{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T23:17:06Z","timestamp":1765840626522,"version":"3.48.0"},"reference-count":18,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,4,26]]},"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We piloted an intervention to determine if support from a case manager would assist adults being investigated for tuberculosis (TB) to link into TB and HIV care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Pilot interventional cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and setting<\/jats:title>\n                    <jats:p>Patients identified by primary healthcare clinic staff in South Africa as needing TB investigations were enrolled.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Participants were supported for 3\u2009months by case managers who facilitated the care pathway by promoting HIV testing, getting laboratory results, calling patients to return for results and facilitating treatment initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes measured<\/jats:title>\n                    <jats:p>Linkage to TB care was defined as starting TB treatment within 28 days in those with a positive test result; linkage to HIV care, for HIV-positive people, was defined as having blood taken for CD4 count and, for those eligible, starting antiretroviral therapy within 3\u2009months. Intervention implementation was measured by number of attempts to contact participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 562 participants (307 (54.6%) female, median age: 36 years (IQR 29\u201344)), most 477 (84.8%) had previously tested for HIV; of these, 328\/475 (69.1%) self-reported being HIV-positive. Overall, 189\/562 (33.6%) participants needed linkage to care (132 HIV care linkage only; 35 TB treatment linkage only; 22 both). Of 555 attempts to contact these 189 participants, 407 were to facilitate HIV care linkage, 78 for TB treatment linkage and 70 for both. At the end of 3-month follow-up, 40 participants had not linked to care (29 of the 132 (22.0%) participants needing linkage to HIV care only, 4 of the 35 (11.4%) needing to start on TB treatment only and 7 of the 22 (31.8%) needing both).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Many people testing for TB need linkage to care. Despite case manager support, non-linkage into HIV care remained higher than desirable, suggesting a need to modify this intervention before implementation. Innovative strategies to enable linkage to care are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-021111","type":"journal-article","created":{"date-parts":[[2018,5,24]],"date-time":"2018-05-24T07:10:15Z","timestamp":1527145815000},"page":"e021111","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Linkage to care among adults being investigated for tuberculosis in South Africa: pilot study of a case manager intervention"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3974-5961","authenticated-orcid":false,"given":"Noriah","family":"Maraba","sequence":"first","affiliation":[{"name":"The Aurum Institute, Johannesburg, Gauteng, South Africa"},{"name":"School of Public Health, Faculty of Health Science, University of Witwatersrand, Johannesburg, Gauteng, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Violet","family":"Chihota","sequence":"additional","affiliation":[{"name":"The Aurum Institute, Johannesburg, Gauteng, South Africa"},{"name":"School of Public Health, Faculty of Health Science, University of Witwatersrand, Johannesburg, Gauteng, South Africa"},{"name":"Foundation for Innovative New Diagnostics, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerrigan","family":"McCarthy","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Health Science, University of Witwatersrand, Johannesburg, Gauteng, South Africa"},{"name":"National Institute for Communicable Diseases, Sandringham, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gavin J","family":"Churchyard","sequence":"additional","affiliation":[{"name":"The Aurum Institute, Johannesburg, Gauteng, South Africa"},{"name":"School of Public Health, Faculty of Health Science, University of Witwatersrand, Johannesburg, Gauteng, South Africa"},{"name":"Advancing Treatment and Care for TB and HIV, South African Medical Research Council Collaborating Centre for HIV\/TB, Cape Town, South Africa"},{"name":"London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison D","family":"Grant","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Health Science, University of Witwatersrand, Johannesburg, Gauteng, South Africa"},{"name":"TB Centre, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"School of Nursing and Public Health, Africa Health Research Institute, University of Kwazulu-Natal, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,5,24]]},"reference":[{"key":"2025121515115642000_8.5.e021111.1","first-page":"936","article-title":"From suspect to patient: tuberculosis diagnosis and treatment initiation in health facilities in South Africa","volume":"12","author":"Botha","year":"2008","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025121515115642000_8.5.e021111.2","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.12.0505"},{"key":"2025121515115642000_8.5.e021111.3","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.tube.2013.05.001","article-title":"Lack of patient registration in the electronic TB register for sputum smear-positive patients in KwaZulu-Natal, South Africa","volume":"93","author":"Bristow","year":"2013","journal-title":"Tuberculosis"},{"key":"2025121515115642000_8.5.e021111.4","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00100-X"},{"key":"2025121515115642000_8.5.e021111.5","unstructured":"McCarthy K , Fielding K , Grant A , et al . High risk of early mortality among persons suspected of TB in South Africa. Poster 834 session 145 Conference on retroviruses and opportunistic infections;\u00a0March, 2013."},{"key":"2025121515115642000_8.5.e021111.6","unstructured":"National tuberculosis management guidelines. South Africa: National Department of Health, 2014. http:\/\/sahivsoc.org\/Files\/NTCP_Adult_TB%20Guidelines%2027.5.2014.pdf. 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