HIV treatment cascade in tuberculosis patients.
OBJECTIVE
Globally, the number of deaths associated with tuberculosis (TB) and HIV coinfection remains unacceptably high. We review the evidence around the impact of strengthening the HIV treatment cascade in TB patients and explore recent findings about how best to deliver integrated TB/HIV services.


RESULTS
There is clear evidence that the timely provision of antiretroviral therapy (ART) reduces mortality in TB/HIV coinfected adults. Despite this, globally in 2013, only around a third of known HIV-positive TB cases were treated with ART. Although there is some recent evidence exploring the barriers to achieve high coverage of HIV testing and ART initiation in TB patients, our understanding of which factors are most important and how best to address these within different health systems remains incomplete. There are some examples of good practice in the delivery of integrated TB/HIV services to improve the HIV treatment cascade. However, evidence of the impact of such strategies is of relatively low quality for informing integrated TB/HIV programming more broadly. In most settings, there remain barriers to higher-level organizational and functional integration.


CONCLUSIONS
There remains a need for commitment to patient-centred integrated TB/HIV care in countries affected by the dual epidemic. There is a need for better quality evidence around how best to deliver integrated services to strengthen the HIV treatment cascade in TB patients, both at primary healthcare level and within community settings.
aDepartment of Clinical Research bTB Centre, London School of Hygiene and Tropical Medicine, London, UK cAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa dNational Institute for Research in Tuberculosis, Chennai, India.
Richard J
RJ
Lessells
Soumya
S
Swaminathan
Peter
P
Godfrey-Faussett
D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000175:diagnosis* / Q000188:drug therapy*; D003695:Delivery of Health Care / Q000379:methods*; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D014376:Tuberculosis / Q000150:complications*
D044966:Anti-Retroviral Agents