Integration of HIV and TB services results in improved TB treatment outcomes and earlier, prioritized ART initiation in a large urban HIV clinic in Uganda

Background—WHO recommends that treatment of TB in HIV-infected patients should be integrated with HIV care. In December 2008, a separate, outdoor integrated TB/HIV clinic was instituted for attendees of a large urban HIV clinic in Uganda. We sought to evaluate associated TB and HIV treatment outcomes. Methods—Routinely collected clinical, pharmacy and laboratory data was merged with TB clinic data for patients initiating TB treatment in 2009 and with TB register data for patients in 2007. TB treatment outcomes and (timing of) ART initiation in ART-naïve patients (overall and stratified by CD4+ T cell [CD4] count) in 2007 and 2009 were compared. Nosocomial transmission rates could not be assessed. Results—346 patients were initiated on TB treatment in 2007 and 366 in 2009. Median CD4 counts at TB diagnosis did not differ. TB treatment cure or completion increased from 62 % to 68%, death or default decreased from 33 % to 25 % (P<0.001). Fewer ART naïve TB patients were initiated on ART in 2009 versus 2007 (57 % and 66%, P=0.031), but this decrease was only in patients with CD4 counts>250/mm3 (19 % versus 48%, P=0.003). More patients were started o