Date of this Version
International Journal of Tuberculosis and Lung Disease
To determine if starting anti-tuberculosis treatment at clinics in Gaborone without co-located human immunodeficiency virus (HIV) clinics would delay time to highly active antiretroviral therapy (HAART) initiation and be associated with lower survival compared to starting anti-tuberculosis treatment at clinics with on-site HIV clinics.
Retrospective cohort study. Subjects were HAART-naïve, aged ≥21 years with pulmonary tuberculosis (TB), HIV and CD4 counts ≤250 cells/mm3 initiating anti-tuberculosis treatment between 2005 and 2010. Survival at completion of anti-tuberculosis treatment or at 6 months post-treatment initiation and time to HAART after anti-tuberculosis treatment initiation were compared by clinic type.
Respectively 259 and 80 patients from clinics without and with on-site HIV facilities qualified for the study. Age, sex, CD4, baseline sputum smears and loss to follow-up rate were similar by clinic type. Mortality did not differ between clinics without or with on-site HIV clinics (20/250, 8.0% vs. 8/79, 10.1%, relative risk 0.79, 95%CI 0.36–1.72), nor did median time to HAART initiation (respectively 63 and 66 days, P = 0.53).
In urban areas where TB and HIV programs are separate, geographic co-location alone without further integration may not reduce mortality or time to HAART initiation among co-infected patients.
Published in final, edited form as: Int J Tuberc Lung Dis. Oct 2013; 17(10): 1298–1303. doi: 10.5588/ijtld.12.0861
care coordination, health systems, co-infection, antiretroviral therapy
Schwartz, Adam B.; Tamuhla, Neo; Steenhoff, Andrew P.; Nkakana, Kelebogile; Letlhogile, Rona; Chadborn, Tim R.; Kestler, Mary; Zetola, Nicola M.; Ravimohan, Shruthi; and Bisson, Gregory P., "Outcomes in HIV-Infected Adults With Tuberculosis at Clinics With and Without Co-Located HIV Clinics in Botswana" (2013). Botswana-UPenn Scholarly Publications. 24.
Date Posted: 13 November 2014
This document has been peer reviewed.