Integrating tuberculosis and HIV services in low‐ and middle‐income countries: a systematic review

Objectives Given the imperative to scale up integrated tuberculosis (TB) and HIV services in settings where both are of major public health importance, we aimed to synthesise knowledge concerning implementation of TB/HIV service integration. Methods Systematic review of studies describing a strategy to facilitate TB and HIV service integration, searching 15 bibliographic databases including Medline, Embase and the Cochrane library; and relevant conference s. Results Sixty‐three of 1936 peer‐reviewed articles and 70 of 170 s met our inclusion criteria. We identified five models: entry via TB service, with referral for HIV testing and care; entry via TB service, on‐site HIV testing, and referral for HIV care; entry via HIV service with referral for TB screening and treatment; entry via HIV service, on‐site TB screening, and referral for TB diagnosis and treatment; and TB and HIV services provided at a single facility. Referral‐based models are most easily implemented, but referral failure is a key risk. Closer integration requires more staff training and additional infrastructure (e.g. private space for HIV counselling; integrated records). Infection control is a major concern. More integrated models hold potential efficiencies from both provider and user perspective. Most papers report ‘outcomes’ (e.g. proportion of TB patients tested for HIV); few report downstream ‘impacts’ such as outcomes of TB treatment or antiretroviral therapy. Very few studies address the perspectives of service users or staff, or costs or cost‐effectiveness. Conclusions While scaling up integrated services, robust comparisons of the impacts of different models are needed using standardised outcome measures. Intégration des services de tuberculose et VIH dans les pays à faibles et moyens revenus: une revue systématique Objectifs Compte tenu de l'impératif du déploiement des services intégrés de la tuberculose (TB) et du VIH dans les contextes où les deux sont d'une importance majeure de santé publique, nous avons cherché à synthétiser les connaissances en matière d'intégration des services TB/VIH. Méthodes Revue systématique des études décrivant une stratégie visant à faciliter l'intégration des services TB et VIH, recherchant dans 15 bases de données bibliographiques dont Medline, Embase et la Bibliothèque Cochrane, et des résumés de conférences pertinents. Résultats 63/1936 articles publiés et 70/170 résumés répondaient à nos critères d'inclusion. Nous avons identifié cinq modèles