Article

Integrated tuberculosis and HIV care in a resource-limited setting: experience from the Martin Preuss centre, Malawi

Lighthouse Trust, Lilongwe, Malawi.
Tropical Medicine & International Health (Impact Factor: 2.3). 08/2011; 16(11):1397-403. DOI: 10.1111/j.1365-3156.2011.02848.x
Source: PubMed

ABSTRACT 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.
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.
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.
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.

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    • "Patients must register and begin treatment at one of these sites but may elect to continue TB treatment at the registration site or another peripheral health facility. MPC's integrated TB ⁄ HIV model was described in detail previously (Phiri et al. 2011). At MPC's TB treatment registration, more than 95% of patients with TB have known HIV status at TB treatment initiation in large part owing to its opt-out HIV testing policy for TB suspects and patients. "
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