Integration of HIV and TB Services Results in Improved TB Treatment Outcomes and Earlier Prioritized ART Initiation in a Large Urban HIV Clinic in Uganda
BACKGROUND:The World Health Organization recommends that treatment of tuberculosis (TB) in HIV-infected patients should be integrated with HIV care. In December 2008, a separate outdoor-integrated TB/HIV clinic was instituted for attendees of a large urban HIV clinic in Uganda. We sought to evaluate...
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| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2012-06, Vol.60 (2), p.e29-e35 |
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| container_title | Journal of acquired immune deficiency syndromes (1999) |
| container_volume | 60 |
| creator | Hermans, Sabine M Castelnuovo, Barbara Katabira, Catherine Mbidde, Peter Lange, Joep M A Hoepelman, Andy I M Coutinho, Alex Manabe, Yukari C |
| description | BACKGROUND:The World Health Organization recommends that treatment of tuberculosis (TB) in HIV-infected patients should be integrated with HIV care. In December 2008, a separate outdoor-integrated TB/HIV clinic was instituted for attendees of a large urban HIV clinic in Uganda. We sought to evaluate associated TB and HIV treatment outcomes.
METHODS:Routinely collected clinical, pharmacy, and laboratory data were merged with TB clinic data for patients initiating TB treatment in 2009 and with TB register data for patients in 2007. TB treatment outcomes and (timing of) antiretroviral therapy (ART) initiation in ART-naive patients [overall and stratified by CD4+ T cell (CD4) count] in 2007 and 2009 were compared. Nosocomial transmission rates could not be assessed.
RESULTS:Three hundred forty-six patients were initiated on TB treatment in 2007 and 366 in 2009. Median CD4 counts at TB diagnosis did not differ. TB treatment cure or completion increased from 62% to 68%, death or default decreased from 33% to 25% (P < 0.001). Fewer ART-naive TB patients were initiated on ART in 2009 versus 2007 (57% and 66%, P = 0.031), but this decrease was only in patients with CD4 counts >250 cells per cubic millimeter (19% vs. 48%, P = 0.003). More patients were started on ART during TB treatment (94% vs. 78%, P < 0.001). Moreover, the majority were now initiated during intensive phase (60% vs. 23%, P < 0.001).
CONCLUSIONS:Integration of TB and HIV care has led to improved TB treatment outcomes and earlier, prioritized ART initiation. This supports rollout of a fully integrated TB/HIV service delivery model throughout high-prevalence TB and HIV settings. |
| doi_str_mv | 10.1097/QAI.0b013e318251aeb4 |
| format | Article |
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METHODS:Routinely collected clinical, pharmacy, and laboratory data were merged with TB clinic data for patients initiating TB treatment in 2009 and with TB register data for patients in 2007. TB treatment outcomes and (timing of) antiretroviral therapy (ART) initiation in ART-naive patients [overall and stratified by CD4+ T cell (CD4) count] in 2007 and 2009 were compared. Nosocomial transmission rates could not be assessed.
RESULTS:Three hundred forty-six patients were initiated on TB treatment in 2007 and 366 in 2009. Median CD4 counts at TB diagnosis did not differ. TB treatment cure or completion increased from 62% to 68%, death or default decreased from 33% to 25% (P < 0.001). Fewer ART-naive TB patients were initiated on ART in 2009 versus 2007 (57% and 66%, P = 0.031), but this decrease was only in patients with CD4 counts >250 cells per cubic millimeter (19% vs. 48%, P = 0.003). More patients were started on ART during TB treatment (94% vs. 78%, P < 0.001). Moreover, the majority were now initiated during intensive phase (60% vs. 23%, P < 0.001).
CONCLUSIONS:Integration of TB and HIV care has led to improved TB treatment outcomes and earlier, prioritized ART initiation. This supports rollout of a fully integrated TB/HIV service delivery model throughout high-prevalence TB and HIV settings.</description><identifier>ISSN: 1525-4135</identifier><identifier>ISSN: 1944-7884</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0b013e318251aeb4</identifier><identifier>PMID: 22395671</identifier><identifier>CODEN: JDSRET</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins, Inc</publisher><subject>Adult ; Ambulatory Care Facilities - organization & administration ; Antiretroviral drugs ; Antiretroviral Therapy, Highly Active ; Antitubercular Agents - administration & dosage ; Cohort Studies ; Female ; HIV ; HIV Infections - complications ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Humans ; Indexing in process ; Integration ; Male ; Middle Aged ; Retrospective Studies ; T cell receptors ; Treatment Outcome ; Tuberculosis ; Tuberculosis - complications ; Tuberculosis - drug therapy ; Uganda ; Urban areas ; Urban Population</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2012-06, Vol.60 (2), p.e29-e35</ispartof><rights>2012 Lippincott Williams & Wilkins, Inc.</rights><rights>Copyright Lippincott Williams & Wilkins Jun 1, 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5184-459bd6d888be9bfc5060c337016b9397f6294878e8629a1e5617612d857c97993</citedby><cites>FETCH-LOGICAL-c5184-459bd6d888be9bfc5060c337016b9397f6294878e8629a1e5617612d857c97993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22395671$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hermans, Sabine M</creatorcontrib><creatorcontrib>Castelnuovo, Barbara</creatorcontrib><creatorcontrib>Katabira, Catherine</creatorcontrib><creatorcontrib>Mbidde, Peter</creatorcontrib><creatorcontrib>Lange, Joep M A</creatorcontrib><creatorcontrib>Hoepelman, Andy I M</creatorcontrib><creatorcontrib>Coutinho, Alex</creatorcontrib><creatorcontrib>Manabe, Yukari C</creatorcontrib><title>Integration of HIV and TB Services Results in Improved TB Treatment Outcomes and Earlier Prioritized ART Initiation in a Large Urban HIV Clinic in Uganda</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>BACKGROUND:The World Health Organization recommends that treatment of tuberculosis (TB) in HIV-infected patients should be integrated with HIV care. In December 2008, a separate outdoor-integrated TB/HIV clinic was instituted for attendees of a large urban HIV clinic in Uganda. We sought to evaluate associated TB and HIV treatment outcomes.
METHODS:Routinely collected clinical, pharmacy, and laboratory data were merged with TB clinic data for patients initiating TB treatment in 2009 and with TB register data for patients in 2007. TB treatment outcomes and (timing of) antiretroviral therapy (ART) initiation in ART-naive patients [overall and stratified by CD4+ T cell (CD4) count] in 2007 and 2009 were compared. Nosocomial transmission rates could not be assessed.
RESULTS:Three hundred forty-six patients were initiated on TB treatment in 2007 and 366 in 2009. Median CD4 counts at TB diagnosis did not differ. TB treatment cure or completion increased from 62% to 68%, death or default decreased from 33% to 25% (P < 0.001). Fewer ART-naive TB patients were initiated on ART in 2009 versus 2007 (57% and 66%, P = 0.031), but this decrease was only in patients with CD4 counts >250 cells per cubic millimeter (19% vs. 48%, P = 0.003). More patients were started on ART during TB treatment (94% vs. 78%, P < 0.001). Moreover, the majority were now initiated during intensive phase (60% vs. 23%, P < 0.001).
CONCLUSIONS:Integration of TB and HIV care has led to improved TB treatment outcomes and earlier, prioritized ART initiation. This supports rollout of a fully integrated TB/HIV service delivery model throughout high-prevalence TB and HIV settings.</description><subject>Adult</subject><subject>Ambulatory Care Facilities - organization & administration</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Antitubercular Agents - administration & dosage</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Indexing in process</subject><subject>Integration</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>T cell receptors</subject><subject>Treatment Outcome</subject><subject>Tuberculosis</subject><subject>Tuberculosis - complications</subject><subject>Tuberculosis - drug therapy</subject><subject>Uganda</subject><subject>Urban areas</subject><subject>Urban Population</subject><issn>1525-4135</issn><issn>1944-7884</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks1uEzEUhUcIREvhDRCyxIZNij3-3yCFqNCRIhVKwtbyTG4Slxk7tWdSwZvwtniaUkEXiJWvdb57rq91iuIlwacEa_n287Q6xTUmFChRJScWavaoOCaasYlUij3ONS_5hBHKj4pnKV1hTARj-mlxVJZUcyHJcfGz8j1sou1d8Cis0Xn1FVm_Qov36AvEvWsgoUtIQ9sn5Dyqul0Me7jVFxFs34Hv0cXQN6HL5Nh5ZmPrIKJP0YXoevcj09PLBap8vhzmZCOL5jZuAC1jbf3t1FnrvGtGbbnJPvZ58WRt2wQv7s6TYvnhbDE7n8wvPlaz6XzScKLYhHFdr8RKKVWDrtcNxwI3lMq8a62plmtRaqakApULS4ALIgUpV4rLRkut6Unx7uC7G-oOVk1eKNrW7KLrbPxugnXmb8W7rdmEvaFUC0ZJNnhzZxDD9QCpN51LDbSt9RCGZAguFS6ZpPQ_UCKEzDjP6OsH6FUYos8_MVJSCMzEaMgOVBNDShHW9-8m2IwxMTkm5mFMcturP3e-b_qdiwyoA3AT2h5i-tYONxDNFmzbb__t_Qtyh8qt</recordid><startdate>20120601</startdate><enddate>20120601</enddate><creator>Hermans, Sabine M</creator><creator>Castelnuovo, Barbara</creator><creator>Katabira, Catherine</creator><creator>Mbidde, Peter</creator><creator>Lange, Joep M A</creator><creator>Hoepelman, Andy I M</creator><creator>Coutinho, Alex</creator><creator>Manabe, Yukari C</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7T5</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120601</creationdate><title>Integration of HIV and TB Services Results in Improved TB Treatment Outcomes and Earlier Prioritized ART Initiation in a Large Urban HIV Clinic in Uganda</title><author>Hermans, Sabine M ; Castelnuovo, Barbara ; Katabira, Catherine ; Mbidde, Peter ; Lange, Joep M A ; Hoepelman, Andy I M ; Coutinho, Alex ; Manabe, Yukari C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5184-459bd6d888be9bfc5060c337016b9397f6294878e8629a1e5617612d857c97993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Ambulatory Care Facilities - organization & administration</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Antitubercular Agents - administration & dosage</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>HIV</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Indexing in process</topic><topic>Integration</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>T cell receptors</topic><topic>Treatment Outcome</topic><topic>Tuberculosis</topic><topic>Tuberculosis - complications</topic><topic>Tuberculosis - drug therapy</topic><topic>Uganda</topic><topic>Urban areas</topic><topic>Urban Population</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hermans, Sabine M</creatorcontrib><creatorcontrib>Castelnuovo, Barbara</creatorcontrib><creatorcontrib>Katabira, Catherine</creatorcontrib><creatorcontrib>Mbidde, Peter</creatorcontrib><creatorcontrib>Lange, Joep M A</creatorcontrib><creatorcontrib>Hoepelman, Andy I M</creatorcontrib><creatorcontrib>Coutinho, Alex</creatorcontrib><creatorcontrib>Manabe, Yukari C</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hermans, Sabine M</au><au>Castelnuovo, Barbara</au><au>Katabira, Catherine</au><au>Mbidde, Peter</au><au>Lange, Joep M A</au><au>Hoepelman, Andy I M</au><au>Coutinho, Alex</au><au>Manabe, Yukari C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Integration of HIV and TB Services Results in Improved TB Treatment Outcomes and Earlier Prioritized ART Initiation in a Large Urban HIV Clinic in Uganda</atitle><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle><addtitle>J Acquir Immune Defic Syndr</addtitle><date>2012-06-01</date><risdate>2012</risdate><volume>60</volume><issue>2</issue><spage>e29</spage><epage>e35</epage><pages>e29-e35</pages><issn>1525-4135</issn><issn>1944-7884</issn><eissn>1944-7884</eissn><coden>JDSRET</coden><abstract>BACKGROUND:The World Health Organization recommends that treatment of tuberculosis (TB) in HIV-infected patients should be integrated with HIV care. In December 2008, a separate outdoor-integrated TB/HIV clinic was instituted for attendees of a large urban HIV clinic in Uganda. We sought to evaluate associated TB and HIV treatment outcomes.
METHODS:Routinely collected clinical, pharmacy, and laboratory data were merged with TB clinic data for patients initiating TB treatment in 2009 and with TB register data for patients in 2007. TB treatment outcomes and (timing of) antiretroviral therapy (ART) initiation in ART-naive patients [overall and stratified by CD4+ T cell (CD4) count] in 2007 and 2009 were compared. Nosocomial transmission rates could not be assessed.
RESULTS:Three hundred forty-six patients were initiated on TB treatment in 2007 and 366 in 2009. Median CD4 counts at TB diagnosis did not differ. TB treatment cure or completion increased from 62% to 68%, death or default decreased from 33% to 25% (P < 0.001). Fewer ART-naive TB patients were initiated on ART in 2009 versus 2007 (57% and 66%, P = 0.031), but this decrease was only in patients with CD4 counts >250 cells per cubic millimeter (19% vs. 48%, P = 0.003). More patients were started on ART during TB treatment (94% vs. 78%, P < 0.001). Moreover, the majority were now initiated during intensive phase (60% vs. 23%, P < 0.001).
CONCLUSIONS:Integration of TB and HIV care has led to improved TB treatment outcomes and earlier, prioritized ART initiation. This supports rollout of a fully integrated TB/HIV service delivery model throughout high-prevalence TB and HIV settings.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>22395671</pmid><doi>10.1097/QAI.0b013e318251aeb4</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of acquired immune deficiency syndromes (1999), 2012-06, Vol.60 (2), p.e29-e35 |
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| source | MEDLINE; Journals@Ovid LWW Legacy Archive; Free E- Journals; Journals@Ovid Complete |
| subjects | Adult Ambulatory Care Facilities - organization & administration Antiretroviral drugs Antiretroviral Therapy, Highly Active Antitubercular Agents - administration & dosage Cohort Studies Female HIV HIV Infections - complications HIV Infections - drug therapy Human immunodeficiency virus Humans Indexing in process Integration Male Middle Aged Retrospective Studies T cell receptors Treatment Outcome Tuberculosis Tuberculosis - complications Tuberculosis - drug therapy Uganda Urban areas Urban Population |
| title | Integration of HIV and TB Services Results in Improved TB Treatment Outcomes and Earlier Prioritized ART Initiation in a Large Urban HIV Clinic in Uganda |
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