# name
A Bundle of Services Increased Ascertainment of Tuberculosis
                among HIV-Infected Individuals Enrolled in a HIV Cohort in Rural
                Sub-Saharan Africa

# metadata.dc.description.abstract[].value
OBJECTIVES: To report on trends of tuberculosis ascertainment
                among HIV patients in a rural HIV cohort in Tanzania, and
                assessing the impact of a bundle of services implemented in
                December 2012, consisting of three components:(i)integration of
                HIV and tuberculosis services; (ii)GeneXpert for tuberculosis
                diagnosis; and (iii)electronic data collection. DESIGN:
                Retrospective cohort study of patients enrolled in the Kilombero
                Ulanga Antiretroviral Cohort (KIULARCO), Tanzania.). METHODS:
                HIV patients without prior history of tuberculosis enrolled in
                the KIULARCO cohort between 2005 and 2013 were included.Cox
                proportional hazard models were used to estimate rates and
                predictors of tuberculosis ascertainment. RESULTS: Of 7114 HIV
                positive patients enrolled, 5123(72%) had no history of
                tuberculosis. Of these, 66% were female, median age was 38
                years, median baseline CD4+ cell count was 243 cells/microl, and
                43% had WHO clinical stage 3 or 4. During follow-up, 421
                incident tuberculosis cases were notified with an estimated
                incidence of 3.6 per 100 person-years(p-y)[95% confidence
                interval(CI)3.26-3.97]. The incidence rate varied over time and
                increased significantly from 2.96 to 43.98 cases per 100 p-y
                after the introduction of the bundle of services in December
                2012. Four independent predictors of tuberculosis ascertainment
                were identified:poor clinical condition at baseline (Hazard
                Ratio (HR) 3.89, 95% CI 2.87-5.28), WHO clinical stage 3 or 4
                (HR 2.48, 95% CI 1.88-3.26), being antiretroviralnaive (HR 2.97,
                95% CI 2.25-3.94), and registration in 2013(HR 6.07, 95% CI
                4.39-8.38). CONCLUSION: The integration of tuberculosis and HIV
                services together with comprehensive electronic data collection
                and use of GeneXpert increased dramatically the ascertainment of
                tuberculosis in this rural African HIV cohort.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1371/journal.pone.0123275

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
A Bundle of Services Increased Ascertainment of Tuberculosis
                among HIV-Infected Individuals Enrolled in a HIV Cohort in Rural
                Sub-Saharan Africa