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. 2012:2012:238012.
doi: 10.1155/2012/238012. Epub 2012 Feb 16.

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, Josphat B Bett, Ignatius N Kiptoo, Jonah K Maswai, Fredrick K Sawe, E Jane Carter
Affiliations

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

Douglas N Shaffer et al. AIDS Res Treat. 2012.

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% < 50 cells/mm(3). 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 ≥ 50 cells/mm(3) were twice as likely to achieve treatment success (OR = 2.0, 95% CI = 1.3-3.1) compared to those with CD4 < 50 cells/mm(3). 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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Figures

Figure 1
Figure 1
Kericho District Hospital Integrated TB/HIV Clinic (est. 2005) and subsequent roll-out of seven regional integrated TB/HIV clinics (est. 2007–2009). Notes: DH: District Hospital, MH: Mission/Faith Based Hospital, SDH: Sub-District Hospital.
Figure 2
Figure 2
Overall treatment success by year in the Kericho District Hospital TB/HIV Clinic. Note: treatment success defined as proportion with cure or treatment complete.
See this image and copyright information in PMC

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