GOOD SHEPHERD HOSPITAL - SWAZILAND

TB HIV integration in Hospitals (GSH) Swaziland.

Swaziland is ranked as the country where the highest estimated incidence rate of both TB and HIV (annual TB incidence = 1,262 per 100,000 population). Much attention has been paid to the HIV epidemic but relatively little has been undertaken to integrate the HIV and TB services in the country. Good Shepherd Hospital is a regional TB diagnostic and treatment facility in Swaziland, and also a regional provider of ART. Approximately 70% of those starting TB treatment have a known HIV status, and approximately 70% of these are HIV positive. About one in four of those commencing ART have a diagnosis of TB. International recommendations have been made for the integration of TB/HIV care in resource limited settings. However, evidence is lacking for the effects of such integration on a practical setting, particularly in the context of concern for nosocomial transmission of drug resistant TB. This study examined the effect of integrating HIV and TB management in a rural sub Saharan African hospital setting, relying mainly on existing data collection systems.

The proposed model involves an integrated TB-HIV service. Emphasis was placed on screening all patients for TB at HIV care settings, with interventions to reduce transmission and screening for HIV as a routine part of TB care. Currently a two-wing system is in place, whereby a comprehensive package of care for TB/HIV can be supplied while maintaining physical barriers between those with known TB and others awaiting HIV care. The package of intervention were evaluated in terms of ability to detect new cases of HIV/TB, qualitative perception of services and an assessment on impact of defaulting/adherence among those with TB/HIV co-infection. This first phase of study provided evidence for the model to be used for the effects of such integration to support development of programmes locally and more widely. This is still an ongoing intervention aiming further decentralisation of ART/TB services at primary health care levels.