Presentation on theme: "Hellen Muttai, MBChB, MPH Clinical Care Manager"— Presentation transcript:
1 Integration of TB and HIV Services A Case Study of Kericho District Hospital Hellen Muttai, MBChB, MPHClinical Care ManagerSouth Rift Valley HIV Care & Treatment ProgramKenya Medical Research Institute/Walter Reed Project
2 Why Integration? TB Clinic HIV Clinic Patients Programmatic Clinicians Patient’s hospital timeDouble clinics, queues, drug prescriptions, sets of labs, different clinic daysProgrammaticLow uptake of collaborative servicesCliniciansFocusing on individual diseases in one patient
3 TB Treatment Completion Integrated TB/HIV clinic opened July 2005HIV ClinicOut-patientIn-patientIntegrated TB/HIV ClinicTB Diagnosis and Treatment (for both HIV negative patientsHIV Testing & Counseling (for all TB patients)HIV SurveillanceTB and HIV Care & Treatment (for co-infected patients)Co-trimoxazole Preventive TherapyHIV PreventionTB Treatment Completion
4 Methods Retrospective TB/HIV Clinic chart review All patients seen in the clinic during a 18 month periodAdvantage of electronic medical records system
5 Achievements Provider Initiated Testing and Counseling (PITC) Total TB pts seen in 2006: 1226Tested for HIV- 1155: Testing rate 94.2%National PITC Uptake- 60% (2006)Routine HIV surveillance among TB patientsHIV+ 525: Co-infection rate 45.4%Routine HIV prevention services among TB and TB/HIV co-infected patientsCo-trimoxazole preventive therapy100% uptakeNational Uptake- 87% (2006)
6 Achievements Uptake of HIV Care and Treatment 100% of co-infected patients offered HIV Care and Treatment servicesEligible 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 togetherReduction in time spent in hospital by patients
8 Treatment Outcomes for Co-infected Patients Mean 6-Month CD4 Change (cells/mm3)Care *ART *TB Treatment OutcomeNo %Completed %Transferred out %Loss to Follow up %Deaths %Total %p value <0.001
9 Strengths/ Conclusions PROGRAM/ CLINIC LEVELSuccessful management of co-infected patients with good clinical outcomesSuccessful integration of TB and HIV services at a district hospital settingHigh uptake of TB/HIV collaborative servicesANALYTICPatients with combined TB/HIV infections may receive benefit from:primary TB treatment (“care”) aloneand additionally ARTPatients with combined TB/HIV infections often present with advanced HIV disease
10 LimitationsPRIMARY:Inherent limitations in retrospective chart reviewsClinic set-up not designed for systematic researchIncomplete/missing clinical data
11 RecommendationsIntegration of TB and HIV services needs to be considered in health facilities in order to improve uptake of collaborative servicesClinicians 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/NASCOPPresident’s Emergency Plan for AIDS ReliefKericho District Hospital - Eunice ObieroKEMRI – Fredrick Sawe & Charles SigeiUSMHRP – Douglas Shaffer, Tiffany HammBrown University – Jane CarterThe Kericho HIV cohort study is an important Epidemiological study with a wealth information unique to HIV in rural, East Africa.I appreciate the opportunity to present our data today, and I am thankful to many collaborators:Dr. Debbi Birx is the founder of the Kericho site and remains a strong advocate of HIV research as well as HIV care and treatment now throughout Africa in her new position as the CDC/GAP Director.Most importantly, I have the honor to work with remarkable Kenyan colleagues and friends who are the backbone of this study and the larger program: particularly, Dr. Fred Sawe, Dr. Robert Kimutai, and Dr. Stanley Kiplangat among others.Thank you.