title: Outcomes of integrated treatment for tuberculosis and HIV in children at the primary health care level.
abstract: BACKGROUND
  Little is known about the integration of tuberculosis (TB) and human immunodeficiency virus (HIV) treatment in pediatric populations.
  
  
  METHODS
  Prospective cohort of 31 HIV-infected children aged 3-18 years initiating anti-tuberculosis treatment at five primary health care (PHC) clinics in Kinshasa, Democratic Republic of Congo, to describe survival, clinical and immunological outcomes of nurse-centered integrated TB-HIV treatment.
  
  
  RESULTS
  Almost all of the children (87.1%) were diagnosed with HIV during TB diagnosis. Most (87.0%) were successfully treated for TB. Two (6.5%) died during anti-tuberculosis treatment; both presented with low CD4 counts (36 and 59 cells/mm(3) compared to a median of 228 cells/mm(3) in the entire cohort). Most (74.2%) initiated antiretroviral therapy (ART) during anti-tuberculosis treatment. Overall, a median CD4 count increase of 106 cells/mm(3) was observed (P = 0.014), an increase of 113 cells/mm(3) among children on ART and of 71.5 cells/mm(3) in those not on ART (P = 0.78). Median body mass index increase during anti-tuberculosis treatment was 2.1 kg/m(2) overall (P = 0.002), 2.2 kg/m(2) among children on ART and 0.72 kg/m(2) in those not on ART (P = 0.08).
  
  
  CONCLUSIONS
  Integrated, nurse-centered, pediatric TB-HIV treatment at the PHC level in highly resource-limited settings is feasible and effective in achieving successful outcomes, including high ART uptake, low mortality, and immunological and clinical improvement.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. monitap@email.unc.edu
authors.forename: M R
authors.initials: MR
authors.lastname: Patel
authors.forename: M
authors.initials: M
authors.lastname: Yotebieng
authors.forename: F
authors.initials: F
authors.lastname: Behets
authors.forename: K
authors.initials: K
authors.lastname: Vanden Driessche
authors.forename: M
authors.initials: M
authors.lastname: Nana
authors.forename: A
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D019033:Delivery of Health Care, Integrated; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000451:nursing; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011237:Predictive Value of Tests; D059017:Primary Care Nursing; D011320:Primary Health Care; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000451:nursing; D015430:Weight Gain
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents