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Good antiretroviral and TB treatment outcomes in a nurse-centered primary health care program for HIV co-infected TB patients
A. Van Rie1, N. Mbonze2, K. Tillerson1, F. Kitenge3, I. Roger1, K. Vanden Driessche2, F. Behets1
1University of North Carolina, Epidemiology, Chapel Hill, United States, 2UNC-DRC, Kinshasa, Congo, the Democratic Republic of the, 3University of Kinshasa, School of Public Health, Kinshasa, Congo, the Democratic Republic of the
Background: Integrated care of HIV and tuberculosis (TB) at the primary health care level is imperative. TB is the most common AIDS presenting illness and a frequent cause of death in people living with HIV. We initiated and evaluated a comprehensive HIV care and treatment program implemented by TB nurses at primary health care clinics.
Methods: Prospective cohort of HIV co-infected TB patients at 5 clinics in Kinshasa, DRC. TB nurses were trained in HIV care, including clinical staging, opportunistic infections, and basics of ART. HIV management was standardized using algorithms. ART-certified physicians visited the clinics weekly and were available by phone for advice.
Results: Among the first 229 patients (62.5% female), 179 (78.9%) presented with pulmonary TB, 42 (18.5%) with extrapulmonary TB and 6 (2.6%) with both. Eighty-two (35.8%) patients were eligible for ART within the first month of TB treatment, 44 (19.2%) because of clinical stage IV and 38 (16.6%) had CD4 count < 100. Another 103 (45.0%) patients were ART-eligible at the end of the intensive phase of TB treatment. Forty-one (17.9%) patients were not eligible because of clinical stage III and CD4 >350. CD4 was missing in 3 (1.3%) patients. TB treatment was successful in 104/123 (84.6%) patients who had completed treatment. We observed no TB treatment failures; 15 (12.2%) patients died. Among patients on ART, mean CD4 count gain was 78 cells by the end of TB treatment. Among those not on ART, mean CD4 count loss was 155 cells by the 5th month of TB treatment.
Conclusions: In our primary health care based, nurse-centered HIV care and treatment program for HIV co-infected TB patients, we observed good TB treatment success rates (85%) and clinical and immunological antiretroviral treatment outcomes comparable to those observed in physician-based ART programs in Africa.
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