TB/HIV one-stop clinic reduces nonmedical cost of staying in care at Makululu Urban clinic and Kabwe Women, Newborn & Children's Hospital (KWNCH) in Kabwe District, Zambia

BACKGROUND: TB and HIV services integration has not been optimized in many resource-limited settings in Zambia, creating additional costs for TB/HIV co-infected clients who require an average of 4 appointments for each condition in 6 months. At Makululu Urban clinic and Kabwe Women Newborn and Children's Hospital (KWNCH), USAID Eradicate TB (ETB) implemented One-Stop TB/HIV Clinic to reduce non-medical costs, improve patient's adherence and outcomes of the TB/HIV clients.
DESCRIPTION: Front line Health Care Workers (HCWs) and Community Based Volunteers (CBVs) from ART and TB clinics received onsite orientation on the formation and objectives of One-Stop TB/HIV clinic in March 2020 followed by monthly mentorship by District health supervisors on TB and HIV treatment and management according to Ministry of Health (MOH) guidelines. TB-HIV coinfected patient case records were stored at the TB clinic during the duration of TB treatment and returned to ART clinic upon completion of TB treatment. Routine screening and recording for TB among PLHIV and HIV testing among TB clients were intensified.
LESSONS LEARNED: A total of 112 TB/HIV co-infected patients were enrolled from March 2020 to December 2020 at Makululu Urban clinic and KWNCH. Of these, 17% completed TB treatment, 9% died and 74% are still on treatment. All the enrolled clients received integrated services for laboratory, clinical and pharmacy. The number of appointments halved after integration during the 6 months of TB treatment and a proportional 50% decrease in the transport costs, and time spent by patients at the facility. The period between ART initiation and TB diagnosis among coinfected reduced from three days to one day. Testing of HIV among TB clients and screening for TB among PLHIV improved from 88% to 99%, and adherence levels improved from 90% to 100%.
CONCLUSIONS: One-Stop TB/HIV clinic intervention of integrating TB/HIV services reduced TB's catastrophic economic burden by halving non-medical costs (transport and time) of staying in care for TB/HIV coinfected patients. It also improved TB/HIV appointment adherence and TB treatment outcomes.