This policy brief makes the following key points:
TB and HIV services need to be coordinated, particularly in settings where most patients with TB are also HIV positive.
A review of examples of how TB and HIV services have been integrated in practice suggests five models of integration of HIV and TB services: TB service refers for HIV testing and treatment; TB service tests for HIV and refers for treatment; HIV service refers for TB screening and treatment; HIV service screens for TB and refers for treatment; TB and HIV services provided at a single facility.
Models based on referral require minimal extra resources, but are dependent on a robust referral system.
When TB services provide HIV testing, and HIV services screen for TB and then refer for treatment, some additional staff training and infrastructure may be needed; this level of integration is likely to benefit patients in most settings.
Single facility models reduce the transport costs and patient time needed to access both services, and should save staff time, but may require significant investment.
Research is needed to provide data on the effectiveness, cost-effectiveness and patients' and health service staff's perspectives of these models.
Standardised measures of how well integration is working should be reported by TB and HIV programmes, to make it easier to compare between different programmes and models of integration.
Evidence for Action Policy Briefing Issue 06, December 2010, 4 pp.