Table 2. Program Characteristics and Implementation of Three I’s by HIV-TB service integration status in 47 ART programs treating adults in lower income countries.
| Integrated | Not integrated | TOTAL | P-value | |
|---|---|---|---|---|
| (n = 12) | (n = 35) | (n = 47) | ||
| IeDEA region, n (%) | 0.16 | |||
| Asia-Pacific | 0 (0%) | 6 (17%) | 6 (13%) | |
| CCASAnet | 3 (25%) | 4 (11%) | 7 (15%) | |
| Central Africa | 0 (0%) | 5 (14%) | 5 (11%) | |
| East Africa | 4 (33%) | 4 (11%) | 8 (17%) | |
| Southern Africa | 4 (33%) | 10 (29%) | 14 (30%) | |
| West Africa | 1 (8%) | 6 (17%) | 7 (15%) | |
| Number of countries, n* | 10 | 22 | 26 | |
| Setting, n (%) | 0.16 | |||
| Urban | 10 (83%) | 28 (80%) | 38 (81%) | |
| Peri-urban | 1 (8%) | 6 (17%) | 7 (15%) | |
| Rural | 1 (8%) | 1 (3%) | 2 (4%) | |
| Level of care, n (%) | 0.58 | |||
| Primary | 2 (17%) | 13 (27%) | 15 (32%) | |
| Secondary | 4 (33%) | 4 (11%) | 8 (17%) | |
| Tertiary | 6 (50%) | 18 (52%) | 24 (51%) | |
| Patient population, n (%) | 0.40 | |||
| Adults and children | 7 (58%) | 25 (71%) | 32 (68%) | |
| Adults only | 5 (42%) | 10 (29%) | 15 (32%) | |
| ART provision, n (%) | 0.84 | |||
| All HIV-infected patients | 9 (75%) | 25 (71%) | 34 (72%) | |
| <200 CD4 | 0 (0%) | 1 (3%) | 1 (2%) | |
| <350 CD4 | 3 (25%) | 9 (26%) | 12 (26%) | |
| Intensified case finding | ||||
| Screening algorithm during follow-up include the following symptoms and/or diagnostic tests, n (%) | ||||
| Four symptom screening† | 6 (50%) | 20 (57%) | 26 (55%) | 0.67 |
| Cough (any duration) | 6 (50%) | 21 (60%) | 27 (57%) | 0.79 |
| Fever (any duration) | 8 (67%) | 22 (63%) | 30 (64%) | 0.99 |
| Night sweats | 8 (67%) | 22 (63%) | 30 (64%) | 0.99 |
| Weight loss | 8 (67%) | 23 (66%) | 31 (66%) | 0.99 |
| Contact history with a TB case in family | 4 (33%) | 21 (60%) | 25 (53%) | 0.21 |
| Sputum AFB smear | 5 (42%) | 14 (40%) | 19 (40%) | 0.99 |
| Induced sputum | 0 (0%) | 2 (6%) | 2 (4%) | 0.99 |
| Gastric lavage | 1 (8%) | 0 (0%) | 1 (2%) | 0.57 |
| Biopsy | 3 (25%) | 5 (14%) | 8 (17%) | 0.68 |
| Chest radiography | 6 (50%) | 14 (40%) | 20 (43%) | 0.79 |
| TB culture | 1 (8%) | 3 (9%) | 4 (9%) | 0.99 |
| Other | 1 (8%) | 2 (6%) | 3 (6%) | 0.99 |
| Specific intensified case finding program, n (%) | 8 (67%) | 15 (43%) | 23 (49%) | 0.28 |
| Household intervention with contact tracing, n (%) | 4 (33%) | 8 (23%) | 12 (26%) | 0.74 |
| Isoniazid preventive therapy (IPT) | ||||
| IPT available for all adults at enrollment or at ART start | 5 (42%) | 3 (9%) | 8 (17%) | 0.029 |
| TST-positive only | 1 (8%) | 3 (9%) | 4 (9%) | 0.99 |
| Duration of IPT, n (%)‡ | 0.20 | |||
| 6 months | 2 (17%) | 3 (9%) | 5 (11%) | |
| 9–12 months | 3 (25%) | 3 (9%) | 6 (13%) | |
| Lifetime | 1 (8%) | 0 (0%) | 1 (2%) | |
| Never (not administered) | 6 (50%) | 29 (82%) | 35 (74%) | |
| Infection control measures | ||||
| Separation of sputum smear-positive TB patients and HIV-positive patients, n (%) | 9 (75%) | 20 (57%) | 29 (62%) | 0.45 |
| Separate waiting rooms and emergency wards for "coughing" patients, n (%) | 5 (42%) | 9 (26%) | 14 (30%) | 0.50 |
| Natural air exchange by dedicated windows, n (%) | 0.673 | |||
| Optimized natural ventilation | 6 (50%) | 15 (43%) | 21 (45%) | |
| Natural ventilation, but not optimized | 6 (50%) | 18 (51%) | 24 (51%) | |
| No natural ventilation | 0 (0%) | 2 (6%) | 2 (4%) | |
| Operated and maintained ventilators, n (%) | 6 (50%) | 11 (31%) | 17 (36%) | 0.42 |
| TB screening for medical staff working with TB patients, n (%) | 5 (42%) | 12 (34%) | 17 (36%) | 0.91 |
| Staff wears masks in close contact to TB patients, n (%) | 7 (58%) | 20 (57%) | 27 (57%) | 0.99 |
| Staff offered no specified TB protection, n (%) | 3 (25%) | 13 (37%) | 16 (34%) | 0.68 |
| Turn-around time for TB diagnosis, median days (IQR)§ | ||||
| Smear-positive patients | 3 (2, 5) | 4 (2, 7) | 4 (2, 7) | 0.27 |
| Smear-negative patients | 10 (3, 14) | 7 (4, 14) | 7 (4, 14) | 0.51 |
*Chi-squared and rank sum tests of association between integration and site characteristic
†Four symptom screening includes: cough, fever, night sweat, and weight loss
‡One site in Southern Africa reported unspecified “other” conditions for and duration of IPT use
§Continuous variables are reported as medians (interquartile range)
CCASAnet = Caribbean, Central and South America; TB = tuberculosis; ART = antiretroviral therapy; AFB = acid fast bacilli