodes. Such trends are likely to be associated with improved survival, and these data strongly support this HIV-testing strategy.
authors.affiliation: The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town. stevelawn@yahoo.co.uk
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
authors.forename: Anna
authors.initials: A
authors.lastname: Fraenzel
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
authors.forename: Judy
authors.initials: J
authors.lastname: Caldwell
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000458:organization & administration; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications*
chemical_list: D044966:Anti-Retroviral Agents