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dc.rights.licenseCC BY-NC-ND license
dc.contributor.authorKufa, T.en
dc.contributor.authorFielding, K. L.en
dc.contributor.authorHippner, P.en
dc.contributor.authorKielmann, Karinaen
dc.contributor.authorVassall, A.en
dc.contributor.authorChurchyard, G. J.en
dc.contributor.authorGrant, A. D.en
dc.contributor.authorCharalambous, S.en
dc.date.accessioned2019-11-04T09:47:57Z
dc.date.available2019-11-04T09:47:57Z
dc.date.issued2018-07-25
dc.identifier.citationKufa, T., Fielding, K. L., Hippner, P., Kielmann, K., Vassall, A., Churchyard, G. J., Grant, A. D. & Charalambous, S. (2018) An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: Results of the MERGE cluster randomised trial. Contemporary Clinical Trials, 72, pp. 43-52.en
dc.identifier.issn1551-7144en
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/10171
dc.identifier.urihttps://doi.org/10.1016/j.cct.2018.07.013
dc.descriptionKielmann, Karina - ORCID 0000-0001-5519-1658 https://orcid.org/0000-0001-5519-1658en
dc.description.abstractObjectives: To evaluate the effect of an intervention to optimize TB/HIV integration on patient outcomes.en
dc.description.abstractMethods: Cluster randomised control trial at 18 primary care clinics in South Africa. The intervention was placement of a nurse (TB/HIV integration officer) to facilitate provision of integrated TB/HIV services, and a lay health worker (TB screening officer) to facilitate TB screening for 24 months. Primary outcomes were i) incidence of hospitalisation/death among individuals newly diagnosed with HIV, ii) incidence of hospitalisation/ death among individuals newly diagnosed with TB and iii) proportion of HIV-positive individuals newly diagnosed with TB who were retained in HIV care 12 months after enrolment.
dc.description.abstractResults: Of 3328 individuals enrolled, 3024 were in the HIV cohort, 731 in TB cohort and 427 in TB-HIV cohort. For the HIV cohort, the hospitalisation/death rate was 12.5 per 100 person-years (py) (182/1459py) in the intervention arm vs. 10.4/100py (147/1408 py) in the control arms respectively (Relative Risk (RR) 1.17 [95% CI 0.92–1.49]).For the TB cohort, hospitalisation/ death rate was 17.1/100 py (67/ 392py) vs. 11.1 /100py (32/ 289py) in intervention and control arms respectively (RR 1.37 [95% CI 0.78–2.43]). For the TB-HIV cohort, retention in care at 12 months was 63.0% (213/338) and 55.9% (143/256) in intervention and control arms (RR 1.11 [95% 0.89–1.38]).
dc.description.abstractConclusions: The intervention as implemented failed to improve patient outcomes beyond levels at control clinics. Effective strategies are needed to achieve better TB/HIV service integration and improve TB and HIV outcomes in primary care clinics.
dc.description.abstractTrial registration: South African Register of Clinical Trials (registration number DOH-27-1011-3846).
dc.description.sponsorshipThis study was supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of [Cooperative agreement 5U2GPS000811]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.en
dc.description.urihttps://doi.org/10.1016/j.cct.2018.07.013en
dc.format.extent43-52en
dc.language.isoenen
dc.publisherElsevieren
dc.relation.ispartofContemporary Clinical Trialsen
dc.rights© 2018 The Authors
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectTuberculosisen
dc.subjectHIVen
dc.subjectIntegrationen
dc.subjectCluster Randomised Trialen
dc.titleAn intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: Results of the MERGE cluster randomised trialen
dc.typeArticleen
dcterms.accessRightspublic
dcterms.dateAccepted2018-07-23
dc.description.volume72en
dc.description.ispublishedpub
rioxxterms.typeJournal Article/Reviewen
rioxxterms.publicationdate2018-06-25
refterms.dateFCD2019-11-04
refterms.depositExceptionpublishedGoldOAen
refterms.accessExceptionNAen
refterms.technicalExceptionNAen
refterms.panelUnspecifieden
qmu.authorKielmann, Karinaen
qmu.centreInstitute for Global Health and Developmenten
dc.description.statuspub
refterms.versionVoRen
refterms.dateDeposit2019-11-04


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