Integration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa

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dc.contributor.authorKaplan, R
dc.contributor.authorCaldwell, J
dc.contributor.authorBekker, L- G
dc.contributor.authorJennings, K
dc.contributor.authorLombard, C
dc.contributor.authorEnarson, D A
dc.contributor.authorWood, R
dc.contributor.authorBeyers, N
dc.date.accessioned2021-10-08T07:20:27Z
dc.date.available2021-10-08T07:20:27Z
dc.date.issued2014
dc.description.abstractBACKGROUND: The combined tuberculosis (TB) and HIV epidemics in South Africa (SA) have created enormous operational challenges for a health service that has traditionally run vertical programmes for TB treatment and antiretroviral therapy (ART) in separate facilities. This is particularly problematic for TB/HIV co-infected patients who need to access both services. OBJECTIVE: To determine whether integrated TB facilities had better TB treatment outcomes than single-service facilities in Cape Town, SA. METHODS: TB treatment outcomes were determined for newly registered, adult TB patients (aged > or = 18 years) at 13 integrated ART/TB primary healthcare (PHC) facilities and four single-service PHC facilities from 1 January 2009 to 30 June 2010. A chi2 test adjusted for a cluster sample design was used to compare outcomes by type of facility. RESULTS: Of 13,542 newly registered patients, 10,030 received TB treatment in integrated facilities and 3,512 in single-service facilities. There was no difference in baseline characteristics between the two groups with HIV status determined for 9,351 (93.2%) and 3,227 (91.9%) patients, of whom 6 649 (66.3%) and 2,213 (63%) were HIV-positive in integrated facilities and single-service facilities, respectively. The median CD4+ count of HIV-positive patients was 152 cells/microl (interquartile range (IQR) 71-277) for integrated facilities and 148 cells/microl (IQR 67-260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p = 0.56) or for the sub-set of HIV-positive TB patients (p = 0.58) CONCLUSION: This study did not demonstrate improved TB treatment outcomes in integrated PHC facilities and showed that the provision of ART in the same facility as TB services was not associated with lower TB death and default rates.
dc.identifier.apacitationKaplan, R., Caldwell, J., Bekker, L. G., Jennings, K., Lombard, C., Enarson, D. A., ... Beyers, N. (2014). Integration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa. <i>South African Medical Journal</i>, 104(3), 204 - 177. http://hdl.handle.net/11427/34922en_ZA
dc.identifier.chicagocitationKaplan, R, J Caldwell, L- G Bekker, K Jennings, C Lombard, D A Enarson, R Wood, and N Beyers "Integration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa." <i>South African Medical Journal</i> 104, 3. (2014): 204 - 177. http://hdl.handle.net/11427/34922en_ZA
dc.identifier.citationKaplan, R., Caldwell, J., Bekker, L.G., Jennings, K., Lombard, C., Enarson, D.A., Wood, R. & Beyers, N. et al. 2014. Integration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa. <i>South African Medical Journal.</i> 104(3):204 - 177. http://hdl.handle.net/11427/34922en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Kaplan, R AU - Caldwell, J AU - Bekker, L- G AU - Jennings, K AU - Lombard, C AU - Enarson, D A AU - Wood, R AU - Beyers, N AB - BACKGROUND: The combined tuberculosis (TB) and HIV epidemics in South Africa (SA) have created enormous operational challenges for a health service that has traditionally run vertical programmes for TB treatment and antiretroviral therapy (ART) in separate facilities. This is particularly problematic for TB/HIV co-infected patients who need to access both services. OBJECTIVE: To determine whether integrated TB facilities had better TB treatment outcomes than single-service facilities in Cape Town, SA. METHODS: TB treatment outcomes were determined for newly registered, adult TB patients (aged > or = 18 years) at 13 integrated ART/TB primary healthcare (PHC) facilities and four single-service PHC facilities from 1 January 2009 to 30 June 2010. A chi2 test adjusted for a cluster sample design was used to compare outcomes by type of facility. RESULTS: Of 13,542 newly registered patients, 10,030 received TB treatment in integrated facilities and 3,512 in single-service facilities. There was no difference in baseline characteristics between the two groups with HIV status determined for 9,351 (93.2%) and 3,227 (91.9%) patients, of whom 6 649 (66.3%) and 2,213 (63%) were HIV-positive in integrated facilities and single-service facilities, respectively. The median CD4+ count of HIV-positive patients was 152 cells/microl (interquartile range (IQR) 71-277) for integrated facilities and 148 cells/microl (IQR 67-260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p = 0.56) or for the sub-set of HIV-positive TB patients (p = 0.58) CONCLUSION: This study did not demonstrate improved TB treatment outcomes in integrated PHC facilities and showed that the provision of ART in the same facility as TB services was not associated with lower TB death and default rates. DA - 2014 DB - OpenUCT DP - University of Cape Town IS - 3 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2014 SM - 0038-2469 T1 - Integration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa TI - Integration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa UR - http://hdl.handle.net/11427/34922 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34922
dc.identifier.vancouvercitationKaplan R, Caldwell J, Bekker LG, Jennings K, Lombard C, Enarson DA, et al. Integration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa. South African Medical Journal. 2014;104(3):204 - 177. http://hdl.handle.net/11427/34922.en_ZA
dc.language.isoeng
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue3
dc.source.journalvolume104
dc.source.pagination204 - 177
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.7696
dc.subject.otherAdolescent
dc.subject.otherAdult
dc.subject.otherAnti-Retroviral Agents
dc.subject.otherCommunity Health Services
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHumans
dc.subject.otherMale
dc.subject.otherSouth Africa
dc.subject.otherTreatment Outcome
dc.subject.otherTuberculosis
dc.subject.otherAnti-Retroviral Agents
dc.titleIntegration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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