title: Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya.
abstract: Objective. To describe TB/HIV clinic outcomes in a rural, Ministry of Health hospital. Design. Retrospective, secondary analyses. Descriptive statistics and logistic regression analyses evaluated baseline characteristics and outcomes. Results. Of 1,911 patients, 89.8% were adults aged 32.0 (±12.6) years with baseline CD4 = 243.3 (±271.0), 18.2% < 50 cells/mm(3). Pulmonary (84.8%, (32.2% smear positive)) exceeded extrapulmonary TB (15.2%). Over 5 years, treatment success rose from 40.0% to 74.6%, lost to follow-up dropped from 36.0% to 12.5%, and deaths fell from 20.0% to 5.4%. For patients starting ART after TB treatment, those with CD4 ≥ 50 cells/mm(3) were twice as likely to achieve treatment success (OR = 2.0, 95% CI = 1.3-3.1) compared to those with CD4 < 50 cells/mm(3). Patients initiating ART at/after 2 months were twice as likely to achieve treatment success (OR = 2.0, 95% CI = 1.3-3.3). Yearly, odds of treatment success improved by 20% (OR = 1.2, 95% CI = 1.0-1.5). Conclusions. An integrated TB/HIV clinic with acceptable outcomes is a feasible goal in resource-limited settings.
authors.affiliation: Kenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, Kenya.
authors.forename: Douglas N
authors.initials: DN
authors.lastname: Shaffer
authors.forename: Eunice T
authors.initials: ET
authors.lastname: Obiero
authors.forename: Josphat B
authors.initials: JB
authors.lastname: Bett
authors.forename: Ignatius N
authors.initials: IN
authors.lastname: Kiptoo
authors.forename: Jonah K
authors.initials: JK
authors.lastname: Maswai
authors.forename: Fredrick K
authors.initials: FK
authors.lastname: Sawe
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Carter