Missed opportunities for accessing HIV care among Tshwane tuberculosis patients under different models of care.
OBJECTIVE
To compare access to human immunodeficiency virus (HIV) care for tuberculosis (TB) patients in settings with antiretroviral treatment (ART) and TB care under one roof ('semi-integrated sites') and in settings with geographically separately rendered care in Tshwane,  South Africa.


METHODS
Historical cohort study of patients registered with TB at 46 TB treatment points, with follow-up until the end of anti-tuberculosis treatment. ART initiation for HIV-positive TB patients was established through linkage of TB register patient identifiers to the electronic  ART register. Data analysis entailed univariate and multivariate competing risk analysis.


RESULTS
The records of 636 and 1297 patients for semi-integrated and separate facilities, respectively, were reviewed. Cotrimoxazole prophylactic therapy and recording of CD4 count were lower in semi-integrated  than in separate facilities, but the reverse was true for referral to HIV-related care. A higher percentage of patients started ART in the semi-integrated than in the separate facilities (70.5% vs. 44.6%, P < 0.001). In competing risk analysis (with death and lost to follow-up as  competing risks), attending a semi-integrated facility (sub-hazard ratio [SHR] 2.49, 95%CI 1.06-5.88) and TB case load > 401 (SHR 1.45, 95%CI 1.04-2.03) were associated with increased ART initiation.


CONCLUSIONS
ART and TB treatment under one roof appears to facilitate ART  initiation for HIV-positive TB patients.
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa. Goedele.louwagie@up.ac.za
G
G
Louwagie
B
B
Girdler-Brown
R
R
Odendaal
T
T
Rossouw
S
S
Johnson
M
M
Van der Walt
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D060085:Coinfection; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008498:Medical Record Linkage; D017146:Models, Organizational; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents