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

dc.contributor.authorKaplan, R.en_ZA
dc.contributor.authorCaldwell, J.en_ZA
dc.contributor.authorBekker, L-G.en_ZA
dc.contributor.authorJennings, K.en_ZA
dc.contributor.authorLombard, C.en_ZA
dc.contributor.authorEnarson, D. A.en_ZA
dc.contributor.authorWood, R.en_ZA
dc.contributor.authorBeyers, Nuldaen_ZA
dc.date.accessioned2016-01-13T08:10:30Z
dc.date.available2016-01-13T08:10:30Z
dc.date.issued2014-03
dc.identifier.citationKaplan, R. 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. South African Medical Journal, 104(3):204-209, doi:10.7196/SAMJ.7696.en_ZA
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJ.7696
dc.identifier.urihttp://hdl.handle.net/10019.1/98156
dc.descriptionPlease cite as follows: Kaplan, R. 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. South African Medical Journal, 104(3):204-209, doi:10.7196/SAMJ.7696.en_ZA
dc.descriptionThe original publication is available at http://www.samj.org.zaen_ZA
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 ≥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 χ2 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/μl (interquartile range (IQR) 71 - 277) for integrated facilities and 148 cells/μl (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.en_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/7696en_ZA
dc.format.extent6 pagesen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherHealth & Medical Publishing Groupen_ZA
dc.subjectTuberculosis -- Treatment -- South Africa -- Cape Townen_ZA
dc.subjectHIV infections -- Treatment -- South Africa -- Cape Townen_ZA
dc.subjectAntiretroviral agentsen_ZA
dc.subjectHighly active antiretroviral therapyen_ZA
dc.titleIntegration of TB and ART services fails to improve TB treatment outcomes : comparison of ART/TB primary healthcare services in Cape Town, South Africaen_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's versionen_ZA
dc.rights.holderSouth African Medical Journalen_ZA


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