One-stop TB-HIV services evaluation in Rwanda: comparison of the 2001–2005 and 2006–2010 cohorts

Ndagijimana, Albert; Rugigana, Etienne; Uwizeye, Claude Bernard; Ntaganira, Joseph

doi:10.5588/pha.15.0093

Cited by 13 publications

(16 citation statements)

References 15 publications

(23 reference statements)

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“…40 The lack of a common understanding of the concept of 'integration' was also identified as a barrier that contributed to poor quality of services. 41 In Rwanda and Kenya, implementation started using a 'one-stop' TB/HIV integrated services model (Figure 3), 17,33,42,43 on the WHO Three 'I's initiative (intensified TB case-finding, IPT, and infection control). 14,15 8.…”

Section: Towards Implementing Tb and Hiv Collaborative Service Reseamentioning

confidence: 99%

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

Linguissi

Gwom

Nkenfou

et al. 2017

International Journal of Infectious Diseases

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The Republic of Congo is on the World Health Organization (WHO) list of 'high burden' countries for tuberculosis (TB) and HIV. TB is the leading cause of death among HIV-infected patients in the Republic of Congo. In this viewpoint, the available data on TB and HIV in the Republic of Congo are reviewed, and the gaps and bottlenecks that the National TB Control Program (NTCP) faces are discussed. Furthermore, priority requirements for developing and implementing TB and HIV collaborative service activities are identified. HIV and TB control programs operate as distinct entities with separate case management plans. The implementation of collaborative TB/HIV activities to evaluate and monitor the management of TB/HIV co-infected individuals remains inefficient in most regions, and these activities are sometimes non-existent. This reveals major challenges that require definition in order to improve the delivery of healthcare. The NTCP lacks adequate resources for optimal implementation of control measures of TB and HIV compliance and outcomes. The importance of aligning and integrating TB and HIV treatment services (including follow-up) and adherence support services through coordinated and collaborative efforts between individual TB and HIV programs is discussed. Aligning and integrating TB and HIV treatment services through coordinated and collaborative efforts between individual TB and HIV programs is required. However, the WHO recommendations are generic, and health services in the Republic of Congo need to tailor their TB and HIV programs according to the availability of resources and operational feasibility. This will also open opportunities for synergizing collaborative TB/HIV research and training activities, which should be prioritized by the donors supporting the TB/HIV programs.

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Section: Towards Implementing Tb and Hiv Collaborative Service Reseamentioning

confidence: 99%

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

Linguissi

Gwom

Nkenfou

et al. 2017

International Journal of Infectious Diseases

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“…[33] To assess the feasibility of integrating HIV care and treatment into TB clinics and to evaluate the effects of the intervention on timely linkage to HIV care, early ART uptake, and TB treatment outcomes. [38] To evaluate one-stop TB-HIV services in Rwanda by comparing the TB treatment outcomes before and after their implementation Historical (before-and-after) study in 12 public facilities in rural and urban areas of Rwanda involving 888 patients: 413 postintervention cases and 475 pre-intervention cases ------------One-stop services w operation facilities. treatmen after the interv comparab the interv Owiti 2015, Kenya [39] To assess the uptake and timing of cotrimoxazole preventive therapy and antiretroviral treatment as well as anti-tuberculosis treatment outcomes among HIV-infected TB patients before and after the introduction of integrated TB-HIV care.…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta-analysis of the association between integrated tuberculosis and Human Immuno-deficiency Virus therapy and tuberculosis treatment outcomes among adults in sub-Saharan Africa

Kadia

Fongwen

Dimala

et al. 2020

Preprint

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Background: Despite the scale-up of programmes integrating treatment of tuberculosis (TB) and Human Immuno-deficiency Virus (HIV) in sub-Saharan Africa (SSA), TB treatment outcomes in TB/HIV co-infected patients in the region remain sub-optimal.Objective: To summarize the available evidence on the association between integrated TB/HIV treatment and TB treatment outcomes specifically, successful treatment and all-cause mortality in TB/HIV co-infected adults in SSA.Method: A systematic review of studies published between March 2004 and 10 July 2019 was performed. Seven electronic databases including Medline, Embase and Cochrane were searched to identify interventional and observational quantitative studies reporting on integrated TB/HIV treatment in SSA. Two investigators independently screened the search output, reviewed the eligible studies, and rated the quality of eligible studies using quality assessment tools of the National Heart Lung and Blood Institute. Pooled odds ratios (ORs) were derived using random-effects meta-analysis. Heterogeneity across studies was assessed using the I2 statistic. The confidence in the pooled ORs was rated using the GRADE. The final review was reported using the PRISMA.Results: Eleven studies including 4181 participants were retained. The studies were of moderate to good quality, with 10 being quasi-experimental and cohort. Pooling of relevant studies showed that the odds of treatment success with integration was 1.1 times (95% CI: 0.93-1.29; I2=74.5%; p-value for heterogeneity=0.001) the odds of treatment success without integration and the odds of mortality with integration was 1.27 (95% CI 1.02-1.59; I2=87.3%; p-value for heterogeneity<0.0001) times the odds of mortality without integration. On sensitivity analysis, the odds of mortality with integration decreased to 1.06 (95% CI: 0.83-1.34; I2=80.1%; p-value for heterogeneity<0.0001) times the odds of mortality without integration and there was strong evidence of an association between sample size variation and heterogeneity (p=0.01). Good quality studies (4/11) tended to support the effectiveness of integrated treatment in increasing successful outcomes and decreasing mortality. Certainty in the pooled ORs was low.Conclusion: Evidence on the effect of integrated TB/HIV treatment services on treatment success and all-cause mortality in TB/HIV co-infected patients in SSA is inconclusive but the few available good quality studies tend to favour the effectiveness of these services. More robust primary studies are warranted.

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“…Some of these studies reported more rapid ART start and higher median CD4 counts at ART initiations among HIV positive individuals diagnosed with TB [7][8][9][10] while others reported no effect on ART uptake [5,[24][25][26]. In addition, with respect to TB treatment outcomes among HIV positive individuals, some studies found reduced mortality and better retention [9,10,27,28], where others did not [10,25,26,[29][30][31]. Complex health systems interventions to improve TB/HIV integration have also been evaluated in trials.…”

Section: Discussionmentioning

confidence: 99%

An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: results of the MERGE cluster randomised trial

Kufa

Fielding

Hippner

et al. 2018

Contemporary Clinical Trials

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A B S T R A C TObjectives: To evaluate the effect of an intervention to optimize TB/HIV integration on patient outcomes. Methods: Cluster randomised control trial at 18 primary care clinics in South Africa. The intervention was placement of a nurse (TB/HIV integration officer) to facilitate provision of integrated TB/HIV services, and a lay health worker (TB screening officer) to facilitate TB screening for 24 months. Primary outcomes were i) incidence of hospitalisation/death among individuals newly diagnosed with HIV, ii) incidence of hospitalisation/ death among individuals newly diagnosed with TB and iii) proportion of HIV-positive individuals newly diagnosed with TB who were retained in HIV care 12 months after enrolment. Results: Of 3328 individuals enrolled, 3024 were in the HIV cohort, 731 in TB cohort and 427 in TB-HIV cohort. For the HIV cohort, the hospitalisation/death rate was 12.5 per 100 person-years (py) (182/1459py) in the intervention arm vs. 10.4/100py (147/1408 py) in the control arms respectively (Relative Risk (RR) 1.17 [95% CI 0.92-1.49]).For the TB cohort, hospitalisation/ death rate was 17.1/100 py (67/ 392py) vs. 11.1 /100py (32/ 289py) in intervention and control arms respectively (RR 1.37 [95% CI 0.78-2.43]). For the TB-HIV cohort, retention in care at 12 months was 63.0% (213/338) and 55.9% (143/256) in intervention and control arms ]).Conclusions: The intervention as implemented failed to improve patient outcomes beyond levels at control clinics. Effective strategies are needed to achieve better TB/HIV service integration and improve TB and HIV outcomes in primary care clinics. Trial registration: South African Register of Clinical Trials (registration number DOH-27-1011-3846).

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One-stop TB-HIV services evaluation in Rwanda: comparison of the 2001–2005 and 2006–2010 cohorts

Cited by 13 publications

References 15 publications

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

A systematic review and meta-analysis of the association between integrated tuberculosis and Human Immuno-deficiency Virus therapy and tuberculosis treatment outcomes among adults in sub-Saharan Africa

An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: results of the MERGE cluster randomised trial

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