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Integration of TB and HIV Services A Case Study of Kericho District Hospital Hellen Muttai, MBChB, MPH Clinical Care Manager South Rift Valley HIV Care.

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Presentation on theme: "Integration of TB and HIV Services A Case Study of Kericho District Hospital Hellen Muttai, MBChB, MPH Clinical Care Manager South Rift Valley HIV Care."— Presentation transcript:

1 Integration of TB and HIV Services A Case Study of Kericho District Hospital Hellen Muttai, MBChB, MPH Clinical Care Manager South Rift Valley HIV Care & Treatment Program Kenya Medical Research Institute/Walter Reed Project

2 Patients Patients hospital time Double clinics, queues, drug prescriptions, sets of labs, different clinic days TB Clinic HIV Clinic Why Integration? Clinicians Focusing on individual diseases in one patient Programmatic Low uptake of collaborative services

3 HIV ClinicIn-patient Integrated TB/HIV Clinic TB Diagnosis and Treatment (for both HIV negative patients HIV Testing & Counseling (for all TB patients) HIV Surveillance TB and HIV Care & Treatment (for co-infected patients) Co-trimoxazole Preventive Therapy HIV Prevention TB Treatment Completion Integrated TB/HIV clinic opened July 2005 Out-patient

4 Methods Retrospective TB/HIV Clinic chart review –All patients seen in the clinic during a 18 month period –Advantage of electronic medical records system

5 Achievements Provider Initiated Testing and Counseling (PITC) –Total TB pts seen in 2006: 1226 –Tested for HIV- 1155: Testing rate 94.2% –National PITC Uptake- 60% (2006) Routine HIV surveillance among TB patients –HIV+ 525: Co-infection rate 45.4% Routine HIV prevention services among TB and TB/HIV co-infected patients Co-trimoxazole preventive therapy –100% uptake –National Uptake- 87% (2006)

6 Uptake of HIV Care and Treatment –100% of co-infected patients offered HIV Care and Treatment services –Eligible for ART- 78% –100% (of eligible) started on ART (56.1% started in course of TB treatment; 22% started after completion of TB treatment) –National ART Uptake-26% (2006) Clinicians tying the management of both diseases together Reduction in time spent in hospital by patientsAchievements

7 TB/HIV Clinic Summary Patients Enrolled = 792 (July 2005 to Dec. 2006) Characteristic No. % Female % Age (yrs, mean/SD) 33.1 (+12.3) TB Characteristics Pulmonary % Smears done (PTB) % smear – (smears done) % Baseline CD4 (cells/mm 3 ) < % % % > %

8 Treatment Outcomes for Co-infected Patients Mean 6-Month CD4 Change (cells/mm 3 ) Care +78* ART +139* TB Treatment Outcome No. % Completed % Transferred out 87 11% Loss to Follow up % Deaths 87 11% Total % p value <0.001

9 Strengths/ Conclusions PROGRAM/ CLINIC LEVEL –Successful management of co-infected patients with good clinical outcomes –Successful integration of TB and HIV services at a district hospital setting –High uptake of TB/HIV collaborative services ANALYTIC –Patients with combined TB/HIV infections may receive benefit from: primary TB treatment (care) alone and additionally ART –Patients with combined TB/HIV infections often present with advanced HIV disease

10 Limitations PRIMARY: –Inherent limitations in retrospective chart reviews Clinic set-up not designed for systematic research Incomplete/missing clinical data

11 Recommendations Integration of TB and HIV services needs to be considered in health facilities in order to improve uptake of collaborative services Clinicians treating patients with TB/HIV should be aware of the benefit to HIV infection by treating TB and offering supportive care alone, and additionally ART. Efforts to identify patients with TB/HIV early in their disease may offer tangible benefit by providing the opportunity to consider early ART. Further controlled studies are needed to best identify when (and what settings) to initiate ART in patients receiving TB treatment.

12 Acknowledgements Kericho District Hospital TB/HIV Clinic Kenya Ministry of Health/NLTP/NASCOP Kenya Ministry of Health/NLTP/NASCOP Presidents Emergency Plan for AIDS Relief Presidents Emergency Plan for AIDS Relief Kericho District Hospital - Eunice Obiero Kericho District Hospital - Eunice Obiero KEMRI – Fredrick Sawe & Charles Sigei KEMRI – Fredrick Sawe & Charles Sigei USMHRP – Douglas Shaffer, Tiffany Hamm USMHRP – Douglas Shaffer, Tiffany Hamm Brown University – Jane Carter Brown University – Jane Carter


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