Integrating tuberculosis and HIV services in low- and middle- income countries: a systematic review
Background: Tuberculosis and human immunodeficiency virus (HIV) infection are diseases of major public health importance in low and middle-income countries. Overlap varies: in 2007, HIV prevalence in tuberculosis patients was 73% in South Africa, compared with 1.9% in China. There is increasing recognition of the importance of effective management of tuberculosis and HIV disease together, and the need for service integration.
Aim and objectives: Our aim was to synthesise knowledge concerning the integrated delivery of TB/HIV services at health facility level in low- and middle-income countries. Specific objectives were to summarise how tuberculosis and HIV services have been integrated; to describe strengths and weakness of different models; to describe how effectiveness of integration has been measured; to identify barriers to integration; to identify gaps in knowledge and to formulate research priorities.
Methods: We conducted a systematic review of literature from low- or middle-income countries describing implementation of integrated HIV and tuberculosis services at health facility level. We did not limit to studies reporting outcome measures, or to specified study designs.
Findings: Among 1954 peer-reviewed articles/reports and 170 abstracts retrieved, 63 papers and 70 abstracts met our inclusion criteria, describing 136 examples of models of integration. We categorised examples into five models: (a) tuberculosis service, referring for HIV testing and treatment (16 examples); (b) tuberculosis service, testing for HIV and referring for treatment (35 examples); (c) HIV service, referring for tuberculosis screening and treatment (11 examples); (d) HIV service, screening for tuberculosis and referring for treatment (30 examples); (e) \"single facility\" where tuberculosis and HIV services were provided in the same facility (44 examples). In 18 papers, the model could not be classified. Reports of closer integration were generally more recently published, and mostly from sub- Saharan Africa.
Legido-Quigley, H.; Montgomery, C.M.; Khan, P.; Fakoya, A.; Getahun, H.; Grant, A.D. Integrating tuberculosis and HIV services in low- and middle- income countries: a systematic review. Presented at First Global Symposium on health systems research, 16-19 November 2010, Montreux, Switzerland. (2010) 4 pp.