Sensitivity analyses and assumptions of different models in multivariate Cox proportional hazards regression analyses.

<p>Adjusted hazard ratios (HR) of ART initiation after integration compared to before integration in alternative Cox proportional hazards models. The baseline model is the one presented in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0046988#pone-0046988-t002" target="_blank">table 2</a> and includes the following variables: gender, age, CD4 count and previous TB initiation. SA, Sensitivity analysis; (n), number; <b>SA 1</b>: inclusion of the variables TB classification (pulmonary TB; extra-pulmonary TB; both pulmonary and extra-pulmonary TB) and TB patient category (new TB case; re-treatment TB case) into the model; <b>SA 2</b>: exclusion of patients transferred in from other TB services; <b>SA 3</b>: exclusion of patients with unknown exact ART initiation date during TB treatment; <b>SA 4</b>: patients with unknown exact ART initiation date during TB treatment assumed to have initiated ART in the middle of TB treatment; <b>SA 5</b>: categorization of continues variables (age, sex, TB Rx start outside of clinic); <b>SA 6:</b> only patients with CD4 cell counts ≤200 considered as according to national guidelines.</p

Kaplan-Meier curve for time from start of TB treatment to ART initiation for before and after service integration in Town 2 clinic from June 2008 to May 2009.

<p>Kaplan-Meier curve for time from start of TB treatment to ART initiation for before and after service integration in Town 2 clinic from June 2008 to May 2009.</p

Flow chart of patients included in the study in Town 2 clinic from June 2008 to May 2009.

<p>Legend: TB, tuberculosis; ART, antiretroviral treatment; TFO, transferred out; LTFU, lost to follow-up.</p

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

<div><p>Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29–90) and 44 days (interquartile range 24–90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.</p></div

Selection of public health facilities and numbers of patients on ART, Kinshasa 2015.

<p>(a) Antiretroviral treatment (ART) facilities in Kinshasa. Out of 35 existing health zones in Kinshasa, the two zones managed by the police and the military, serving 1187 patients, were excluded before analysis. (b) ART facilities included in the study. All high-burden facilities were targeted, and a purposive sample of low-burden facilities, including for each health zone the largest facility with 100–200 patients and the largest facility with < 100 patients.</p

Baseline characteristics of TB/HIV co-infected patients included in the study in Town 2 clinic from June 2008 to May 2009.

<p>TB Rx, TB treatment; IQR, interquartile range. *In clinic: TB treatment initiated in study clinic; outside clinic: number of days of TB treatment received in referral clinic before TB registration and treatment continuation in the study clinic.</p

Roles of health staff in Town 2 clinic after TB/HIV service integration.

<p>Model of care as it was implemented in Town 2 clinic in December 2008.</p

Cox proportional hazards models of factors associated with loss to follow-up before and after correction for mortality.

<p>ART, antiretroviral treatment; WHO, World Health Organization; HR, hazard ratio; CI, confidence interval; PMTCT, prevention of mother to child transmission; TB, tuberculosis; AZT, zidovudine; 3TC, lamivudine; NVP, nevirapine; D4T, stavudine; EFV, efavirenz. P-values for CD4 count, WHO stage, year of initiation on ART and antiretroviral regimen are from Wald test for linear hypothesis after estimation. After correction for mortality, loss to follow-up was not associated with male gender or weight anymore, while new associations emerged with higher baseline CD4 counts and pregnancy at initiation of ART.</p

Cox proportional hazards models for the effect of TB/HIV integration and baseline covariates on time to ART.

<p>cHR, crude Hazard Ratio; CI, confidence interval; aHR, adjusted Hazard Ratio;</p>*<p>The number of days that TB treatment was received in referral clinics before TB registration and treatment continuation in the study clinic. After adjusting for gender, age, CD4 count and previous TB initiation, patients were 60% more likely to initiate ART after service integration.</p

Patient characteristics at initiation of ART.

<p>ART, antiretroviral treatment; LTF, Lost to follow-up; IQR, interquartile range; PMTCT, prevention of mother to child transmission; TB, tuberculosis; AZT, zidovudine; 3TC, lamivudine; NVP, nevirapine; D4T, stavudine; EFV, efavirenz. </p><p>* All patients not lost to follow-up, including deaths occurring within 3 months after loss to follow-up;</p><p>** Patients lost to follow-up with available civil identification number who were alive 3 months after being lost.</p