title: Impact of integrating HIV and TB care and treatment in a regional tuberculosis hospital in rural Guatemala.
abstract: Resource-limited settings have made slow progress in integrating TB and HIV care for co-infected patients. We examined the impact of integrated TB/HIV care on clinical and survival outcomes in rural western Guatemala. Prospective data from 254 newly diagnosed TB/HIV patients (99 enrolled in the pre-integrated program from August 2005 to July 2006, and 155 enrolled in the integrated program from February 2008 to January 2009) showed no significant baseline differences between clients in the two periods. They were principally male (65.5 %), Mayan (71 %), median age 33 years, and CD4 count averaged 111 cells/mm³. TB/HIV co-infected patients were more likely to receive antiretroviral therapy in the integrated program than in the pre-integrated program (72 vs. 22 %, respectively) and had lower mortality (HR 0.22, 95 % CI 0.14–0.33). This study shows how using a TB setting as the entry point for integrated TB/HIV care can improve health outcomes for HIV-positive patients in rural Guatemala.
authors: Janet Midori
authors: JM
authors: Ikeda
authors: Cesar A López
authors: CA
authors: Tellez
authors: Esther Sid
authors: ES
authors: Hudes
authors: Kimberly
authors: K
authors: Page
authors: Jennifer
authors: J
authors: Evans
authors: Oliver
authors: O
authors: Racancoj
authors: Norman
authors: N
authors: Hearst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000453:epidemiology; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000458:organization & administration*; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods; D016730:Program Development / Q000379:methods; D015397:Program Evaluation; D011446:Prospective Studies; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D016019:Survival Analysis; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents