Huerga H., Spillane H., Guerrero W., Odongo A., Varaine F.
Médecins Sans Frontières, Nairobi, Kenya; National Tuberculosis Programme, Homa Bay, KEN, Kenya; Médecins Sans Frontières France, Paris, France
Huerga, H., Médecins Sans Frontières, Nairobi, Kenya; Spillane, H., Médecins Sans Frontières, Nairobi, Kenya; Guerrero, W., Médecins Sans Frontières, Nairobi, Kenya; Odongo, A., National Tuberculosis Programme, Homa Bay, KEN, Kenya; Varaine, F., Médecins Sans Frontières France, Paris, France
SETTING: In July 2005, Médecins Sans Frontières and the Ministry of Health, Kenya, implemented an integrated tuberculosis-human immunodefi ciency 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 HIVpositive cases was respectively 303, 323 and 331 in the three periods. The proportion of patients receiving cotrimoxazole prophylaxis increased signifi cantly 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 signifi cant 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. © 2010 The Union.
antiretrovirus agent; cotrimoxazole; antibiotic prophylaxis; article; diagnostic test; health program; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; integrated health care system; intervention study; Kenya; lung tuberculosis; major clinical study; patient care; priority journal; retrospective study; treatment outcome; tuberculosis control; Anti-HIV Agents; Anti-Infective Agents; Delivery of Health Care, Integrated; HIV Infections; Humans; Kenya; Patient Care; Retrospective Studies; Rural Health Services; Treatment Outcome; Trimethoprim-Sulfamethoxazole Combination; Tuberculosis