AIDS Research and Treatment 3 Figure 1: Kericho District Hospital Integrated TB/HIV Clinic (est. 2005) and subsequent roll-out of seven regional integrated TB/HIV clinics (est. 2007–2009). Notes: DH: District Hospital, MH: Mission/Faith Based Hospital, SDH: Sub-District Hospital. Data compilation and statistical analyses were completed using Microsoft Excel and PC SAS (SAS Institute, Carey, NC). Further details are outlined in protocol RV215 [30]. 2.5. Ethics Approval. This study was reviewed and approved by the Kenya Medical Research Institute, Lifespan, and Wal- ter Reed Army Institute of Research respective Institutional Review Boards and/or Ethics Review Committees. 3. Results 3.1. Baseline Characteristics. Between 2005 and 2010, 1,911 TB/HIV coinfected patients were registered in the TB/HIV clinic: 1,716 adult (52.6% female) and 195 pediatric (58.5% female) (Table 1). Of the adults, 42.8% were in care in the HIV Clinic at the time of their TB diagnosis, resulting in enrollment at the combined clinic. Most adults (51.2%) had their TB diagnosis at the TB clinic and were diagnosed with HIV coinfection by HIV rapid testing in the TB clinic. The remaining adults were referred to the integrated clinic from outside facilities. For pediatric patients, this ratio was reversed with 59.0% cared for in the HIV clinic prior to TB diagnosis and 36.9% having TB diagnosed initially followed by HIV testing in the TB clinic. Most adults (84.8%) presented with pulmonary TB (34.9% smear positive) and advanced HIV disease (mean CD4+ T-cell count = 216.4 ± 206.8 cells/mm3, CD4+ T-cell count <50 cells/mm3 = 18.4%). Although pediatric patients presented with similar frequencies of pulmonary TB, far fewer were smear positive (8.7%) but their HIV disease was advanced (CD4+ T-cell count <50 cells/mm3 = 16.2%). Nearly all received chest X-rays (93.0% and 95.9%, resp.), contributing to diagnosis in smear negative cases. Among the 1,911 enrolled in the TB/HIV clinic, 684 (35.8%) initiated ART through care in the integrated clinic while receiving TB therapy. Few patients (186 (9.7%)) were already treated with ART at the time of TB diagnosis and had care transferred to the integrated clinic. Most patients (1,041 (54.5%)) with higher CD4+ T-cell counts received ART in the HIV clinic after completion of TB therapy, reﬂecting treatment approaches prior to more recent guidelines. 3.2. TB Treatment Outcomes. Overall 5-year treatment suc- cess (cure or completion of therapy) frequencies were 74.7% in children but only 56.8% in adults (Table 2). Proportions lost to followup were high: 14.1% in children and 20.7% in adults. Frequencies of death (5.9% and 8.2%, resp.) were low, although these likely reﬂect an underestimate if the much larger proportions of lost to followup (14.1% in pediatrics and 20.7% in adults) included patients who died. For adult and pediatric patients over the 5-year period, treatment success rose from 40.0% in 2005 to 74.6% in 2010 (Figure 2). A notable, temporary decrease in treatment success occurred in 2007-2008. This reversal may reﬂect the societal unrest during the postelection violence that resulted in displacement of both patients and staﬀ. Also during the 5-year period, proportions lost to followup (36.0% year-1 to 12.5% year-5) and having died (20.0% year-1 to 5.4% year-5) also improved. In the 684 patients who started ART while on TB therapy, ART was initiated on average 74.0 (±93.1) days following TB treatment initiation. Review of TB treatment outcomes stratiﬁed by baseline CD4+ T-cell count distribution reveals that those patients with a CD4 count of <50 cells/mm3 had the highest proportion of death (10.7%) and accounted for over half of the deaths in the entire cohort (Table 3(a)).