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Infectious Diseases of Poverty

, 1:13

Co-infection and SyndemicsSurveillance and Response to Infectious Diseases of Poverty


BackgroundThe impact of the human immunodeficiency virus HIV on tuberculosis TB, and the implications for TB and HIV control, is a public health challenge in Ghana – almost a quarter 23% of all TB cases were HIV positive in 2010. The integration of TB-HIV services has therefore emerged as an essential component of the national response to TB and HIV. The aim is to reduce fragmentation, improve access, enhance efficiency and improve quality of care. Ghana’s TB-HIV policy comprises three linked sets of activities: effective implementation of the Stop TB Strategy for TB control, improved HIV prevention and care, and the implementation of additional TB-HIV activities. Different models of service delivery with increasing integration of TB-HIV activities are expected to provide greater access to more comprehensive care. The objective of this paper is to assess the impact of TB-HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB-HIV indicators.

MethodsA before-and-after study to observe the introduction of TB-HIV activities into TB programmes in three hospitals with different levels of integration was conducted. Anonymised patient data was collated from TB registers from each facility, and analysed to determine if TB treatment outcomes changed significantly after integration.

ResultsTB treatment success was 50% 95% CI 49 – 52 prior to, and 69% 95% CI 65 – 73 after, integration Χ 43.96, p < 0.00. Treatment success increased from 43% to 53% at the one-stop shop OSS, from 69% to 78% at the partially integrated site PIS and substantially from 46% to 78% at the referral site RS Χ 64.54; p<0.01. Defaults and cases transferred out reduced from 14.3% and 15.3% prior to integration, to 1.4% and 9.0% after integration, respectively, accounting for a significant increase in treatment success. Death rates remained high at 18% in all cases studied and 25% in HIV-associated cases after integration.

ConclusionTB-HIV integration may improve TB treatment success, but its exact impact is difficult to ascertain due to non-specificity and design limitations. TB mortality may be more useful as an indicator for monitoring TB-HIV activities in Ghana.

KeywordsTuberculosis HIV Integration Indicator Treatment outcome Referral Partial integration One-stop shop AbbreviationsARTAntiretroviral therapy

CIConfidence interval

CPTCo-trimoxazole preventive therapy

DOTSDirectly observed therapy short course

HIVHuman Immunodeficiency Virus

OSSOne-stop shop

PICTProvider-initiated counselling and testing

PISPartially integrated site

RSReferral site

SPSSStatistical product for service solutions

Stop TBWHO Stop TB strategy


Electronic supplementary materialThe online version of this article doi:10.1186-2049-9957-1-13 contains supplementary material, which is available to authorized users.

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Autor: Gloria Akosua Ansa - John D Walley - Kamran Siddiqi - Xiaolin Wei


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