title: Impact of introducing human immunodeficiency virus testing, treatment and care in a tuberculosis clinic in rural Kenya.
abstract: METHODS
  In July 2005, Médecins Sans Frontières and the Ministry of Health, Kenya, implemented an integrated tuberculosis-human immunodeficiency virus (TB-HIV) programme in western Kenya.
  
  
  OBJECTIVE
  To evaluate the impact of an integrated TB-HIV programme on patient care and TB programme outcomes.
  
  
  METHODS
  Retrospective evaluation of three time periods: before (January-June 2005), shortly after (January-June 2006) and medium term after (January-December 2007) the implementation of the integrated programme.
  
  
  RESULTS
  Respectively 79% and 91% of TB patients were HIV tested shortly and at medium term after service integration. The HIV-positive rate varied from 96% before the intervention to respectively 88% (305/347) and 74% (301/405) after. The estimated number of HIV-positive cases was respectively 303, 323 and 331 in the three periods. The proportion of patients receiving cotrimoxazole prophylaxis increased significantly from 47% (142/303) to 94% (303/323) and 86% (285/331, P < 0.05). Before the intervention, 87% (171/197) of the TB-HIV patients would have been missed when initiating antiretroviral treatment, compared to respectively 29% (60/210) and 36% (78/215) after the integration. The TB programme success rate increased from 56% (230/409) to 71% (319/447) in the third period (P < 0.05); however, there was no significant decrease in the default rate: 20% to 22% (P = 0.66) and 18% (P = 0.37).
  
  
  CONCLUSIONS
  Integrated TB-HIV care has a very positive impact on the management of TB-HIV patients and on TB treatment outcomes.
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya. helena.huerga@paris.msf.org
authors.forename: H
authors.initials: H
authors.lastname: Huerga
authors.forename: H
authors.initials: H
authors.lastname: Spillane
authors.forename: W
authors.initials: W
authors.lastname: Guerrero
authors.forename: A
authors.initials: A
authors.lastname: Odongo
authors.forename: F
authors.initials: F
authors.lastname: Varaine
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D005791:Patient Care; D012189:Retrospective Studies; D019035:Rural Health Services; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy*
chemical_list: D019380:Anti-HIV Agents; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination