title: The influence of integrated tuberculosis and human immunodeficiency virus service delivery on patient outcomes.
abstract: METHODS
  Public health clinics in Cape Town, South Africa.
  
  
  OBJECTIVE
  To examine the influence of integrated tuberculosis (TB) and human immunodeficiency virus (HIV) service delivery on mortality, TB cure and successful treatment completion and loss to follow-up of TB-HIV co-infected patients on concurrent anti-tuberculosis and antiretroviral treatment (ART).
  
  
  METHODS
  A survey instrument was used to measure the degree to which TB and HIV services were jointly delivered, and patient data were collected retrospectively from clinic sites and the Department of Health. Six domains measuring integrated TB and HIV service delivery were modelled to assess their relationship with patient outcomes.
  
  
  RESULTS
  Two domains, integrated TB and ART service delivery and the delivery of TB and HIV care by one clinical team, were associated with lowered odds of death. Care by the same clinical team was also associated with reduced loss to follow-up.
  
  
  CONCLUSIONS
  Overall, these findings show that the organization and delivery of health services are important factors that influence health outcomes. These findings strongly support efforts by local governments to integrate TB and ART services, and may help to alleviate concerns that restructuring of TB programs could have a negative impact on long-standing gains.
authors.affiliation: School of Medicine, Department of Population Health, Section on Value and Effectiveness, New York University, New York, New York, USA; Department of Nutrition, Food Studies, and Public Health, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Uyei
authors.affiliation: School of Public Health and Family Medicine, Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Coetzee
authors.affiliation: Department of Nutrition, Food Studies, and Public Health, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Macinko
authors.affiliation: Department of Humanities and Social Sciences, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Weinberg
authors.affiliation: Department of Nutrition, Food Studies, and Public Health, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA.
authors.forename: S
authors.initials: S
authors.lastname: Guttmacher
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D011634:Public Health; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents