Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya

doi:10.1155/2012/238012

AIDS Res Treat. 2012; 2012: 238012.

Published online 2012 February 16. doi: 10.1155/2012/238012

PMCID: PMC3287023

Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya

Douglas N. Shaffer,¹^* Eunice T. Obiero,² Josphat B. Bett,¹ Ignatius N. Kiptoo,¹ Jonah K. Maswai,¹ Fredrick K. Sawe,¹ and E. Jane Carter³

¹Kenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, Kenya

²The Kericho District Hospital, Kenya Ministry of Health, P.O. Box 11, Kericho 20200, Kenya

³Miriam Hospital, Alpert Medical School, Brown University, 164 Summit Avenue, Providence, RI 02908, USA

*Douglas N. Shaffer: Email: dshaffer/at/wrp-kch.org

Academic Editor: Anthony Harries

Received September 14, 2011; Revised November 11, 2011; Accepted November 28, 2011.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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% <

cells/mm³. 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 ≥

cells/mm³ were twice as likely to achieve treatment success (OR = 2.0, 95% CI

1.3–3.1) compared to those with CD4 <

cells/mm³. 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.

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