title: Integrating tuberculosis and HIV services in rural Kenya: uptake and outcomes.
abstract: METHODS
  Seventeen rural public health facilities in Western Kenya that introduced three models of integrated care for tuberculosis (TB) and human immunodeficiency virus (HIV) patients.
  
  
  OBJECTIVE
  To assess the uptake and timing of cotrimoxazole preventive therapy (CPT) and antiretroviral treatment (ART) as well as anti-tuberculosis treatment outcomes among HIV-infected TB patients before (March-October 2010) and after (March-October 2012) the introduction of integrated TB-HIV care.
  
  
  METHODS
  A before-and-after cohort study using programme data.
  
  
  RESULTS
  Of 501 HIV-infected TB patients, 357 (71%) were initiated on CPT and 178 (39%) on ART in the period before the introduction of integrated TB-HIV care. Following the integration of services, respectively 316 (98%) and 196 (61%) of 323 HIV-infected individuals were initiated on CPT and on ART (P < 0.001). The median time to CPT and ART initiation dropped from 7 to 2 days and from 42 to 34 days during the pre- and post-integration phases, respectively. Overall TB success rates did not vary with integration or with type of model instituted.
  
  
  CONCLUSIONS
  Integration of TB and HIV services enhanced uptake and reduced delay in instituting CPT and ART in rural health facilities. There is a need to increase impetus in these efforts.
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: P
authors.initials: P
authors.lastname: Owiti
authors.affiliation: Médecins Sans Frontières (MSF), Brussels Operational Centre, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Bissell
authors.affiliation: The Union, South East Asia Regional Office, New Delhi, India.
authors.forename: A M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya ; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: L
authors.initials: L
authors.lastname: Diero
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya ; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Carter
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya ; Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA ; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya ; Department of Medicine, School of Medicine, Indiana University, Bloominton, Indiana, USA.
authors.forename: A
authors.initials: A
authors.lastname: Gardner
keywords: ART; TB-HIV; integration; one-stop shop; treatment outcome