Impact of integrating an ART clinic into a regional tuberculosis hospital in rural Guatemala
J.M. Ikeda1, O. Racancoj2, J. Alvarado de Ramirez3, C.A. López Téllez4, R. Barrios5, N. Hearst6
1Asociación de Investigación, Desarrollo y Educación Integral, Research, Quetzaltenango, Guatemala, 2Asociación de Investigación, Desarrollo y Educación Integral, Statistics, Quetzaltenango, Guatemala, 3Hospital Nacional Dr. Rodolfo Robles de Quetzaltenango, Nursing, Quetzaltenango, Guatemala, 4Hospital Nacional Dr. Rodolfo Robles de Quetzaltenango, Medicine, Quetzaltenango, Guatemala, 5BC Centre for Excellence in HIV/AIDS, Medicine, Vancouver, Canada, 6University of California at San Francisco, Family and Community Medicine/Biostatistics, San Francisco, United States
Background: Internationally, there is an increasing trend toward integrating ART clinics with tuberculosis centers, but this has not previously been attempted in Guatemala. We studied the impact of integrating an ART clinic into a regional TB hospital in Quetzaltenango that has seen a rapid increase in HIV seroprevalence among its mostly Mayan Indian tuberculosis patients (from 12% in 2002 to 31% in 2008).
Methods: We compared newly diagnosed HIV/TB patients from the National Hospital Dr. Rodolfo Robles from August 2005 to July 2006 (before adding an ART clinic to the hospital) and from February 2008 to January 2009 (after doing so) We evaluated these two cohorts for access to ART treatment, fatality rate, and the cost-benefit of treatment.
Results: From August 2005 to July 2006, 94 TB patients (70% male and 30% female) were newly diagnosed with HIV in the regional TB hospital. Only 5% of the patients received ART in other clinics. The 12 month fatality rate was 66%. The cost of treatment (Anti-TB, ART and personnel administrating medications) was $1281 per patient with 34% surviving one year. From February 2008 to January 2009, 157 TB patients (64% male and 36% female) were newly diagnosed with HIV; 71% of these received ART. There was a significant reduction in the fatality rate to 17%. The cost of treatment was $1520 with a one-year survival rate of 83%. Cost per surviving patient fell from $3,768 to $1,831.
Conclusions: The integration of the ART clinic in this TB center provided mutual benefits for TB and AIDS treatment by providing one-site treatment access for both. Early HIV diagnosis and treatment is essential to reduce the fatality rate from co-infection. In addition to saving lives, providing ART treatment improved the cost-benefit ratio of the TB program for co-infected patients.
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