Uwimana, J., and Jackson, D. The International Journal of Tuberculosis and Lung Disease (October 2013), Vol. 17 No. 10, pp. 1285-1290.
The authors assessed the integration of tuberculosis (TB) services with prevention of mother-to-child transmission (PMTCT) services at antenatal care (ANC) clinics in Sisonke District in South Africa’s KwaZulu-Natal province. They conducted surveys with 150 ANC clients and interviews with 26 program managers, and reviewed data from 1,700 registered ANC clients (2008 to 2009). While there was some integration, active TB case finding among pregnant HIV-positive women was substandard. TB prevalence among pregnant clients was 1.3 percent overall and 8 percent among HIV-positive clients (2 of 26 HIV-positive women). TB diagnosis was statistically associated with HIV status. In total, 83 clients (56 percent) reported being screened for TB; 75 percent of clients interviewed reported receiving education about TB. Among all registered clients, 55 percent of HIV-positive pregnant women (n=298) were screened for TB, with four women diagnosed and on TB treatment. However, there was no record of treatment outcomes or screening for isoniazid preventative therapy (IPT) for latent TB infection. Most key informants found integration inadequate because of insufficient coordination and supervision, staff shortages, referral structures between services, and poor monitoring and evaluation of integrated services. Programs need to address health system barriers and develop key indicators to measure integration. The authors concluded that improving integration is vital and will require strong leadership and supportive supervision for health care workers.