title: Integrated tuberculosis and HIV care in a resource-limited setting: experience from the Martin Preuss centre, Malawi.
abstract: OBJECTIVE
  To describe the development and operation of integrated tuberculosis (TB) and HIV care at the Martin Preuss Centre, a multipartner organization bringing together governmental and non-governmental providers of HIV and TB services in Lilongwe, Malawi.
  
  
  METHODS
  We used a case study approach to describe the integrated TB/HIV service and to illustrate successes and challenges faced by service providers. We quantified effective TB and HIV integration using indicators defined by the World Health Organization.
  
  
  RESULTS
  The custom-designed building facilitates patient flow and infection control, and other important elements include coordinated leadership; joint staff training and meetings; and data systems prompting coordinated care. Some integrated services have worked well from the outset, such as promoting HIV testing among patients with TB (96% of patients with TB had documented HIV status in 2009). Other aspects of integrated care have been more challenging, for example achieving high uptake of antiretroviral therapy among HIV-positive TB patients and combining data from paper and electronic systems. Good TB treatment outcomes (>85% cure or completion) have been achieved among both HIV-positive and HIV-negative individuals.
  
  
  CONCLUSIONS
  High-quality integrated services for TB and HIV care can be provided in a resource-limited setting. Lessons learned may be valuable for service providers in other settings of high HIV and TB prevalence.
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi.
authors.forename: S
authors.initials: S
authors.lastname: Phiri
authors.forename: P Y
authors.initials: PY
authors.lastname: Khan
authors.forename: A D
authors.initials: AD
authors.lastname: Grant
authors.forename: D
authors.initials: D
authors.lastname: Gareta
authors.forename: H
authors.initials: H
authors.lastname: Tweya
authors.forename: M
authors.initials: M
authors.lastname: Kalulu
authors.forename: T
authors.initials: T
authors.lastname: Chaweza
authors.forename: L
authors.initials: L
authors.lastname: Mbetewa
authors.forename: H
authors.initials: H
authors.lastname: Kanyerere
authors.forename: R
authors.initials: R
authors.lastname: Weigel
authors.forename: C
authors.initials: C
authors.lastname: Feldacker
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000379:methods*; D019033:Delivery of Health Care, Integrated; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006295:Health Resources; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D014944:World Health Organization