Linkage to care and treatment for TB and HIV among people newly diagnosed with TB or HIV-associated TB at a large, inner city South African hospital
To assess the outcomes of linkage to TB and HIV care and identify risk factors for poor referral outcomes. Cohort study of TB patients diagnosed at an urban hospital. Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to...
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| Veröffentlicht in: | PloS one 2013-01, Vol.8 (1), p.e49140-e49140 |
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| creator | Voss De Lima, Yara Evans, Denise Page-Shipp, Liesl Barnard, Antonia Sanne, Ian Menezes, Colin N Van Rie, Annelies |
| description | To assess the outcomes of linkage to TB and HIV care and identify risk factors for poor referral outcomes.
Cohort study of TB patients diagnosed at an urban hospital.
Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to care, delayed linkage to care (>7 days for TB treatment, >30 days for HIV care), or failed linkage to care. We performed log-binomial regression to identify patient and referral characteristics associated with poor referral outcomes.
Among 593 TB patients, 23% failed linkage to TB treatment and 30.3% of the 77.0% who linked to care arrived late. Among 486 (86.9%) HIV-infected TB patients, 38.3% failed linkage to HIV care, and 32% of the 61.7% who linked to care presented late. One in six HIV-infected patients failed linkage to both TB and HIV care. Only 20.2% of HIV-infected patients were referred to a single clinic for integrated care. A referral letter was present in 90.3%, but only 23.7% included HIV status and 18.8% CD4 cell count. Lack of education (RR 1.85) and low CD4 count (CD4≤50 vs. >250cells/mm(3); RR 1.66) were associated with failed linkage to TB care. Risk factors for failed linkage to HIV care were antiretroviral-naïve status (RR 1.29), and absence of referral letter with HIV or CD4 cell count (RR1.23).
Linkage to TB/HIV care should be strengthened by communication of HIV and CD4 results, ART initiation during hospitalization and TB/HIV integration at primary care. |
| doi_str_mv | 10.1371/journal.pone.0049140 |
| format | Article |
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Cohort study of TB patients diagnosed at an urban hospital.
Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to care, delayed linkage to care (>7 days for TB treatment, >30 days for HIV care), or failed linkage to care. We performed log-binomial regression to identify patient and referral characteristics associated with poor referral outcomes.
Among 593 TB patients, 23% failed linkage to TB treatment and 30.3% of the 77.0% who linked to care arrived late. Among 486 (86.9%) HIV-infected TB patients, 38.3% failed linkage to HIV care, and 32% of the 61.7% who linked to care presented late. One in six HIV-infected patients failed linkage to both TB and HIV care. Only 20.2% of HIV-infected patients were referred to a single clinic for integrated care. A referral letter was present in 90.3%, but only 23.7% included HIV status and 18.8% CD4 cell count. Lack of education (RR 1.85) and low CD4 count (CD4≤50 vs. >250cells/mm(3); RR 1.66) were associated with failed linkage to TB care. Risk factors for failed linkage to HIV care were antiretroviral-naïve status (RR 1.29), and absence of referral letter with HIV or CD4 cell count (RR1.23).
Linkage to TB/HIV care should be strengthened by communication of HIV and CD4 results, ART initiation during hospitalization and TB/HIV integration at primary care.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0049140</identifier><identifier>PMID: 23341869</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Antiretroviral agents ; Antiretroviral drugs ; CD4 antigen ; Default ; Demography ; Drug therapy ; Epidemiology ; Evidence-based medicine ; Female ; Health aspects ; Health care ; Health risks ; Health sciences ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV patients ; Hospitals ; Hospitals, Urban - statistics & numerical data ; Human immunodeficiency virus ; Humans ; Inner city ; Laboratories ; Male ; Medical diagnosis ; Medical research ; Medicine ; Patient Care - statistics & numerical data ; Patients ; Referral and Consultation ; Risk analysis ; Risk Factors ; South Africa - epidemiology ; Studies ; Treatment Outcome ; Tuberculosis ; Tuberculosis - complications ; Tuberculosis - diagnosis ; Tuberculosis - drug therapy ; Tuberculosis - epidemiology</subject><ispartof>PloS one, 2013-01, Vol.8 (1), p.e49140-e49140</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Voss De Lima et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Voss De Lima et al 2013 Voss De Lima et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-f705c430e7b3ab894a13dc1097e8125e2de6b273ff96905fb92e1f0a32848a753</citedby><cites>FETCH-LOGICAL-c692t-f705c430e7b3ab894a13dc1097e8125e2de6b273ff96905fb92e1f0a32848a753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547004/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547004/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23341869$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Vermund, Sten H.</contributor><creatorcontrib>Voss De Lima, Yara</creatorcontrib><creatorcontrib>Evans, Denise</creatorcontrib><creatorcontrib>Page-Shipp, Liesl</creatorcontrib><creatorcontrib>Barnard, Antonia</creatorcontrib><creatorcontrib>Sanne, Ian</creatorcontrib><creatorcontrib>Menezes, Colin N</creatorcontrib><creatorcontrib>Van Rie, Annelies</creatorcontrib><title>Linkage to care and treatment for TB and HIV among people newly diagnosed with TB or HIV-associated TB at a large, inner city South African hospital</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>To assess the outcomes of linkage to TB and HIV care and identify risk factors for poor referral outcomes.
Cohort study of TB patients diagnosed at an urban hospital.
Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to care, delayed linkage to care (>7 days for TB treatment, >30 days for HIV care), or failed linkage to care. We performed log-binomial regression to identify patient and referral characteristics associated with poor referral outcomes.
Among 593 TB patients, 23% failed linkage to TB treatment and 30.3% of the 77.0% who linked to care arrived late. Among 486 (86.9%) HIV-infected TB patients, 38.3% failed linkage to HIV care, and 32% of the 61.7% who linked to care presented late. One in six HIV-infected patients failed linkage to both TB and HIV care. Only 20.2% of HIV-infected patients were referred to a single clinic for integrated care. A referral letter was present in 90.3%, but only 23.7% included HIV status and 18.8% CD4 cell count. Lack of education (RR 1.85) and low CD4 count (CD4≤50 vs. >250cells/mm(3); RR 1.66) were associated with failed linkage to TB care. Risk factors for failed linkage to HIV care were antiretroviral-naïve status (RR 1.29), and absence of referral letter with HIV or CD4 cell count (RR1.23).
Linkage to TB/HIV care should be strengthened by communication of HIV and CD4 results, ART initiation during hospitalization and TB/HIV integration at primary care.</description><subject>Adult</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>CD4 antigen</subject><subject>Default</subject><subject>Demography</subject><subject>Drug therapy</subject><subject>Epidemiology</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Health risks</subject><subject>Health sciences</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV patients</subject><subject>Hospitals</subject><subject>Hospitals, Urban - statistics & numerical data</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Inner city</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Patient Care - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Voss De Lima, Yara</au><au>Evans, Denise</au><au>Page-Shipp, Liesl</au><au>Barnard, Antonia</au><au>Sanne, Ian</au><au>Menezes, Colin N</au><au>Van Rie, Annelies</au><au>Vermund, Sten H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Linkage to care and treatment for TB and HIV among people newly diagnosed with TB or HIV-associated TB at a large, inner city South African hospital</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-01-16</date><risdate>2013</risdate><volume>8</volume><issue>1</issue><spage>e49140</spage><epage>e49140</epage><pages>e49140-e49140</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>To assess the outcomes of linkage to TB and HIV care and identify risk factors for poor referral outcomes.
Cohort study of TB patients diagnosed at an urban hospital.
Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to care, delayed linkage to care (>7 days for TB treatment, >30 days for HIV care), or failed linkage to care. We performed log-binomial regression to identify patient and referral characteristics associated with poor referral outcomes.
Among 593 TB patients, 23% failed linkage to TB treatment and 30.3% of the 77.0% who linked to care arrived late. Among 486 (86.9%) HIV-infected TB patients, 38.3% failed linkage to HIV care, and 32% of the 61.7% who linked to care presented late. One in six HIV-infected patients failed linkage to both TB and HIV care. Only 20.2% of HIV-infected patients were referred to a single clinic for integrated care. A referral letter was present in 90.3%, but only 23.7% included HIV status and 18.8% CD4 cell count. Lack of education (RR 1.85) and low CD4 count (CD4≤50 vs. >250cells/mm(3); RR 1.66) were associated with failed linkage to TB care. Risk factors for failed linkage to HIV care were antiretroviral-naïve status (RR 1.29), and absence of referral letter with HIV or CD4 cell count (RR1.23).
Linkage to TB/HIV care should be strengthened by communication of HIV and CD4 results, ART initiation during hospitalization and TB/HIV integration at primary care.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23341869</pmid><doi>10.1371/journal.pone.0049140</doi><tpages>e49140</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Antiretroviral agents Antiretroviral drugs CD4 antigen Default Demography Drug therapy Epidemiology Evidence-based medicine Female Health aspects Health care Health risks Health sciences HIV HIV Infections - complications HIV Infections - drug therapy HIV Infections - epidemiology HIV patients Hospitals Hospitals, Urban - statistics & numerical data Human immunodeficiency virus Humans Inner city Laboratories Male Medical diagnosis Medical research Medicine Patient Care - statistics & numerical data Patients Referral and Consultation Risk analysis Risk Factors South Africa - epidemiology Studies Treatment Outcome Tuberculosis Tuberculosis - complications Tuberculosis - diagnosis Tuberculosis - drug therapy Tuberculosis - epidemiology |
| title | Linkage to care and treatment for TB and HIV among people newly diagnosed with TB or HIV-associated TB at a large, inner city South African hospital |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T16%3A07%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Linkage%20to%20care%20and%20treatment%20for%20TB%20and%20HIV%20among%20people%20newly%20diagnosed%20with%20TB%20or%20HIV-associated%20TB%20at%20a%20large,%20inner%20city%20South%20African%20hospital&rft.jtitle=PloS%20one&rft.au=Voss%20De%20Lima,%20Yara&rft.date=2013-01-16&rft.volume=8&rft.issue=1&rft.spage=e49140&rft.epage=e49140&rft.pages=e49140-e49140&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0049140&rft_dat=%3Cgale_plos_%3EA478255962%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1327244875&rft_id=info:pmid/23341869&rft_galeid=A478255962&rft_doaj_id=oai_doaj_org_article_9ba28670143942fe8d1ad8ba83fd6fc8&rfr_iscdi=true |