Hindawi Publishing Corporation AIDS Research and Treatment Volume 2012, Article ID 238012, 8 pages doi:10.1155/2012/238012 Clinical Study Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya Douglas N. Shaffer,1 Eunice T. Obiero,2 Josphat B. Bett,1 Ignatius N. Kiptoo,1 Jonah K. Maswai,1 Fredrick K. Sawe,1 and E. Jane Carter3 1 Kenya Medical Research Institute/Walter Reed Project HIV Program, P.O. Box 1357, Kericho 20200, Kenya 2 The Kericho District Hospital, Kenya Ministry of Health, P.O. Box 11, Kericho 20200, Kenya 3 Miriam Hospital, Alpert Medical School, Brown University, 164 Summit Avenue, Providence, RI 02908, USA Correspondence should be addressed to Douglas N. Shaﬀer, dshaﬀer@wrp-kch.org Received 14 September 2011; Revised 11 November 2011; Accepted 28 November 2011 Academic Editor: Anthony Harries Copyright © 2012 Douglas N. Shaﬀer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To describe TB/HIV clinic outcomes in a rural, Ministry of Health hospital. Design. Retrospective, secondary analyses. Descriptive statistics and logistic regression analyses evaluated baseline characteristics and outcomes. Results. Of 1,911 patients, 89.8% were adults aged 32.0 (±12.6) years with baseline CD4 = 243.3 (±271.0), 18.2% < 50 cells/mm3. Pulmonary (84.8%, (32.2% smear positive)) exceeded extrapulmonary TB (15.2%). Over 5 years, treatment success rose from 40.0% to 74.6%, lost to follow-up dropped from 36.0% to 12.5%, and deaths fell from 20.0% to 5.4%. For patients starting ART after TB treatment, those with CD4 ≥ 50 cells/mm3 were twice as likely to achieve treatment success (OR = 2.0, 95% CI = 1.3–3.1) compared to those with CD4 < 50 cells/mm3. Patients initiating ART at/after 2 months were twice as likely to achieve treatment success (OR = 2.0, 95% CI = 1.3–3.3). Yearly, odds of treatment success improved by 20% (OR = 1.2, 95% CI = 1.0–1.5). Conclusions. An integrated TB/HIV clinic with acceptable outcomes is a feasible goal in resource-limited settings. 1. Introduction Tuberculosis (TB) remains the leading cause of death among persons living with HIV/AIDS with nearly 25% of HIV mortality attributable to TB and 380,000 deaths in 2009 related to HIV-associated TB [1]. In 2009, there were an estimated 1.1 million HIV-positive TB patients globally with nearly 80% living in sub-Saharan Africa [1]. While guidelines [2–5] and peer-reviewed journals [6–12] call for integrated TB/HIV services and clinical trials demonstrate early antiretroviral therapy (ART) in patients with TB/HIV coinfection result in better outcomes [13–16], experience from ﬁeld implementation of TB/HIV integration is now critical. The Kericho District Hospital (KDH), a Ministry of Health public hospital in rural Kenya, fully integrated HIV services into their TB clinic in 2005 quickly following the development of their HIV clinic services. Integration was deemed necessary for a variety of reasons: (1) treatment of one patient with two diseases (TB/HIV) seemed more practical in a single location; (2) both patients and clinicians preferred a combined TB/HIV care delivery system [10]; (3) the belief that treatment outcomes could be maximized by developing a cadre of health care providers capable of pro- viding both TB and HIV treatments; (4) planned increases in HIV testing within the TB clinic would result in identifying large numbers of HIV-infected persons that could over- whelm a burdened HIV clinic (who would already received treatment in the TB clinic); (5) rudimentary infection control in the HIV clinic could be strengthened by caring for all TB/HIV suspects in the TB clinic rather than comingling in the HIV clinic. The objectives of this study were to describe character- istics of patients enrolled in the TB/HIV clinic, consider