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AIDS Research and Treatment
Volume 2012, Article ID 238012, 8 pages
http://dx.doi.org/10.1155/2012/238012
Clinical Study

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

1Kenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, Kenya
2The Kericho District Hospital, Kenya Ministry of Health, P.O. Box 11, Kericho 20200, Kenya
3Miriam Hospital, Alpert Medical School, Brown University, 164 Summit Avenue, Providence, RI 02908, USA

Received 14 September 2011; Revised 11 November 2011; Accepted 28 November 2011

Academic Editor: Anthony Harries

Copyright © 2012 Douglas N. Shaffer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 (±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 ( , 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 ( , 95% CI = 1.3–3.3). Yearly, odds of treatment success improved by 20% ( , 95% CI = 1.0–1.5). Conclusions. An integrated TB/HIV clinic with acceptable outcomes is a feasible goal in resource-limited settings.