Free Content Impact of introducing human immunodeficiency virus testing, treatment and care in a tuberculosis clinic in rural Kenya

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

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: May 1, 2010

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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