Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya
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 (±1...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | AIDS Research and Treatment |
| Online Access: | http://dx.doi.org/10.1155/2012/238012 |
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| author | Douglas N. Shaffer Eunice T. Obiero Josphat B. Bett Ignatius N. Kiptoo Jonah K. Maswai Fredrick K. Sawe E. Jane Carter |
| author_facet | Douglas N. Shaffer Eunice T. Obiero Josphat B. Bett Ignatius N. Kiptoo Jonah K. Maswai Fredrick K. Sawe E. Jane Carter |
| author_sort | Douglas N. Shaffer |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-86ec110d7bb84081aa9fdb4bb9a1cf57 |
| institution | Kabale University |
| issn | 2090-1240 2090-1259 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | AIDS Research and Treatment |
| spelling | doaj-art-86ec110d7bb84081aa9fdb4bb9a1cf572025-02-03T05:50:47ZengWileyAIDS Research and Treatment2090-12402090-12592012-01-01201210.1155/2012/238012238012Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, KenyaDouglas N. Shaffer0Eunice T. Obiero1Josphat B. Bett2Ignatius N. Kiptoo3Jonah K. Maswai4Fredrick K. Sawe5E. Jane Carter6Kenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, KenyaThe Kericho District Hospital, Kenya Ministry of Health, P.O. Box 11, Kericho 20200, KenyaKenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, KenyaKenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, KenyaKenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, KenyaKenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, KenyaMiriam Hospital, Alpert Medical School, Brown University, 164 Summit Avenue, Providence, RI 02908, USAObjective. 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.http://dx.doi.org/10.1155/2012/238012 |
| spellingShingle | Douglas N. Shaffer Eunice T. Obiero Josphat B. Bett Ignatius N. Kiptoo Jonah K. Maswai Fredrick K. Sawe E. Jane Carter Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya AIDS Research and Treatment |
| title | Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya |
| title_full | Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya |
| title_fullStr | Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya |
| title_full_unstemmed | Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya |
| title_short | Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya |
| title_sort | successes and challenges in an integrated tuberculosis hiv clinic in a rural resource limited setting experiences from kericho kenya |
| url | http://dx.doi.org/10.1155/2012/238012 |
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