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Hellen Muttai, MBChB, MPH Clinical Care Manager

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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, MPH Clinical Care Manager South Rift Valley HIV Care & Treatment Program Kenya Medical Research Institute/Walter Reed Project

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

3 TB Treatment Completion
Integrated TB/HIV clinic opened July 2005 HIV Clinic Out-patient In-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

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 Achievements 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 patients

7 TB/HIV Clinic Summary Patients Enrolled = 792 (July 2005 to Dec. 2006)
Characteristic No. % Female % Age (yrs, mean/SD) (+12.3) TB Characteristics Pulmonary % Smears done (PTB) % smear – (smears done) % Baseline CD4 (cells/mm3) < % % % > %

8 Treatment Outcomes for Co-infected Patients
Mean 6-Month CD4 Change (cells/mm3) Care * ART * TB Treatment Outcome No % Completed % Transferred out % Loss to Follow up % Deaths % 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 President’s Emergency Plan for AIDS Relief Kericho District Hospital - Eunice Obiero KEMRI – Fredrick Sawe & Charles Sigei USMHRP – Douglas Shaffer, Tiffany Hamm Brown University – Jane Carter The 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.

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