Integrating both clinical and service delivery approaches
High rates of tuberculosis (TB) have been found at autopsy in people living with HIV in sub-Saharan Africa. Coordinating clinical management and service delivery of TB and HIV would help to reduce mortality through earlier diagnosis of each, reduced time to treatment initiation, and improved adherence support. In high burden settings, the goal should be full integration and provision of a ‘one stop service’ for co-infected patients, not just a collaborative approach. TB-HIV integration could also improve the efficiency of service delivery in some settings, thereby reducing the workload on staff. This dossier consists of:
- A manual by the South African Dept of Health to guide integration of TB/HIV services, including ART, at primary health facilities
- A review by Quigley et al that looked at 5 different models of integration.
- A poster and publication showing that integration can both increase the chance that co-infected patients start ART and reduce the time to ART initiation
- A document by the World Health Organization (WHO)
N.B. The related issues of TB infection control and improved TB diagnostics (that are ‘nearer to the patient’) are addressed comprehensively in other Dossiers.