title: Efficacy of a new model for delivering integrated TB and HIV services for people living with HIV/AIDS in Delhi -- case for a paradigm shift in national HIV/TB cross-referral strategy.
abstract: Under National TB/HIV framework, all TB patients are referred by Revised National Tuberculosis Programme (RNTCP) service providers to Integrated Counseling and Testing Centers (ICTCs) for voluntary counseling and testing (C&T) and ICTC "TB-suspects" are referred to RNTCP facilities for TB diagnosis and treatment. HIV-TB coinfected patients are then referred to Anti Retroviral Treatment (ART) center for initiation of ART between two weeks and two months of initiating TB treatment. During the third phase of National AIDS Control Programme (NACP-III, April 2007-April 2012), 30749/130503 (23.6%) TB/HIV cross-referrals were lost to follow up (LTFU) and there was missed opportunity for 940/1884 (49.9%) HIV-TB coinfected patients for initiation of ART during TB treatment. This motivated Delhi State AIDS Control Society (DSACS) and State TB Cell (STC) to revise existing cross-referral strategy. The new strategy was launched in May 2012, wherein HIV-TB coinfected and HIV-positive "TB-suspects" were referred to nearest ART center for HIV care and investigations of TB at Chest Clinic/Designated Microscopy Centre (DMC) located within the same hospital instead of referral to area RNTCP facility. Outcome of the strategy was evaluated in March 2013. The new HIV-TB cross-referral strategy in Delhi has shown advantage over national strategy: first, improved retention of coinfected clients in HIV care; second, ensured timely initiation of TB-treatment and ART; and third, significantly improved survival of HIV-TB coinfected patients.
authors.affiliation: a Department of Health & Family Welfare, Delhi State AIDS Control Society , Government of Delhi , New Delhi , India.
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Gupta
authors.forename: Girraj Pratap
authors.initials: GP
authors.lastname: Singh
authors.forename: Sudha
authors.initials: S
authors.lastname: Goel
authors.forename: Pratap Bhan
authors.initials: PB
authors.lastname: Kaushik
authors.forename: Bipin Chandra
authors.initials: BC
authors.lastname: Joshi
authors.forename: Sabyasachi
authors.initials: S
authors.lastname: Chakraborty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D003153:Community Health Services / Q000458:organization & administration*; D003376:Counseling; D005260:Female; D006078:Government Programs / Q000458:organization & administration; D015658:HIV Infections / Q000401:mortality / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015397:Program Evaluation; D012017:Referral and Consultation; D014376:Tuberculosis / Q000401:mortality / Q000628:therapy*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents