title: Integration of HIV care into primary care in South Africa: effect on survival of patients needing antiretroviral treatment.
abstract: BACKGROUND
  Integration of HIV care into primary care is a potential strategy to improve access to antiretroviral therapy (ART) in high-burden countries. This study was conducted to determine the effect of integration of HIV care on the survival of patients needing ART.
  
  
  METHODS
  A questionnaire was used to measure the integration of HIV care into primary care during a randomized controlled trial of task shifting and decentralization of HIV care in South Africa. Cox proportional hazard ratios (HRs) were estimated for the effect of 5 different integration scores (total, pre-ART, ART, mainstreaming HIV, and internal integration) on the survival of patients with CD4 count ≤350 cells per microliter and not yet on ART.
  
  
  RESULTS
  A total of 9252 patients were followed up for 12-18 months. Cox proportional HRs adjusted for patient and clinic characteristics showed decreased risk of mortality in clinics with high scores for total integration [HR, 0.97; 95% confidence interval (CI), 0.95 to 0.98; P < 0.001], ART integration (HR, 0.94; 95% CI, 0.90 to 0.99; P = 0.013), and internal integration (HR, 0.97; 95% CI, 0.95 to 1.00; P = 0.041). Analysis of the effect of component scores adjusted for patient characteristics only showed decreased risk of mortality in clinics with high scores for total integration (HR, 0.97; 95% CI, 0.94 to 1.00; P = 0.032), pre-ART integration (HR, 0.92; 95% CI, 0.85 to 0.99; P = 0.027), ART integration (HR, 0.95; 95% CI, 0.93 to 0.98; P = 0.001), and mainstreaming HIV (HR, 0.90; 95% CI, 0.83 to 0.97; P = 0.007).
  
  
  CONCLUSIONS
  In a context of task shifting and decentralization of care, integration of HIV care into primary care is associated with improved survival of HIV-positive patients needing ART.
authors.affiliation: Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa. uebelke@fshealth.gov.za
authors.forename: Kerry E
authors.initials: KE
authors.lastname: Uebel
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.forename: Gina
authors.initials: G
authors.lastname: Joubert
authors.forename: Lara R
authors.initials: LR
authors.lastname: Fairall
authors.forename: Max O
authors.initials: MO
authors.lastname: Bachmann
authors.forename: Willie F
authors.initials: WF
authors.lastname: Mollentze
authors.forename: Dingie
authors.initials: D
authors.lastname: van Rensburg
authors.forename: Edwin
authors.initials: E
authors.lastname: Wouters
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D016016:Proportional Hazards Models; D013019:South Africa; D011795:Surveys and Questionnaires; D013534:Survival; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents