Missed opportunities for accessing HIV care among Tshwane tuberculosis patients under different models of care

Abstract

BACKGROUND: This study aimed to compare access to HIV care for tuberculosis patients in settings with Antiretroviral Treatment (ART) and tuberculosis care under one roof (“semi-integrated sites”) and settings with geographically separately rendered care, in Tshwane, South Africa. METHODS: Historical cohort study of patients registered with tuberculosis at 46 TB treatment points, with follow-up until the end of TB treatment. ART initiation for HIV-positive TB patients was established through linkage of TB register patient identifiers to the electronic ART register. Data analysis entailed univariate and multivariate competing risk analysis. RESULTS: Records of 636 and 1297 patients for semi-integrated and separate facilities respectively were reviewed. Co-trimoxazole prophylactic therapy and CD4 count recording were lower in semi-integrated than separate facilities, but the reverse was true for referral to HIV-related care. A higher percentage of patients started ART in semi-integrated than in separate facilities (70.5% vs. 44.6%, P < 0.001). In competing risk analysis (with death and LTFU as competing risks), attending a semi-integrated facility (SHR 2.49, 95%CI 1.06-5.88) and TB case load > 401 (SHR 1.45, 95%CI 1.04-2.03) were associated with increased ART initiation. CONCLUSIONS: ART and TB treatment under one roof appears to facilitate ART initiation for HIV-positive TB patients.