RESUMO
OBJECTIVE: To compare access to human immunodeficiency virus (HIV) care for tuberculosis (TB) patients in settings with antiretroviral treatment (ART) and TB care under one roof ('semi-integrated sites') and in settings with geographically separately rendered care in Tshwane, South Africa. METHODS: Historical cohort study of patients registered with TB at 46 TB treatment points, with follow-up until the end of anti-tuberculosis treatment. ART initiation for HIV-positive TB patients was established through linkage of TB register patient identifiers to the electronic ART register. Data analysis entailed univariate and multivariate competing risk analysis. RESULTS: The records of 636 and 1297 patients for semi-integrated and separate facilities, respectively, were reviewed. Cotrimoxazole prophylactic therapy and recording of CD4 count were lower in semi-integrated than in separate facilities, but the reverse was true for referral to HIV-related care. A higher percentage of patients started ART in the semi-integrated than in the separate facilities (70.5% vs. 44.6%, P < 0.001). In competing risk analysis (with death and lost to follow-up as competing risks), attending a semi-integrated facility (sub-hazard ratio [SHR] 2.49, 95%CI 1.06-5.88) and TB case load > 401 (SHR 1.45, 95%CI 1.04-2.03) were associated with increased ART initiation. CONCLUSIONS: ART and TB treatment under one roof appears to facilitate ART initiation for HIV-positive TB patients.
Assuntos
Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Coinfecção , Prestação Integrada de Cuidados de Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Acessibilidade aos Serviços de Saúde/organização & administração , Modelos Organizacionais , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Distribuição de Qui-Quadrado , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Modelos Logísticos , Masculino , Registro Médico Coordenado , Análise Multivariada , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , África do Sul/epidemiologia , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologiaRESUMO
A novel reversed-phase HPLC method with UV-detection for separation, identification and quantification of azithromycin (AZH) was developed. The method was validated for the purpose of quantifying AZH in stability, dissolution and solubility studies. The method was validated at two optimum wavelengths where linear regression at both 205 and 210 nm, resulted in correlation coefficients of r2 = 0.9999. This HPLC method proved to be superior to other published methods due to the specificity, resulting in less peak interference and tailing. The pH of the mobile phase, as well as the ratio of buffer to organic component included in the mobile phase, proved to be critical factors in the improved detection of AZH.
