Current Integration of Tuberculosis (TB) and HIV Services in South Africa, 2011

Joel C Chehab,Amanda K Vilakazi-Nhlapo,Jeffrey D Klausner,Peter Vranken,Annatjie Peters,Eduard J Beck

doi:10.1371/journal.pone.0057791

Joel C Chehab, Amanda K Vilakazi-Nhlapo + Show 4 more

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https://doi.org/10.1371/journal.pone.0057791

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Journal: PLoS ONE	Publication Date: Mar 4, 2013
Citations: 42	License type: CC0 1.0

Affiliation: University of Pretoria, Department of Health

Abstract

SettingPublic Health Facilities in South Africa.ObjectiveTo assess the current integration of TB and HIV services in South Africa, 2011.DesignCross-sectional study of 49 randomly selected health facilities in South Africa. Trained interviewers administered a standardized questionnaire to one staff member responsible for TB and HIV in each facility on aspects of TB/HIV policy, integration and recording and reporting. We calculated and compared descriptive statistics by province and facility type.ResultsOf the 49 health facilities 35 (71%) provided isoniazid preventive therapy (IPT) and 35 (71%) offered antiretroviral therapy (ART). Among assessed sites in February 2011, 2,512 patients were newly diagnosed with HIV infection, of whom 1,913 (76%) were screened for TB symptoms, and 616 of 1,332 (46%) of those screened negative for TB were initiated on IPT. Of 1,072 patients newly registered with TB in February 2011, 144 (13%) were already on ART prior to Tb clinical diagnosis, and 451 (42%) were newly diagnosed with HIV infection. Of those, 84 (19%) were initiated on ART. Primary health clinics were less likely to offer ART compared to district hospitals or community health centers (p<0.001).ConclusionAs of February 2011, integration of TB and HIV services is taking place in public medical facilities in South Africa. Among these services, IPT in people living with HIV and ART in TB patients are the least available.

Highlights

Tuberculosis (TB) remains the leading cause of death and morbidity among people living with HIV in developing countries [1], and HIV infection the most potent known risk factor associated with developing active TB [2]
Among assessed sites in February 2011, 2,512 patients were newly diagnosed with HIV infection, of whom 1,913 (76%) were screened for TB symptoms, and 616 of 1,332 (46%) of those screened negative for TB were initiated on Isoniazid Preventive Therapy (IPT)
Since 2009, the response to the HIV epidemic has accelerated in South Africa with a rapid scale up of HIV services, yet the expansion of TB services for people living with HIV has been slower, with only 26% of TB patients having been tested for HIV infection in 2009 [5,6]

Summary

Introduction

Tuberculosis (TB) remains the leading cause of death and morbidity among people living with HIV in developing countries [1], and HIV infection the most potent known risk factor associated with developing active TB [2]. South Africa is home to the highest number of people living with HIV, has one of the highest TB incidence rates worldwide [3], and its TB/HIV co-infection rates are high, with as much as 80% of TB patients living with HIV in the province of KwaZulu-Natal [4]. Isoniazid Preventive Therapy, has been shown to be effective in preventing active TB in people living with HIV [7,8,9,10,11], and is recommended by national guidelines in South Africa for all patients living with HIV where TB has been ruled out [12], yet remains poorly implemented at the country level [13]. In 2010, South Africa reported approximately 760,000 HIV-infected people having been screened for TB, and 120,000 of these having been started on IPT [14]

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