Outcomes in HIV-infected adults with tuberculosis at clinics with and without co-located HIV clinics in Botswana

• Published in: The international journal of tuberculosis and lung disease Vol. 17; no. 10; pp. 1298 - 1303
• Main Authors: Schwartz, A. B., Tamuhla, N., Steenhoff, A. P., Nkakana, K., Letlhogile, R., Chadborn, T. R., Kestler, M., Zetola, N. M., Ravimohan, S., Bisson, G. P.
• Format: Journal Article
• Language: English
• Published: Paris, France International Union Against Tuberculosis and Lung Disease 01.10.2013; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; Age; Ambulatory Care Facilities - organization & administration; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy; Antiretroviral Therapy, Highly Active - methods; Antitubercular Agents - administration & dosage; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Botswana - epidemiology; Care Coordination; Co-Infection; Cohort Studies; Female; Follow-Up Studies; Health Systems; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - mortality; Human bacterial diseases; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; Medical sciences; Middle Aged; Pneumology; Retrospective Studies; Survival Rate; Time Factors; Treatment Outcome; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - mortality; Tuberculosis and atypical mycobacterial infections; Urban Health Services - organization & administration; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; Botswana; Africa; Antiretroviral agent; Mixed infection; Prognosis; antiretroviral therapy; Mycobacterial infection; Adult; Antiviral; Evolution; Human; Health system; Immunopathology; health systems; Coordination; co-infection; Respiratory disease; Retroviridae; AIDS; care coordination; Immune deficiency; Lentivirus; Care; Infection; Virus; Clinic; Chemotherapy; Treatment; Tuberculosis; Viral disease; Bacteriosis; Human immunodeficiency virus
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.12.0861

SETTING: Gaborone, Botswana.OBJECTIVE: 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.DESIGN: 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.RESULTS: 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).CONCLUSION: 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.