Addressing challenges in scaling up TB and HIV treatment integration in public health settings in South Africa

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Tuberculosis is the most common cause of death in people who are HIV-infected. Research has shown that when TB and HIV treatment and services are offered together there is a decrease in deaths for patients who have both these diseases. However, health care facilities in poor and developing countries struggle to efficiently provide both TB and HIV services to patients. We are testing whether an intervention for clinic staff, called ‘Quality Improvement’, will assist the staff to work in a more planned and structured manner to incorporate both TB and HIV services in their clinic and provide excellent quality of services. Our study will select 40 clinics from 2 rural districts in KwaZulu, South Africa and at random assign 20 clinics to receive the Quality Improvement intervention and 20 clinics to receive the standard support for delivering both TB and HIV services. We anticipate that clinics receiving the Quality Improvement intervention will have lower numbers of patient deaths from TB and HIV than those clinics receiving the standard support. Our study will inform how we can make combined TB and HIV services more manageable for clinics in poor and developing countries and so reduce deaths in TB and HIV patients.