Assessing the impact of TB/HIV services integration on TB treatment outcomes and their relevance in TB/HIV monitoring in Ghana
Identifieur interne : 000742 ( Main/Exploration ); précédent : 000741; suivant : 000743Assessing the impact of TB/HIV services integration on TB treatment outcomes and their relevance in TB/HIV monitoring in Ghana
Auteurs : Gloria Akosua Ansa [Ghana] ; John D. Walley [Royaume-Uni] ; Kamran Siddiqi [Royaume-Uni] ; Xiaolin Wei [République populaire de Chine]Source :
- Infectious Diseases of Poverty [ 2049-9957 ] ; 2012.
Abstract
The impact of the human immunodeficiency virus (HIV) on tuberculosis (TB), and the implications for TB and HIV control, is a public health challenge in Ghana – almost a quarter (23%) of all TB cases were HIV positive in 2010. The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV. The aim is to reduce fragmentation, improve access, enhance efficiency and improve quality of care. Ghana’s TB/HIV policy comprises three linked sets of activities: effective implementation of the Stop TB Strategy for TB control, improved HIV prevention and care, and the implementation of additional TB/HIV activities. Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care. The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.
A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted. Anonymised patient data was collated from TB registers from each facility, and analysed to determine if TB treatment outcomes changed significantly after integration.
TB treatment success was 50% (95% CI 49 – 52) prior to, and 69% (95% CI 65 – 73) after, integration (Χ2 43.96, p < 0.00). Treatment success increased from 43% to 53% at the one-stop shop (OSS), from 69% to 78% at the partially integrated site (PIS) and substantially from 46% to 78% at the referral site (RS) (Χ2 64.54; p<0.01). Defaults and cases transferred out reduced from 14.3% and 15.3% prior to integration, to 1.4% and 9.0% after integration, respectively, accounting for a significant increase in treatment success. Death rates remained high at 18% in all cases studied and 25% in HIV-associated cases after integration.
TB/HIV integration may improve TB treatment success, but its exact impact is difficult to ascertain due to non-specificity and design limitations. TB mortality may be more useful as an indicator for monitoring TB/HIV activities in Ghana.
Url:
DOI: 10.1186/2049-9957-1-13
PubMed: 23849044
PubMed Central: 3710204
Affiliations:
- Ghana, Royaume-Uni, République populaire de Chine
- Angleterre, Région du Grand Accra, Yorkshire-et-Humber
- Accra, Leeds, Sha Tin
- Université chinoise de Hong Kong, Université de Leeds
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O. Box LG 79, Legon, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University Hospital, Legon, University of Ghana, P. O. Box LG 79, Legon, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Walley, John D" sort="Walley, John D" uniqKey="Walley J" first="John D" last="Walley">John D. Walley</name><affiliation wicri:level="4"><nlm:aff id="I2">Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Siddiqi, Kamran" sort="Siddiqi, Kamran" uniqKey="Siddiqi K" first="Kamran" last="Siddiqi">Kamran Siddiqi</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, United Kingdom</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD</wicri:regionArea><wicri:noRegion>YO10 5DD</wicri:noRegion></affiliation></author><author><name sortKey="Wei, Xiaolin" sort="Wei, Xiaolin" uniqKey="Wei X" first="Xiaolin" last="Wei">Xiaolin Wei</name><affiliation wicri:level="4"><nlm:aff id="I4">School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China</nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author></analytic><series><title level="j">Infectious Diseases of Poverty</title><idno type="eISSN">2049-9957</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The impact of the human immunodeficiency virus (HIV) on tuberculosis (TB), and the implications for TB and HIV control, is a public health challenge in Ghana – almost a quarter (23%) of all TB cases were HIV positive in 2010. The integration of TB/HIV services has therefore emerged as an essential component of the national response to TB and HIV. The aim is to reduce fragmentation, improve access, enhance efficiency and improve quality of care. Ghana’s TB/HIV policy comprises three linked sets of activities: effective implementation of the Stop TB Strategy for TB control, improved HIV prevention and care, and the implementation of additional TB/HIV activities. Different models of service delivery with increasing integration of TB/HIV activities are expected to provide greater access to more comprehensive care. The objective of this paper is to assess the impact of TB/HIV integration on TB treatment outcomes and to explore the usefulness of TB treatment outcomes as TB/HIV indicators.</p></sec><sec><title>Methods</title><p>A before-and-after study to observe the introduction of TB/HIV activities into TB programmes in three hospitals with different levels of integration was conducted. Anonymised patient data was collated from TB registers from each facility, and analysed to determine if TB treatment outcomes changed significantly after integration.</p></sec><sec><title>Results</title><p>TB treatment success was 50% (95% CI 49 – 52) prior to, and 69% (95% CI 65 – 73) after, integration (Χ<sup>2</sup> 43.96, p < 0.00). Treatment success increased from 43% to 53% at the one-stop shop (OSS), from 69% to 78% at the partially integrated site (PIS) and substantially from 46% to 78% at the referral site (RS) (Χ<sup>2</sup> 64.54; p<0.01). Defaults and cases transferred out reduced from 14.3% and 15.3% prior to integration, to 1.4% and 9.0% after integration, respectively, accounting for a significant increase in treatment success. Death rates remained high at 18% in all cases studied and 25% in HIV-associated cases after integration.</p></sec><sec><title>Conclusion</title><p>TB/HIV integration may improve TB treatment success, but its exact impact is difficult to ascertain due to non-specificity and design limitations. TB mortality may be more useful as an indicator for monitoring TB/HIV activities in Ghana.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kodner, D" uniqKey="Kodner D">D Kodner</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kachiza, C" uniqKey="Kachiza C">C Kachiza</name></author><author><name sortKey="Msiska, T" uniqKey="Msiska T">T Msiska</name></author><author><name sortKey="Kaonga, E" uniqKey="Kaonga E">E Kaonga</name></author><author><name sortKey="Moodie, C" uniqKey="Moodie C">C Moodie</name></author><author><name sortKey="Wandwalo, E" uniqKey="Wandwalo E">E Wandwalo</name></author><author><name sortKey="Kellerman, S" uniqKey="Kellerman S">S Kellerman</name></author></analytic></biblStruct><biblStruct><analytic><author><name 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G" uniqKey="Tembo G">G Tembo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huerga, H" uniqKey="Huerga H">H Huerga</name></author><author><name sortKey="Spillane, H" uniqKey="Spillane H">H Spillane</name></author><author><name sortKey="Guerrero, W" uniqKey="Guerrero W">W Guerrero</name></author><author><name sortKey="Odongo, A" uniqKey="Odongo A">A Odongo</name></author><author><name sortKey="Varaine, F" uniqKey="Varaine F">F Varaine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maher, D" uniqKey="Maher D">D Maher</name></author><author><name sortKey="Watt, Cj" uniqKey="Watt C">CJ Watt</name></author><author><name sortKey="Williams, Bg" uniqKey="Williams B">BG Williams</name></author><author><name sortKey="Raviglione, M" uniqKey="Raviglione M">M Raviglione</name></author><author><name sortKey="Dye, C" uniqKey="Dye C">C Dye</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>Royaume-Uni</li><li>République populaire de Chine</li></country><region><li>Angleterre</li><li>Région du Grand Accra</li><li>Yorkshire-et-Humber</li></region><settlement><li>Accra</li><li>Leeds</li><li>Sha Tin</li></settlement><orgName><li>Université chinoise de Hong Kong</li><li>Université de Leeds</li></orgName></list><tree><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Ansa, Gloria Akosua" sort="Ansa, Gloria Akosua" uniqKey="Ansa G" first="Gloria Akosua" last="Ansa">Gloria Akosua Ansa</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Walley, John D" sort="Walley, John D" uniqKey="Walley J" first="John D" last="Walley">John D. Walley</name></region><name sortKey="Siddiqi, Kamran" sort="Siddiqi, Kamran" uniqKey="Siddiqi K" first="Kamran" last="Siddiqi">Kamran Siddiqi</name></country><country name="République populaire de Chine"><noRegion><name sortKey="Wei, Xiaolin" sort="Wei, Xiaolin" uniqKey="Wei X" first="Xiaolin" last="Wei">Xiaolin Wei</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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