title: Outcomes in HIV-infected adults with tuberculosis at clinics with and without co-located HIV clinics in Botswana.
abstract: METHODS
  Gaborone, Botswana.
  
  
  OBJECTIVE
  To determine if starting anti-tuberculosis treatment at clinics in Gaborone without co-located human immunodeficiency virus (HIV) clinics would delay time to highly active antiretroviral therapy (HAART) initiation and be associated with lower survival compared to starting anti-tuberculosis treatment at clinics with on-site HIV clinics.
  
  
  METHODS
  Retrospective cohort study. Subjects were HAART-naïve, aged ≥ 21 years with pulmonary tuberculosis (TB), HIV and CD4 counts ≤ 250 cells/mm(3) initiating anti-tuberculosis treatment between 2005 and 2010. Survival at completion of anti-tuberculosis treatment or at 6 months post-treatment initiation and time to HAART after anti-tuberculosis treatment initiation were compared by clinic type.
  
  
  RESULTS
  Respectively 259 and 80 patients from clinics without and with on-site HIV facilities qualified for the study. Age, sex, CD4, baseline sputum smears and loss to follow-up rate were similar by clinic type. Mortality did not differ between clinics without or with on-site HIV clinics (20/250, 8.0% vs. 8/79, 10.1%, relative risk 0.79, 95%CI 0.36-1.72), nor did median time to HAART initiation (respectively 63 and 66 days, P = 0.53).
  
  
  CONCLUSIONS
  In urban areas where TB and HIV programs are separate, geographic co-location alone without further integration may not reduce mortality or time to HAART initiation among co-infected patients.
authors.affiliation: New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Schwartz
authors.forename: N
authors.initials: N
authors.lastname: Tamuhla
authors.forename: A P
authors.initials: AP
authors.lastname: Steenhoff
authors.forename: K
authors.initials: K
authors.lastname: Nkakana
authors.forename: R
authors.initials: R
authors.lastname: Letlhogile
authors.forename: T R
authors.initials: TR
authors.lastname: Chadborn
authors.forename: M
authors.initials: M
authors.lastname: Kestler
authors.forename: N M
authors.initials: NM
authors.lastname: Zetola
authors.forename: S
authors.initials: S
authors.lastname: Ravimohan
authors.forename: G P
authors.initials: GP
authors.lastname: Bisson
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001902:Botswana / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D019037:Urban Health Services / Q000458:organization & administration; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents
references.citation: Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):1034-8
references.pmid: 8887603
references.citation: Trop Med Int Health. 2011 Aug;16(8):981-7
references.pmid: 21585625
references.citation: JAMA. 2008 Aug 6;300(5):530-9
references.pmid: 18677025
references.citation: N Engl J Med. 2011 Oct 20;365(16):1482-91
references.pmid: 22010914
references.citation: AIDS. 1997 Mar 15;11(4):455-60
references.pmid: 9084792
references.citation: Trop Med Int Health. 2008 Jul;13(7):904-13
references.pmid: 18466183
references.citation: Am J Respir Crit Care Med. 1999 Mar;159(3):733-40
references.pmid: 10051244
references.citation: AIDS. 2004 Sep 24;18(14):1933-41
references.pmid: 15353979
references.citation: N Engl J Med. 2011 Oct 20;365(16):1492-501
references.pmid: 22010915
references.citation: J Acquir Immune Defic Syndr. 2011 Jun 1;57(2):136-40
references.pmid: 21436714
references.citation: J Acquir Immune Defic Syndr. 2011 Nov 1;58(3):269-76
references.pmid: 21876447
references.citation: Southeast Asian J Trop Med Public Health. 2007 Nov;38(6):1053-60
references.pmid: 18613546
references.citation: Int J Tuberc Lung Dis. 2001 Mar;5(3):225-32
references.pmid: 11326821
references.citation: PLoS One. 2011;6(6):e20755
references.pmid: 21738585
references.citation: PLoS One. 2011 Feb 28;6(2):e16946
references.pmid: 21386993
references.citation: N Engl J Med. 2010 Feb 25;362(8):697-706
references.pmid: 20181971
references.citation: N Engl J Med. 2011 Oct 20;365(16):1471-81
references.pmid: 22010913
references.citation: Clin Infect Dis. 2010 May 15;50 Suppl 3:S238-44
references.pmid: 20397954