Integrating tuberculosis and HIV services in low- and middle-income countries: a systematic review.


Legido-Quigley, H; Montgomery, CM; Khan, P; Atun, R; Fakoya, A; Getahun, H; Grant, AD; (2012) Integrating tuberculosis and HIV services in low- and middle-income countries: a systematic review. Tropical medicine & international health, 18 (2). pp. 199-211. ISSN 1360-2276 DOI: https://doi.org/10.1111/tmi.12029

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Abstract

OBJECTIVES: Given the imperative to scale up integrated tuberculosis (TB) and HIV services in settings where both are of major public health importance, we aimed to synthesise knowledge concerning implementation of TB/HIV service integration.<br/> METHODS: Systematic review of studies describing a strategy to facilitate TB and HIV service integration, searching 15 bibliographic databases including Medline, Embase and the Cochrane library; and relevant conference abstracts.<br/> RESULTS: Sixty-three of 1936 peer-reviewed articles and 70 of 170 abstracts met our inclusion criteria. We identified five models: entry via TB service, with referral for HIV testing and care; entry via TB service, on-site HIV testing, and referral for HIV care; entry via HIV service with referral for TB screening and treatment; entry via HIV service, on-site TB screening, and referral for TB diagnosis and treatment; and TB and HIV services provided at a single facility. Referral-based models are most easily implemented, but referral failure is a key risk. Closer integration requires more staff training and additional infrastructure (e.g. private space for HIV counselling; integrated records). Infection control is a major concern. More integrated models hold potential efficiencies from both provider and user perspective. Most papers report 'outcomes' (e.g. proportion of TB patients tested for HIV); few report downstream 'impacts' such as outcomes of TB treatment or antiretroviral therapy. Very few studies address the perspectives of service users or staff, or costs or cost-effectiveness.<br/> CONCLUSIONS: While scaling up integrated services, robust comparisons of the impacts of different models are needed using standardised outcome measures.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Academic Services & Administration > Academic Administration
Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: TB Centre
ECOHOST - The Centre for Health and Social Change
PubMed ID: 23217030
Web of Science ID: 313894300011
URI: http://researchonline.lshtm.ac.uk/id/eprint/512769

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