title: Integration of TB-HIV services at an ANC facility in Frances Baard District, Northern Cape, South Africa.
abstract: BACKGROUND
  Integrated tuberculosis-human immunodeficiency virus (TB-HIV) service delivery as part of maternal health services, including antenatal care (ANC), is widely recommended. This study assessed the implementation of collaborative TB-HIV service delivery at a hospital-based ANC service unit.
  
  
  METHODS
  A record review of a random sample of 308 pregnant women attending the ANC service between April 2011 and February 2012 was conducted. Data were extracted from registers and patient case notes. Outcomes included the proportion of women who underwent HIV counselling and testing (HCT), CD4 count testing, antiretroviral treatment (ART), cotrimoxazole preventive treatment (CPT), TB screening and isoniazid preventive treatment (IPT). Analysis measured variations in patient characteristics associated with service delivery.
  
  
  RESULTS
  All women underwent HCT; 80% of those who tested HIV-positive were screened for TB. Most (85.9%) of the HIV-positive women received a CD4 count. However, only 12.9% of eligible women received ART prophylaxis onsite, only 35.7% were referred for initiation of ART, only 42.3% commenced IPT and none received CPT or further investigations for TB. HIV-negative women had 2.6 higher odds (95%CI 1.3-5.3) of receiving TB screening than their HIV-positive counterparts.
  
  
  CONCLUSIONS
  Although the identification of HIV-positive women and TB suspects was adequate, implementation of other TB-HIV collaborative activities was sub-optimal.
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom ; Tuberculosis Epidemiology & Intervention Unit, Medical Research Council South Africa, Pretoria, South Africa.
authors.forename: J A
authors.initials: JA
authors.lastname: Peters
authors.affiliation: Centre for Health System Research & Development, University of the Free State, Bloemfontein, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Heunis
authors.affiliation: Centre for Health System Research & Development, University of the Free State, Bloemfontein, South Africa.
authors.forename: G
authors.initials: G
authors.lastname: Kigozi
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Osoba
authors.affiliation: Tuberculosis Epidemiology & Intervention Unit, Medical Research Council South Africa, Pretoria, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: van der Walt
keywords: CD4 count testing; HIV counselling and testing; TB screening; antiretroviral treatment; cotrimoxazole preventive treatment; isoniazid preventive treatment