Fully vs. partially integrated services for TB-HIV in Myanmar: a health services review and a cohort study.

Abstract

<sec id="st1"> <title>SETTING</title> In Myanmar, integrated services for tuberculosis (TB) and human immunodeficiency virus (HIV) are operated either fully (as one single unit) or partially (each vertical programme provides both services). </sec> <sec id="st2"> <title>OBJECTIVE</title> To review the fully and partially integrated services for TB-HIV and to assess their TB treatment outcomes. </sec> <sec id="st3"> <title>METHODS</title> We analysed the compiled service database and conducted a cohort study on newly registered TB-HIV patients in 12 townships in Myanmar. </sec> <sec id="st4"> <title>RESULTS</title> No significant association between region/state and types of integration was detected. Townships with partially integrated services had a significantly larger population size, higher proportion of urban population as well as higher TB and TB-HIV case notification rates; however, the cartridge-based Xpert® MTB/RIF assay was used less frequently than in townships with fully integrated services. Treatment completion rate and unfavourable outcomes were not significantly different between the two models, although fully integrated services reported a higher cure rate. </sec> <sec id="st5"> <title>CONCLUSIONS</title> These mixed results suggest that during expansion of fully integrated services, the progress of treatment outcomes should be monitored carefully. </sec>.