Roadmap for Optimizing TB-HIV Service Integration in Rural Eastern Cape: A Pilot of Clinical Governance Approach

Background: Effective clinical governance is essential for improving tuberculosis (TB) and HIV service integration, particularly in resource-limited settings where fragmented care contributes to poor patient outcomes. This study aimed to identify key governance determinants of successful TB-HIV integration and to model future TB incidence trends under current intervention scenarios. Methods: A quantitative analytical approach was employed using a decision tree classifier to evaluate 10 TB-HIV integration cases. Governance-related variables included funding, healthcare worker training, patient education, medication access, and infection control. The Gini index was used to assess decision-making clarity, while correlation network analysis examined relationships among variables. A logistic decay model was further applied to project TB incidence trends over time. Results: The decision tree model identified funding as the primary determinant of TB-HIV integration success. All cases with increased funding achieved successful integration (6/6), whereas all cases without funding failed (4/4). Correlation analysis showed strong associations between funding and TB-HIV integration (r = 0.78), healthcare worker training (r = 0.76), and patient education (r = 0.62), while infection control demonstrated a moderate association (r = 0.58). The logistic decay model indicated a substantial historical decline in TB incidence, followed by a slower projected reduction to 298 cases per 100,000 population by 2030. Conclusion: Sustained financial investment is the most critical determinant of successful TB-HIV service integration. While training, patient education, and infection control enhance outcomes, their effectiveness depends on adequate funding. Strengthening clinical governance through strategic financing and integrated service delivery is essential for improving patient outcomes and reducing the long-term burden of TB.