Integrated tuberculosis and HIV care in a resource‐limited setting: experience from the Martin Preuss centre, Malawi

Abstract

Summary Objectives To describe the development and operation of integrated tuberculosis (TB) and HIV care at the Martin Preuss Centre, a multipartner organization bringing together governmental and non‐governmental providers of HIV and TB services in Lilongwe, Malawi. Methods We used a case study approach to describe the integrated TB/HIV service and to illustrate successes and challenges faced by service providers. We quantified effective TB and HIV integration using indicators defined by the World Health Organization. Results The custom‐designed building facilitates patient flow and infection control, and other important elements include coordinated leadership; joint staff training and meetings; and data systems prompting coordinated care. Some integrated services have worked well from the outset, such as promoting HIV testing among patients with TB (96% of patients with TB had documented HIV status in 2009). Other aspects of integrated care have been more challenging, for example achieving high uptake of antiretroviral therapy among HIV‐positive TB patients and combining data from paper and electronic systems. Good TB treatment outcomes (>85% cure or completion) have been achieved among both HIV‐positive and HIV‐negative individuals. Conclusions High‐quality integrated services for TB and HIV care can be provided in a resource‐limited setting. Lessons learned may be valuable for service providers in other settings of high HIV and TB prevalence.

Improving antiretroviral therapy scale-up and effectiveness through service integration and decentralization

“…Twelve studies evaluated ART coverage. Nine [27][28][29][30][31][32][33][34][35] reported improved coverage, and three [36][37][38] reported similar coverage, when ARTwas provided in TB care settings versus separate services (Fig. 2).…”

Integrating tuberculosis and HIV services in rural Kenya: uptake and outcomes

“…16,17 The benefits of integration (and of the implementation of the 2010 WHO ART guidelines) have been shown to accelerate the uptake of ART and reduce delays in starting this life-saving treatment. [17][18][19][20][21][22][23][24][25][26] However, most of these studies have been conducted outside the realm of rural, resource-constrained public health facilities. The operational impact on treatment outcomes has also been inconsistent.…”

Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI)

“…For instance, integration of HIV care with tuberculosis (TB) and sexually transmitted infection (STI) services in Haiti showed demonstrable increases in patient access, uptake of testing and case detection, enrollment in antiretroviral therapy (ART), and even benefits in unrelated programs such as vaccine coverage [25-27]. Similar results with TB/HIV integration have demonstrated improved rates of screening [28,29] increased enrollment in antiretroviral treatment programs [30], and even improved TB treatment outcomes in one cohort in Ghana [31], but a recent systematic review of TB/HIV integration suggested that more robust downstream outcome measures should be emphasized in future research [32]. Research has also been conducted on integration of HIV care and treatment services with programs such as Prevention of Mother to Child Transmission (PMTCT) [33] and family planning services [34-36], with generally positive results with respect to patient access, and patient and provider perceptions.…”