HIV and tuberculosis co-infection in Uganda: Clinical management, immune reconstitution and health service delivery

Over time, antiretroviral therapy has been successfully initiated at higher baseline CD4 counts, leading to reduced mortality among HIV-infected patients at the Infectious Diseases Institute. Quality of care has improved which is evidenced by additional mortality improvements, increased tuberculosis case finding, and high retention rates on antiretroviral therapy.
However, significant barriers to further improved outcomes are late presentation to care, limited antiretroviral therapy availability, shortage of health care workers and the absence of a comprehensive strategy to diagnose tuberculosis. Current tuberculosis screening approaches among HIV-infected patients require significant human resource and monetary investment, and need optimising. The role of novel diagnostics in such screening algorithms needs to be defined. Integration of care for both diseases is feasible, can be achieved with minimal
resources, and leads to improved tuberculosis treatment outcomes and earlier initiation of antiretroviral therapy.