Malawi has an HIV prevalence rate of 10.3% and a TB incidence rate of 163 per 100,000. Nearly 60% of TB patients are co-infected with HIV. TB is the leading cause of death among people living with HIV/AIDS. HIV-positive TB patients have worse treatment outcomes than HIV-negative TB patients, and TB-related mortality among TB/HIV co-infected patients is particularly high during the first two to three months of TB treatment. Early initiation of ART during TB treatment has been shown to improve survival. Despite high levels of TB/HIV
co-infection in Malawi and Southern Africa in general, these two diseases have been traditionally treated separately under separate vertical programs. Lack of coordination between National TB Control Program (NTP) and HIV/AIDS Department negatively impacts TB/HIV prevention, care and treatment, as patients are forced to travel to different clinics, make and wait in line for different appointments, and see different health care providers. Studies from Malawi have proven the integrated TB/HIV service delivery model to be more effective in terms of higher percentages of TB patients counseled and tested for HIV, as well as started on ART.1 In Malawi, TB CARE II is working with the NTP and the Ministry of Health to improve care and treatment outcomes for TB/HIV co-infected patients through a one-stop-shop model of integrated TB/HIV services.
Under the one-stop-shop model, TB, HIV, and co-infected patients are able to access a full package of services at one location, managed by one healthcare worker or health care team. For example, TB patients coming for TB treatment are offered HIV counseling and testing, and HIV patients coming for ART are routinely screened for TB. TB/HIV coinfected patients are able to get both TB treatment and ART at once, from staff who are able to more closely monitor their dual treatment outcomes. Health care teams are trained and equipped to provide TB screening and treatment, HTC, ART, as well as other services, including treatment for opportunistic infections and STIs. Patient data, as well as screening, monitoring, and reporting tools, are integrated to ensure high quality and comprehensive care.
Mangochi District Hospital Renovations
In 2014, TB CARE II funded the renovation of a one-stop shop TB/HIV facility at Mangochi District Hospital. Previously, the environment at the hospital was not conducive to integration. TB and HIV services were offered in rooms far apart from one another, and patients were forced to stand in multiple lines to access multiple services. Some patients unfamiliar with the hospital were often confused about where to go to access which services. The District Health Officer reported that many times, patients would simply give up before accessing the full array of necessary services. Now, the joint TB/HIV facility will be able to offer the full range of services to TB, HIV, and co-infected patients at one convenient location. The newly renovated facility was officially handed over to the district health office in September 2014.
To further improve the quality of services provided, TB CARE II supported and intensified TB case finding in HIV settings in order to identify TB patients among HIV-positive patients. Death audits are also being conducted to improve the clinical management of co-infected patients.
In the coming year, TB CARE II will work with the NTP and the HIV Department to establish five new TB/HIV one-stop-shop service centers in selected health facilities.