Integrated tuberculosis and HIV care in a resource-limited setting: experience from the Martin Preuss centre, Malawi.
Phiri, S;
Khan, PY;
Grant, AD;
Gareta, D;
Tweya, H;
Kalulu, M;
Chaweza, T;
Mbetewa, L;
Kanyerere, H;
Weigel, R;
+1 more...Feldacker, C;
(2012)
Integrated tuberculosis and HIV care in a resource-limited setting: experience from the Martin Preuss centre, Malawi.
Tropical medicine & international health, 16 (11).
pp. 1397-1403.
ISSN 1360-2276
DOI: https://doi.org/10.1111/j.1365-3156.2011.02848.x
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OBJECTIVES: To describe the development and operation of integrated tuberculosis (TB) and HIV care at the Martin Preuss Centre, a multipartner organization bringing together governmental and non-governmental providers of HIV and TB services in Lilongwe, Malawi. METHODS: We used a case study approach to describe the integrated TB/HIV service and to illustrate successes and challenges faced by service providers. We quantified effective TB and HIV integration using indicators defined by the World Health Organization. RESULTS: The custom-designed building facilitates patient flow and infection control, and other important elements include coordinated leadership; joint staff training and meetings; and data systems prompting coordinated care. Some integrated services have worked well from the outset, such as promoting HIV testing among patients with TB (96% of patients with TB had documented HIV status in 2009). Other aspects of integrated care have been more challenging, for example achieving high uptake of antiretroviral therapy among HIV-positive TB patients and combining data from paper and electronic systems. Good TB treatment outcomes (>85% cure or completion) have been achieved among both HIV-positive and HIV-negative individuals. CONCLUSIONS: High-quality integrated services for TB and HIV care can be provided in a resource-limited setting. Lessons learned may be valuable for service providers in other settings of high HIV and TB prevalence.