TB/HIV integration at primary care level: A quantitative assessment at 3 clinics in Johannesburg, South Africa

Abstract

Background In 2004 the World Health Organization WHO) released the Interim Policy on Collaborative TB/ HIV activities. According to the policy, for people living with HIV (PLWH), activities include intensified case finding, isoniazid preventive therapy (IPT) and infection control. For TB patients, activities included HIV counselling and testing HCT), prevention messages, and cotrimoxazole preventive therapy (CPT), care and support, and antiretroviral therapy ART) for those with HIV-associated TB. While important progress has been made in implementation, targets of the WHO Global Plan to Stop TB have not been reached. Objective To quantify TB/HIV integration at 3 primary healthcare clinics in Johannesburg, South Africa. Methods Routinely collected TB and HIV data from the HCT register, TB ‘suspect’ register, TB treatment register, clinic files and HIV electronic database, collected over a 3-month period, were reviewed. Results Of 1 104 people receiving HCT: 306 (28%) were HIV-positive; a CD4 count was documented for 57%; and few received TB screening or IPT. In clinic encounters among PLWH, 921 (15%) had documented TB symptoms; only 10% were assessed by smear microscopy, and few asymptomatic PLWH were offered IPT. Infection control was poorly documented and implemented. HIV status was documented for 155 (75%) of the 208 TB patients; 90% were HIV-positive and 88% had a documented CD4 count. Provision of CPT and ART was poorly documented. Conclusion The coverage of most TB/HIV collaborative activities was below Global Plan targets. The lack of standardised recording tools and incomplete documentation impeded assessment at facility level and limited the accuracy of compiled data.

Evaluation of TB/HIV Collaborative Activities: The Case of South Tongu District, Ghana

“…Correspondingly, Rie et al found that in Ethiopia 85% of TB patients at DOTS clinics were tested for HIV/AIDS [13]. Our result is not in conformity with [12,13] where only 75% of TB patients had their HIV status documented and only a little more than half of TB patients were tested for HIV, respectively.…”

“…A quantitative assessment at 3 clinics in Johannesburg, South Africa, to evaluate TB/HIV integration at the primary care level established that the proportion of clients newly diagnosed with HIV who were screened for TB symptoms could not be determined, because it was not systematically documented [12]. Correspondingly, Rie et al found that in Ethiopia 85% of TB patients at DOTS clinics were tested for HIV/AIDS [13]. Our result is not in conformity with [12,13] where only 75% of TB patients had their HIV status documented and only a little more than half of TB patients were tested for HIV, respectively.…”

Treatment outcomes among children, adolescents, and adults on treatment for tuberculosis in two metropolitan municipalities in Gauteng Province, South Africa

“…Increasing ART coverage is important for both preventing TB and improving TB outcomes [28], and collaborative TB/HIV activities have been recommended as a strategy for national programs [29]. However significant barriers to scale up of these activities persist in South Africa [30–33]. For example, routine provision of isoniazid prophylaxis in people living with HIV and rapid initiation of ART among co-infected persons have been identified as the least available TB/HIV services in public medical facilities [33].…”

A cluster‐randomized controlled trial to improve the quality of integrated HIV‐tuberculosis services in primary healthcareclinics in South Africa

“…lic Health, University of KwaZulu-Natal, Durban, South Africa; 7 HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa; 8 Medical Research Council, Clinical Trials Unit at University College London (UCL), London, UK; 9 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA…”

“…By 2016, HIV‐TB services were routine care in SA and comprised: early antiretroviral therapy (ART) for TB patients irrespective of CD4 cell count; isoniazid preventive therapy (IPT) for eligible HIV patients; HIV testing services (HTS) for all patients, especially TB patients; TB screening and diagnostic testing [ 5 ]. Evidence has surfaced of patients accessing primary healthcare (PHC) clinics and being missed for HIV and TB services [ 6 , 7 , 8 , 9 ]. Integrated HIV‐TB service delivery requires high‐level organization and planning by clinic teams against a backdrop of large patient numbers and constrained resources [ 6 , 7 , 10 , 11 ].…”