title: Provider-initiated HIV testing and counselling for TB patients and suspects in Nairobi, Kenya.
abstract: METHODS
  Integrated tuberculosis (TB) and human immunodeficiency virus (HIV) services in a resource-constrained setting.
  
  
  OBJECTIVE
  Pilot provider-initiated HIV testing and counselling (PITC) for TB patients and suspects.
  
  
  METHODS
  Through partnerships, resources were mobilised to establish and support services. After community sensitisation and staff training, PITC was introduced to TB patients and then to TB suspects from December 2003 to December 2005.
  
  
  RESULTS
  Of 5457 TB suspects who received PITC, 89% underwent HIV testing. Although not statistically significant, TB suspects with TB disease had an HIV prevalence of 61% compared to 63% for those without. Of the 614 suspects who declined HIV testing, 402 (65%) had TB disease. Of 2283 patients referred for cotrimoxazole prophylaxis, 1951 (86%) were enrolled, and of 1727 patients assessed for antiretroviral treatment (ART), 1618 (94%) were eligible and 1441 (83%) started treatment.
  
  
  CONCLUSIONS
  PITC represents a paradigm shift and is feasible and acceptable to TB patients and TB suspects. Clear directives are nevertheless required to change practice. When offered to TB suspects, PITC identifies large numbers of persons requiring HIV care. Community sensitisation, staff training, multitasking and access to HIV care contributed to a high acceptance of HIV testing. Kenya is using this experience to inform national response and advocate wide PITC implementation in settings faced with the TB-HIV epidemic.
authors.affiliation: United States Centers for Disease Control and Prevention, Nairobi, Kenya. jodhiambo@ke.cdc.gov
authors.forename: J
authors.initials: J
authors.lastname: Odhiambo
authors.forename: W
authors.initials: W
authors.lastname: Kizito
authors.forename: A
authors.initials: A
authors.lastname: Njoroge
authors.forename: N
authors.initials: N
authors.lastname: Wambua
authors.forename: L
authors.initials: L
authors.lastname: Nganga
authors.forename: M
authors.initials: M
authors.lastname: Mburu
authors.forename: J
authors.initials: J
authors.lastname: Mansoer
authors.forename: L
authors.initials: L
authors.lastname: Marum
authors.forename: E
authors.initials: E
authors.lastname: Phillips
authors.forename: J
authors.initials: J
authors.lastname: Chakaya
authors.forename: K M
authors.initials: KM
authors.lastname: De Cock
mesh_terms: D015492:AIDS Serodiagnosis; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D037001:Directive Counseling; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D015995:Prevalence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
chemical_list: D019380:Anti-HIV Agents; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination