Skip to main content

Advertisement

SpringerLink
Log in

Impact of Integrating HIV and TB Care and Treatment in a Regional Tuberculosis Hospital in Rural Guatemala

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Resource-limited settings have made slow progress in integrating TB and HIV care for co-infected patients. We examined the impact of integrated TB/HIV care on clinical and survival outcomes in rural western Guatemala. Prospective data from 254 newly diagnosed TB/HIV patients (99 enrolled in the pre-integrated program from August 2005 to July 2006, and 155 enrolled in the integrated program from February 2008 to January 2009) showed no significant baseline differences between clients in the two periods. They were principally male (65.5 %), Mayan (71 %), median age 33 years, and CD4 count averaged 111 cells/mm³. TB/HIV co-infected patients were more likely to receive antiretroviral therapy in the integrated program than in the pre-integrated program (72 vs. 22 %, respectively) and had lower mortality (HR 0.22, 95 % CI 0.14–0.33). This study shows how using a TB setting as the entry point for integrated TB/HIV care can improve health outcomes for HIV-positive patients in rural Guatemala.

Resumen

Países en vía de desarrollo con recursos limitados han avanzado lentamente en la integración de los programas de TB y VIH para los pacientes co-infectados. Hemos examinado el impacto de la integración de la atención integral del TB/VIH sobre los resultados clínicos y de la sobrevivencia en área rural de Occidente de Guatemala. Datos prospectivos de 254 nuevos casos de infección de TB/VIH (99 reclutados entre agosto 2005 a julio 2006 en el programa pre-integrado y 155 reclutados entre febrero de 2008 a enero del 2009 en el programa integrado), no mostraron diferencias significativas en la línea basal entre los clientes de los programas en los dos periodos. Estos eran principalmente varones (65.5 %), maya (71 %), promedio de edad fue de 33 años, y el recuento de CD4 al inicio del estudio fue de 111 células/mm³. Los pacientes en el programa TB/VIH integrado comparado a los pacientes en el programa pre-integrado eran más probables para recibir terapia antirretroviral (72 % vs. 22 %, respectivamente) y tuvieron menos riesgo de mortalidad (HR 0.22, 95 % CI 0.14–0.33). Este estudio mostró cómo la clínica de TB fue el punto de entrada para proporcionar un programa de atención integral de TB/VIH y ha logrado un mejor resultado de salud para pacientes con el VIH en el área rural de Guatemala.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. MacDougall DS. TB & HIV: the deadly intersection. J Int Assoc Physicians AIDS Care. 1999;5(5):20–7.

    CAS  PubMed  Google Scholar 

  2. Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. 2003;163(9):1009–21.

    Article  PubMed  Google Scholar 

  3. Tsiouris SJ, Gandhi NR, El-Sadr WM, Friedland G. Tuberculosis and HIV-needed: a new paradigm for the control and management of linked epidemics. MedGenMed. 2007;9(3):62.

    PubMed Central  PubMed  Google Scholar 

  4. Getahun H, Gunneberg C, Granich R, Nunn P. HIV infection-associated tuberculosis: the epidemiology and the response. Clin Infect Dis. 2010;50(Suppl 3):S201–7.

    Article  PubMed  Google Scholar 

  5. Blanc F, Sok, T., Laurellard D., et al Significant enhancement in survival with early (2 weeks) versus late (8 weeks) initiation of highly active antiretroviral treatment (HAART) in severely immunosuppressed HIV-infected adults with newly diagnosed tuberculosis, Abstract THLBB106. Eighteenth international AIDS conference, Vienna; 2010.

  6. Blanc F-X, Sok T, Laureillard D, Borand L, Rekacewicz C, et al. Earlier versus later start of antiretroviral therapy in HIV infected adults with tuberculosis. N Engl J Med. 2011;365(16):1471–81.

    Article  CAS  PubMed  Google Scholar 

  7. Havlir DV, Kendall MA, Ive P, Kumwenda J, Swindells S, et al. Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med. 2011;365(16):1482–91.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Karim ASS, Naidoo K, Grobler A, Padayatchi N, Baxter C, Gray A, et al. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med. 2010;362(8):697–706.

    Article  PubMed Central  Google Scholar 

  9. Abdool Karim SS, Naidoo K, Grobler A, Padayatchi N, Baxter C, Gray A, et al. Integration of antiretroviral therapy with tuberculosis treatment. N Engl J Med. 2011;365(16):1492–501.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Kerschberger BH, Hilderbrand K, Boulle AM, Coetzee D, Goemaere E, et al. The effects of complete integration of HIV and TB services on time to initiation of antiretroviral therapy: a before and after study. PLoS One. 2012;7(10):1–7.

    Article  Google Scholar 

  11. Legido-Quigley H, Montgomery CM, Khan P, Atun R, Fakoya A, Getahun H, Grant AD. Integrating tuberculosis and HIV services in low- and middle-income countries: systematic review. Trop Med Int Health. 2012;18(2):199–211.

    Article  PubMed  Google Scholar 

  12. WHO. Tuberculosis profile for Guatemala. In: Assistance MoHaS, editor. Guatemala City, Guatemala. 2011. https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=GT&LAN=EN&outtype=html. Accessed 20 Jan 2013.

  13. Garcia J. TB epidemiological situation in Guatemala. In: CNE, editor. Guatemala City, Guatemala: Ministry of Health and Social Assistance; 2010.

  14. CNE. Informe Nacional de Estadística de Casos Acumulados de VIH y SIDA en Guatemala, Enero 1984 a Diciembre 2010. In: Ministry NSHApotPHaSA, editor. Guatemala City 2011.

  15. Delgado Hurtado JJ, Pineda M, Cazali I, Mejia C. Knowledge of HIV transmission and condom use among HIV-positive heterosexual men and women in Guatemala. J Int AIDS Soc. 2011;14(58):1–5.

    Google Scholar 

  16. USAID. HIV/AIDS health profile Guatemala City: USAID 2010. http://transition.usaid.gov/our_work/global_health/aids/Countries/lac/guatemala_profile.pdf. Accessed 20 Jan 2013.

  17. Howard AA, El-Sadr WM. Integration of tuberculosis and HIV services in sub-Saharan Africa: lessons learned. Clin Infect Dis. 2010;50(Suppl 3):S238–44.

    Article  PubMed  Google Scholar 

  18. Harries AD, Zachariah R, Corbett EL, Lawn SD, Santos-Filho ET, Chimzizi R, et al. The HIV-associated tuberculosis epidemic: when will we act? Lancet. 2010;375(9729):1906–19.

    Article  PubMed  Google Scholar 

  19. Gandhi NR, Moll AP, Lalloo U, Pawinski R, Zeller K, Moodley P, et al. Successful integration of tuberculosis and HIV treatment in rural South Africa: the Sizonq’oba study. J Acquir Immune Defic Syndr. 2009;50(1):37–43.

    Article  PubMed  Google Scholar 

  20. López Tellez CA, Ikeda JM, Hearst N. Characterization of HIV in tuberculosis patients and implications for universal access to antiretroviral therapy, Abstract #688. Second international conference on pathogenesis and treatment, Paris, France; 2003.

  21. Ikeda JM, López Tellez CA, DeLeon M, Howell S, and Hearst N., Increase in tuberculosis and HIV Co-infection in Southwestern Guatemala, Abstract #MOPEO349. Seventeenth international AIDS conference; Mexico City, Mexico; 2008.

  22. Ministry of Health and Social Assistance NHP. National Protocol for HIV/AIDS Antiretroviral Treatment Guatemala City: Ministry of Health and Social Assistance; 2002.

  23. Ministry of Health and Social Assistance NHP. Guatemala’s antirretroviral and opportunistic infection treatment guidelines. Guatemala City: Ministry of Health and Social Assistance, National HIV Program; 2006.

  24. Ministry of Health and Social Assistance NTP. National Protocol for Tuberculosis. In Assistance, National TB Program https://docs.google.com/viewer?a=v&q=cache:CQZ3konMEU0J:infecciosashr.org/download/85/+sias+tuberculosis&hl=en&gl=gt&pid=bl&srcid=ADGEEShIoWA9Ro852keBboQTa54Jb8PeieysWCaZbzkZpUkMjjCWlrhfKrS0oYe1o8xfGJriP8QaLwcXoUecjrXvulH-UJ1SNaHS83ya6vGxUCzEWyz1Wely5yLQ2hfDMz65S4hK4V83&sig=AHIEtbQ54ape_UNoPQJVA4O4aSZPmYulAw. Guatemala City: Ministry of Health and Social; 2005.

  25. Ministry of Health and Social Assistance NTP. Integral management of the co-infection TB/HIV. Global fund to fight HIV, TB and Malaria, World Vision, PAHO 2009. http://www.misanjuandedios.org/files/Modulo_3_coinfeccion.pdf. Accessed 20 Jan 2013. Guatemala City: Ministry of Health; 2013.

  26. Hermans SM, Castelnuovo B, Katabira C, Mbidde P, Lang J, Hoepelman A, Coutinho A, Manabe YC. Integration of HIV and TB services results in improved TB treatment outcome and earlier prioritized ART initiation in a large urban HIV clinic in Uganda. J Acquir Immune Defic Syndr. 2012;60(2):e29–35.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Kaplan JE, Benson C, Holmes KH, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1–207.

    Google Scholar 

  28. WHO. Treatment of tuberculosis guidelines. 4th ed. Geneva: World Health Organization; 2010 Contract No.: WHO/HTM/TB/2009.420.

    Google Scholar 

Download references

Acknowledgments

This study and authors (JMI, KP) received support from the University of California San Francisco, Center for AIDS Prevention Studies, through the following grants from the U.S. National Institute of Mental Health (NIMH), P30 MH062246; University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), US NIMH, R25MH064712; and the University of California, Berkeley and San Francisco, AIDS International Training and Research Program (AITRP), Fogarty International Center, D43TW000003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH, AITRP or FIC. This study could not have been completed without the participation of the co-infected patients in the National Hospital Rodolfo Robles in Quetzaltenango, who willingly answered sensitive questions and assisted us throughout the study. The authors would like to thank Josefina Ramirez from the Integrated Care Clinic Dr. Isaac Cohen Alcahe for her dedicated assistance with HIV and TB data collection. The authors gratefully acknowledge the assistance of the National AIDS program and the Global Fund project in Guatemala through the grant World Vision/Association IDEI contracts # 21-2006 and 30-2007.

Author information

Authors and Affiliations

  1. Investigation, Development and Integral Education, Avenida 15 “A” 3-33, Zona 1, Quetzaltenango, 09001, Guatemala

    Janet Midori Ikeda & Oliver Racancoj

  2. Integrated Care Clinic Dr. Isaac Cohen Alcahe in the National Hospital Dr. Rodolfo Robles, Quetzaltenango, Guatemala

    Cesar A. López Tellez

  3. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA

    Esther Sid Hudes, Kimberly Page & Jennifer Evans

  4. Department of Family and Community Medicine, University of California at San Francisco, San Francisco, CA, USA

    Norman Hearst

Authors
  1. Janet Midori Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cesar A. López Tellez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Esther Sid Hudes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimberly Page
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Oliver Racancoj
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Norman Hearst
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janet Midori Ikeda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ikeda, J.M., López Tellez, C.A., Hudes, E.S. et al. Impact of Integrating HIV and TB Care and Treatment in a Regional Tuberculosis Hospital in Rural Guatemala. AIDS Behav 18 (Suppl 1), 96–103 (2014). https://doi.org/10.1007/s10461-013-0595-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0595-9

Keywords

Search

Navigation