Integration of HIV and TB Services Results in Improved TB Treatment Outcomes and Earlier Prioritized ART Initiation in a Large Urban HIV Clinic in Uganda
Integration of HIV and TB Services Results in Improved TB Treatment Outcomes and Earlier Prioritized ART Initiation in a Large Urban HIV Clinic in Uganda
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DOI：
10.1097/qai.0b013e318251aeb4
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发表时间：
2012-06-01
影响因子：
3.6
通讯作者：
Manabe, Yukari C.
中科院分区：
文献类型：
--
作者：
Hermans, Sabine M.;Castelnuovo, Barbara;Manabe, Yukari C.
背景：世界卫生组织建议，艾滋病毒感染患者的结核病治疗应与艾滋病毒护理相结合。2008年12月，为乌干达一个大型城市艾滋病毒诊所的参会者设立了一个单独的室外综合结核病/艾滋病毒诊所。我们试图评估相关的结核病和艾滋病治疗结果。方法：将常规收集的临床、药学和实验室数据与2009年开始接受结核病治疗的患者的结核病临床数据和2007年患者的结核病登记数据合并。比较2007年和2009年抗逆转录病毒治疗（ART）初治患者的结核病治疗结果和开始抗逆转录病毒治疗（ART）的时间[总体和按CD4+ T细胞（CD4）计数分层]。医院传播率无法评估。结果：2007年有346例患者开始接受结核病治疗，2009年为366例。结核诊断时的中位数CD4计数没有差异。结核病治疗治愈率或完成率从62%增加到68%，死亡或缺席从33%下降到25% （P < 0.001）。与2007年相比，2009年首次接受抗逆转录病毒治疗的结核病患者较少（57%和66%，P = 0.031），但这种减少仅发生在CD4细胞计数为每立方毫米250个细胞的患者中（19%对48%，P = 0.003）。更多的患者在结核病治疗期间开始抗逆转录病毒治疗（94%对78%，P < 0.001）。此外，大多数在强化期开始（60% vs. 23%, P < 0.001）。结论：结核病和艾滋病毒护理的整合改善了结核病治疗结果，并使抗逆转录病毒治疗更早、更优先地开始。这有助于在结核病和艾滋病毒高流行环境中推广完全一体化的结核病/艾滋病毒服务提供模式。
Background: The World Health Organization recommends that treatment of tuberculosis (TB) in HIV-infected patients should be integrated with HIV care. In December 2008, a separate outdoor-integrated TB/HIV clinic was instituted for attendees of a large urban HIV clinic in Uganda. We sought to evaluate associated TB and HIV treatment outcomes.Methods: Routinely collected clinical, pharmacy, and laboratory data were merged with TB clinic data for patients initiating TB treatment in 2009 and with TB register data for patients in 2007. TB treatment outcomes and (timing of) antiretroviral therapy (ART) initiation in ART-naive patients [overall and stratified by CD4+ T cell (CD4) count] in 2007 and 2009 were compared. Nosocomial transmission rates could not be assessed.Results: Three hundred forty-six patients were initiated on TB treatment in 2007 and 366 in 2009. Median CD4 counts at TB diagnosis did not differ. TB treatment cure or completion increased from 62% to 68%, death or default decreased from 33% to 25% (P < 0.001). Fewer ART-naive TB patients were initiated on ART in 2009 versus 2007 (57% and 66%, P = 0.031), but this decrease was only in patients with CD4 counts >250 cells per cubic millimeter (19% vs. 48%, P = 0.003). More patients were started on ART during TB treatment (94% vs. 78%, P < 0.001). Moreover, the majority were now initiated during intensive phase (60% vs. 23%, P < 0.001).Conclusions: Integration of TB and HIV care has led to improved TB treatment outcomes and earlier, prioritized ART initiation. This supports rollout of a fully integrated TB/HIV service delivery model throughout high-prevalence TB and HIV settings.