title: Delivering TB/HIV services in Ghana: a comparative study of service delivery models.
abstract: BACKGROUND
  TB and HIV interaction increases TB incidence and HIV adverse outcomes. Integration improves patients' access to comprehensive care. This paper compares the impact of increasing integration on TB/HIV service delivery.
  
  
  METHODS
  Three hospitals with different delivery models were identified and a survey of TB cases registered between June 2007 and December 2008 conducted. HIV screening, co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) uptake for HIV-positive TB patients were compared.
  
  
  RESULTS
  Of the 590 TB patients, 85.9% (507/590) knew their HIV status. HIV screening was highest (98.6% [95%CI: 97.6-99.5%]) at the one-stop shop (OSS) and lowest (72.5% [71.9-73.9%]) at the referral site (RS). CPT was highest [(93.8% [91.0-96.7%]) at the RS and least (74.7% [72.8-76.5%]) at the partially-integrated site (PIS). At the OSS it was 82.3% (80.6-84.0%). ART was highest (59.5% [58.0-61.0%]) at the PIS, and 10.8% (10.4-11.1%) at the RS. No ART records existed at the OSS.
  
  
  CONCLUSIONS
  Increasing integration improved HIV screening but not CPT or ART uptake. There was insufficient evidence to identify the most effective model due to design limitations and health system barriers. More research and training is needed to improve uptake, data completeness and accuracy.
authors: Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK nana_akosua@yahoo.com.
authors: Gloria A
authors: GA
authors: Ansa
authors: Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
authors: John D
authors: JD
authors: Walley
authors: Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
authors: Kamran
authors: K
authors: Siddiqi
authors: Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
authors: Xiaolin
authors: X
authors: Wei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000995:Antitubercular Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006291:Health Policy; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D011634:Public Health; D013997:Time Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D019380:Anti-HIV Agents; D000890:Anti-Infective Agents; D000995:Antitubercular Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Ghana; Indicators; Integration; Service delivery models; TB/HIV