Authors: Huerga, H.¹; Spillane, H.¹; Guerrero, W.¹; Odongo, A.²; Varaine, F.³

Source: The International Journal of Tuberculosis and Lung Disease, Volume 14, Number 5, May 2010 , pp. 611-615(5)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: In July 2005, Médecins Sans Frontières and the Ministry of Health, Kenya, implemented an integrated tuberculosis-human immunodeficiency virus (TB-HIV) programme in western Kenya.

OBJECTIVE: To evaluate the impact of an integrated TB-HIV programme on patient care and TB programme outcomes.

DESIGN: Retrospective evaluation of three time periods: before (January-June 2005), shortly after (January-June 2006) and medium term after (January-December 2007) the implementation of the integrated programme.

RESULTS: Respectively 79% and 91% of TB patients were HIV tested shortly and at medium term after service integration. The HIV-positive rate varied from 96% before the intervention to respectively 88% (305/347) and 74% (301/405) after. The estimated number of HIV-positive cases was respectively 303, 323 and 331 in the three periods. The proportion of patients receiving cotrimoxazole prophylaxis increased significantly from 47% (142/303) to 94% (303/323) and 86% (285/331, P < 0.05). Before the intervention, 87% (171/197) of the TB-HIV patients would have been missed when initiating antiretroviral treatment, compared to respectively 29% (60/210) and 36% (78/215) after the integration. The TB programme success rate increased from 56% (230/409) to 71% (319/447) in the third period (P < 0.05); however, there was no significant decrease in the default rate: 20% to 22% (P = 0.66) and 18% (P = 0.37).

CONCLUSION: Integrated TB-HIV care has a very positive impact on the management of TB-HIV patients and on TB treatment outcomes.

Keywords: tuberculosis; HIV; one-stop; integration; ART

Document Type: Regular paper

Affiliations: 1: Médecins Sans Frontières, Nairobi, Kenya 2: National Tuberculosis Programme, Homa Bay, Kenya 3: Médecins Sans Frontières France, Paris, France

Publication date: 2010-05-01

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