Integration of tuberculosis (TB) and HIV services in Ghana

Integration of health services involves managing services to enhance quality for patient needs that cut across multiple services, providers and settings. The rapid growth of human immunodeficiency virus (HIV) has increased tuberculosis (TB) cases, and TB/HIV integration offers a unified strategy for control. This study evaluated TB/HIV integration in Ghana. The three sites evaluated applied varying degrees of integration. A mixed methods approach comprised an uncontrolled before-and-after study involving 1330 TB cases, and qualitative interviews with 29 providers and patients. TB treatment success was 51% before and 69% after integration [p<0.01; OR(95% CI)=2.17 (1.72 to 2.74)]. Treatment success increased in all sites after integration: 43% to 53% at the one-stop shop (OSS), 69% to 78% at the partially integrated site (PIS), and 46% to 78% at the referral site (RS). The change was significant only at the RS [(Χ2=64.54; p<0.01; OR(95% CI)=4.28 (2.97 to 6.18)]. HIV screening was highest (99%) at the OSS (Χ2=68.26; p<0.01), HIV-positive cases on CPT were highest (93.8%) at the RS (Χ2=9.29; p<0.01), and the PIS had the highest number (59.5%) on ART (Χ2=95.00; p