title: Integration of HIV and TB services results in improved TB treatment outcomes and earlier prioritized ART initiation in a large urban HIV clinic in Uganda.
abstract: BACKGROUND
  The World Health Organization recommends that treatment of tuberculosis (TB) in HIV-infected patients should be integrated with HIV care. In December 2008, a separate outdoor-integrated TB/HIV clinic was instituted for attendees of a large urban HIV clinic in Uganda. We sought to evaluate associated TB and HIV treatment outcomes.
  
  
  METHODS
  Routinely collected clinical, pharmacy, and laboratory data were merged with TB clinic data for patients initiating TB treatment in 2009 and with TB register data for patients in 2007. TB treatment outcomes and (timing of) antiretroviral therapy (ART) initiation in ART-naive patients [overall and stratified by CD4+ T cell (CD4) count] in 2007 and 2009 were compared. Nosocomial transmission rates could not be assessed.
  
  
  RESULTS
  Three hundred forty-six patients were initiated on TB treatment in 2007 and 366 in 2009. Median CD4 counts at TB diagnosis did not differ. TB treatment cure or completion increased from 62% to 68%, death or default decreased from 33% to 25% (P < 0.001). Fewer ART-naive TB patients were initiated on ART in 2009 versus 2007 (57% and 66%, P = 0.031), but this decrease was only in patients with CD4 counts >250 cells per cubic millimeter (19% vs. 48%, P = 0.003). More patients were started on ART during TB treatment (94% vs. 78%, P < 0.001). Moreover, the majority were now initiated during intensive phase (60% vs. 23%, P < 0.001).
  
  
  CONCLUSIONS
  Integration of TB and HIV care has led to improved TB treatment outcomes and earlier, prioritized ART initiation. This supports rollout of a fully integrated TB/HIV service delivery model throughout high-prevalence TB and HIV settings.
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda. shermans@idi.co.ug
authors.forename: Sabine M
authors.initials: SM
authors.lastname: Hermans
authors.forename: Barbara
authors.initials: B
authors.lastname: Castelnuovo
authors.forename: Catherine
authors.initials: C
authors.lastname: Katabira
authors.forename: Peter
authors.initials: P
authors.lastname: Mbidde
authors.forename: Joep M A
authors.initials: JM
authors.lastname: Lange
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: Alex
authors.initials: A
authors.lastname: Coutinho
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy*; D014454:Uganda; D014505:Urban Population
chemical_list: D000995:Antitubercular Agents