Integrating tuberculosis and HIV care in rural Rwanda.
METHODS
Rwanda has generalised human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics. The Rwandan Ministry of Health approved a policy on TB-HIV collaborative activities in 2005. The present study is a report on the results of the integrated TB and HIV activities at a rural health care site between July 2005 and June 2006.


METHODS
Activities included provider-initiated HIV testing and counselling (PITC) of TB patients and the implementation of a standardised TB screening questionnaire for in-patients on medical wards and HIV-infected out-patients.


RESULTS
Of a total 259 TB patients registered, 87% with unknown HIV status or who were HIV-negative accepted PITC. Overall, 48% (125/259) of TB patients were HIV-infected. The proportion of TB patients ever tested for HIV increased from 82% (138/169) in 2004-2005 to 93% (240/259) in 2005-2006 (P < 0.001). Of the 770 in-patients screened for TB, 162 (21%) tested positive, of whom 53 (33%) were diagnosed with TB; 39 (76%) of these were HIV co-infected. Three hundred out-patients with HIV were screened for TB; 80 (27%) tested positive, of whom 11 (14%) were diagnosed with TB.


CONCLUSIONS
Activities integrating TB and HIV were feasible in a rural health care setting. PITC was successful in TB patients and unrecognised TB was common, particularly among HIV-infected in-patients.
Gasana
M
M
Programme National Intégré de Lutte contre la Lèpre et la Tuberculose, Rwandan Ministry of Health, Kigali, Rwanda.
Vandebriel
G
G
Kabanda
G
G
Tsiouris
S J
SJ
Justman
J
J
Sahabo
R
R
Kamugundu
D
D
El-Sadr
W M
WM
D015492:AIDS Serodiagnosis; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D037001:Directive Counseling; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006679:HIV Seropositivity; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009313:National Health Programs / Q000458:organization & administration; D019035:Rural Health Services / Q000458:organization & administration; D012432:Rwanda / Q000453:epidemiology; D011795:Surveys and Questionnaires / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology / Q000628:therapy*