title: Antiretroviral treatment among co-infected tuberculosis patients in integrated and non-integrated facilities.
abstract: BACKGROUND
  South Africa has the second worst tuberculosis-human immunodeficiency virus (TB-HIV) syndemic in the world: in 2011, the TB-HIV co-infection rate was estimated at 65%. Integration of TB and HIV health-care services was implemented to increase antiretroviral treatment (ART) uptake among eligible patients.
  
  
  OBJECTIVE
  To evaluate whether integrated TB and HIV facilities had better ART uptake among eligible patients compared to non-integrated facilities.
  
  
  METHODS
  A cross-sectional study using routine TB programme data from January to December 2010. ART eligibility was defined as a CD4+ cell count <350 cells/μl.
  
  
  RESULTS
  Respectively 2761 (86.8%) and 3611 (84.7%) patients were eligible for ART at integrated and non-integrated facilities (P < 0.001). The proportion of patients started on ART at integrated facilities did not differ significantly from that of non-integrated facilities (35.9% vs. 37.1%, P = 0.340), but the proportion with unknown HIV status (31.8% vs. 24.5%, P < 0.001) and unknown CD4+ cell count (40.9% vs. 30.4%, P < 0.001) did.
  
  
  CONCLUSIONS
  Integration of TB and HIV services in the Free State (2009-2010) was not associated with improved ART uptake. The reasons why are not clear. Of concern are the high proportions of unknown HIV status and CD4+ cell count results, especially at integrated facilities, and the small proportion of patients on ART, which may indicate poor implementation of integration.
authors.affiliation: Department of Community Health, University of the Free State, Bloemfontein, South Africa.
authors.forename: T D
authors.initials: TD
authors.lastname: Ledibane
authors.affiliation: Free State Department of Health, Bloemfontein, South Africa.
authors.forename: S C
authors.initials: SC
authors.lastname: Motlhanke
authors.affiliation: Department of Community Health, University of the Free State, Bloemfontein, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Rose
authors.affiliation: Department of Community Health, University of the Free State, Bloemfontein, South Africa.
authors.forename: W H
authors.initials: WH
authors.lastname: Kruger
authors.affiliation: School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
authors.forename: N R T
authors.initials: NR
authors.lastname: Ledibane
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
authors.forename: M M
authors.initials: MM
authors.lastname: Claassens
keywords: ART uptake; HIV; TB; TB-HIV integration