title: A Bundle of Services Increased Ascertainment of Tuberculosis among HIV-Infected Individuals Enrolled in a HIV Cohort in Rural Sub-Saharan Africa.
abstract: OBJECTIVE
  To report on trends of tuberculosis ascertainment among HIV patients in a rural HIV cohort in Tanzania, and assessing the impact of a bundle of services implemented in December 2012, consisting of three components: (i) integration of HIV and tuberculosis services; (ii) GeneXpert for tuberculosis diagnosis; and (iii) electronic data collection.
  
  
  METHODS
  Retrospective cohort study of patients enrolled in the Kilombero Ulanga Antiretroviral Cohort (KIULARCO), Tanzania.).
  
  
  METHODS
  HIV patients without prior history of tuberculosis enrolled in the KIULARCO cohort between 2005 and 2013 were included.Cox proportional hazard models were used to estimate rates and predictors of tuberculosis ascertainment.
  
  
  RESULTS
  Of 7114 HIV positive patients enrolled, 5123 (72%) had no history of tuberculosis. Of these, 66% were female, median age was 38 years, median baseline CD4+ cell count was 243 cells/µl, and 43% had WHO clinical stage 3 or 4. During follow-up, 421 incident tuberculosis cases were notified with an estimated incidence of 3.6 per 100 person-years (p-y) [95% confidence interval (CI) 3.26-3.97]. The incidence rate varied over time and increased significantly from 2.96 to 43.98 cases per 100 p-y after the introduction of the bundle of services in December 2012. Four independent predictors of tuberculosis ascertainment were identified:poor clinical condition at baseline (Hazard Ratio (HR) 3.89, 95% CI 2.87-5.28), WHO clinical stage 3 or 4 (HR 2.48, 95% CI 1.88-3.26), being antiretroviralnaïve (HR 2.97, 95% CI 2.25-3.94), and registration in 2013 (HR 6.07, 95% CI 4.39-8.38).
  
  
  CONCLUSIONS
  The integration of tuberculosis and HIV services together with comprehensive electronic data collection and use of GeneXpert increased dramatically the ascertainment of tuberculosis in this rural African HIV cohort.
authors.affiliation: Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania.
authors.forename: Frederick
authors.initials: F
authors.lastname: Haraka
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Tracy R
authors.initials: TR
authors.lastname: Glass
authors.affiliation: Ifakara Health Institute, Ifakara, United Republic of Tanzania.
authors.forename: George
authors.initials: G
authors.lastname: Sikalengo
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; Ifakara Health Institute, Ifakara, United Republic of Tanzania.
authors.forename: Anna
authors.initials: A
authors.lastname: Gamell
authors.affiliation: Ifakara Health Institute, Ifakara, United Republic of Tanzania.
authors.forename: Alex
authors.initials: A
authors.lastname: Ntamatungiro
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.affiliation: Department of Infectious Diseases, Bern University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.affiliation: University of Basel, Basel, Switzerland; Division of infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; Ifakara Health Institute, Ifakara, United Republic of Tanzania; ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Letang
mesh_terms: D000328:Adult; D060085:Coinfection / Q000175:diagnosis* / Q000453:epidemiology; D003153:Community Health Services; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012424:Rural Population; D013636:Tanzania; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology