Uwimana, J., Zarowsky, C., Hausler, H., et al. The International Journal of Tuberculosis and Lung Disease (October 2013), Vol. 17 No. 10, pp. S48-S55.
The authors assessed the effectiveness of a community-based intervention to integrate tuberculosis (TB), HIV, and prevention of mother-to-child transmission (PMTCT) services in Sisonke District of KwaZulu Natal, South Africa. The intervention entailed training community care workers (CCWs) to provide comprehensive services. Integrated TB/HIV/PMTCT services provided by CCWs were feasible, acceptable, and effective. Pre- and post-intervention data were collected and analyzed from 1,976 intervention and 1,608 control households. Significantly more intervention respondents received health education, HIV testing and counseling (HTC), screening for TB and sexually transmitted infections, and support for anti-TB and antiretroviral therapy; had sputum collected; and had access to PMTCT services. Intervention households were nearly five times more likely to be screened for TB. Higher education and income were associated with access to these services. Willingness to disclose HTC history increased from 68 percent to 92 percent among 2,449 respondents pre-intervention and 3,584 respondents post-intervention, respectively; and reports of receiving HTC increased from 57 to 75 percent. Community care workers performed more poorly than control providers in furnishing education on integrated management of childhood illnesses, vital documents, and referral for social grants, but performed better in referral for weighing and immunization. The authors highlighted the need to ensure comprehensive TB/HIV services, and to examine socioeconomic inequalities and access to community-based services and intervention cost-effectiveness.