title: An integrated approach to improving the availability and utilisation of tuberculosis healthcare in rural South Africa.
abstract: BACKGROUND
  Patients with tuberculosis (TB) face several challenges in accessing care, and an integrated service that includes HIV testing could be preferable for them and ensure timely HIV treatment initiation and optimal TB care.
  
  
  OBJECTIVE
  To investigate factors, including uptake of the offer of HIV testing, associated with availability and utilisation of healthcare by TB patients in a rural programme devolved to primary care in Hlabisa sub-district, KwaZulu-Natal.
  
  
  METHODS
  Three hundred TB patients were randomly selected in a two-stage-sampling scheme with five primary healthcare clinic (PHC) sampling units selected with probability proportional to size. Data were collected using a structured questionnaire. We describe key availability and utilisation factors and analyse factors associated with being offered an HIV test in multiple regressions controlling for sex, age, education, employment and marital status.
  
  
  RESULTS
  Most patients (75.2%) received care for a first episode of TB, mainly pulmonary. Nearly all (94.3%) were offered an HIV test during their current TB treatment episode, patients using their closest clinic being substantially more likely to have been offered HIV testing than those not using their closest clinic (adjusted odds ratio 12.79, p=0.05). About one-fifth (20.3%) of patients did not take medication under observation, and 3.4% reported missing taking their tablets at some stage. Average travelling time to the clinic and back was 2 hours, most patients (56.8%) using minibus taxis.
  
  
  CONCLUSIONS
  We demonstrate high HIV testing rates among TB patients in a rural public programme, suggesting appropriate management of HIV-TB co-infected patients. We describe healthcare availability and utilisation factors that can inform the proposed district management teams for PHC re-engineering on areas needing improvement.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, and School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. nchimbindi@africacentre.ac.za
authors.forename: N Z
authors.initials: NZ
authors.lastname: Chimbindi
authors.forename: T
authors.initials: T
authors.lastname: Bärnighausen
authors.forename: M-L
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000328:Adult; D060085:Coinfection; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D013019:South Africa; D011795:Surveys and Questionnaires; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D055815:Young Adult