the effect of complete integration of hiv and tb services on time to initiation of antiretroviral therapy a before-after study完全集成的影响艾滋病和结核病服务时间开始抗逆转录病毒治疗之后,研究.pdf

The Effect of Complete Integration of HIV and TB Services on Time to Initiation of Antiretroviral Therapy: A Before-After Study 1 1,2 2 2 3 Bernhard Kerschberger , Katherine Hilderbrand , Andrew M. Boulle , David Coetzee , Eric Goemaere , Virginia De Azevedo4, Gilles Van Cutsem1,2* ´ ` 1 Medecins sans Frontieres, Khayelitsha, Cape Town, South Africa, 2 Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family ´ ` Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 3 South African Medical Unit, Medecins sans Frontieres, Johannesburg, South Africa, 4 City of Cape Town, Health Directorate, Khayelitsha, South Africa Abstract Background: Studies have shown that early ART initiation in TB/HIV co-infected patients lowers mortality. One way to implement earlier ART commencement could be through integration of TB and HIV services, a more efficient model of care than separate, vertical programs. We present a model of full TB/HIV integration and estimate its effect on time to initiation of ART. Methodology/Principal Findings: We retrospectively reviewed TB registers and clinical notes of 209 TB/HIV co-infected adults with a CD4 count ,250 cells/ml and registered for TB treatment at one primary care clinic in a South African township between June 2008 and May 2009. Using Kaplan-Meier and Cox proportional hazard analysis, we compared time between initiation of TB treatment and ART for the periods before and after full, ‘‘one-stop shop’’ integration of TB and