Outcomes of integrated treatment for tuberculosis and HIV in children at the primary health care level
METHODS: Prospective cohort of 31 HIV-infected children aged 3–18 years initiating anti-tuberculosis treatment at five primary health care (PHC) clinics in Kinshasa, Democratic Republic of Congo, to describe survival, clinical and immunological outcomes of nurse-centered integrated TB-HIV treatment.
RESULTS: Almost all of the children (87.1%) were diagnosed with HIV during TB diagnosis. Most (87.0%) were successfully treated for TB. Two (6.5%) died during anti-tuberculosis treatment; both presented with low CD4 counts (36 and 59 cells/mm3 compared to a median of 228 cells/mm3 in the entire cohort). Most (74.2%) initiated antiretroviral therapy (ART) during anti-tuberculosis treatment. Overall, a median CD4 count increase of 106 cells/mm3 was observed (P = 0.014), an increase of 113 cells/mm3 among children on ART and of 71.5 cells/mm3 in those not on ART (P = 0.78). Median body mass index increase during anti-tuberculosis treatment was 2.1 kg/m2 overall (P = 0.002), 2.2 kg/m2 among children on ART and 0.72 kg/m2 in those not on ART (P = 0.08).
CONCLUSION: Integrated, nurse-centered, pediatric TB-HIV treatment at the PHC level in highly resource-limited settings is feasible and effective in achieving successful outcomes, including high ART uptake, low mortality, and immunological and clinical improvement.
Keywords: TB-HIV; antiretroviral; nurses; pediatric; task-shifting
Document Type: Research Article
Affiliations: 1: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 2: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
Publication date: 01 September 2013
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