Integration of HIV care into primary care in South Africa: effect on survival of patients needing antiretroviral treatment

INTRODUCTION: Integration of human immunodeficiency virus (HIV) care into primary care is a potential strategy to improve access to antiretroviral therapy (ART) in high-burden countries. This study was conducted to determine the effect of integration of HIV care on survival of patients needing ART. METHODS: A questionnaire was used to measure integration of HIV care into primary care during a randomized controlled trial of task shifting and decentralization of HIV care in South Africa.. Cox proportional hazard ratios were estimated for the effect of 5 different integration scores (total, pre-ART, ART, mainstreaming HIV and internal integration) on survival of patients with CD4=350 cells/µl and not yet on ART. RESULTS: A total of 9,252 patients were followed up for 12-18 months. Cox proportional hazards ratios adjusted for patient and clinic characteristics, showed decreased risk of mortality in clinics with high scores for total integration (HR 0.97; 95% CI 0.95-0.98; p