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

Abstract EN

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/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 ≥ 50 cells/mm3 were twice as likely to achieve treatment success (OR=2.0, 95% CI = 1.3–3.1) compared to those with CD4 < 50 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.