Background

Although TB and HIV are different diseases, it is very common for people who have HIV to contract TB. In July and August 2008, three interns from Yale University conducted a survey on TB management at IDI. As a result of findings, the integrated HIV/TB Clinic was formed in late 2008. A TB working group was also formed, and was given the following mandate:  

• To improve TB/HIV care for patients at IDI
• To standardize TB diagnosis and follow-up procedures
• To increase involvement of medical officers in TB management
• To centralize challenging management decisions
• To improve TB infection prevention
• To decrease TB treatment default rates
  

Approaches Used

The integrated TB/HIV clinic currently runs on a daily basis and is manned by two doctors, a counsellor and a clinic coordinator.
HIV-positive patients who show signs of TB during routine examinations are sent to the TB clinic. Once in the TB clinic, a patient is evaluated by a TB doctor who may request a chest x-ray and a sputum exam. All the necessary investigation forms are completed at that time. The patient’s file is reviewed two weeks later when x-ray and sputum test results become available. If the results are positive for TB, treatment is started and continued for a total of eight months. If the results are negative, the patient is sent back to the main clinic for continued care.

Some patients are referred to the clinic when they already have laboratory results showing TB infection. These patients are registered, counselled and started on TB treatment right away.

In some cases patients’ test results may not indicate TB infection, but based on clinical conditions the doctor may start the patient on TB treatment.   

Key Accomplishments

1. Since the beginning of this year more than 2,400 patients have been screened for TB. Approximately 240 patients have been diagnosed with TB and started on treatment.
2. TB-related SOPs have been developed, including forms for diagnosis and treatment initiation, and a protocol for follow-up.  This has led to an improvement in sputum results reporting. 
3. A number of research activities have been initiated in the clinic following the streamlining of TB management activities.  In June 2009 an oral abstract (Examining Drug Default for Treatment of Tuberculosis in an Urban HIV Clinic in Uganda), generated from this clinic, was presented at the HIV/AIDS Implementers’ Meeting which took place in Windhoek, Namibia.
   

Challenges and Opportunities

There are many opportunities for research, specialized training in TB/HIV co-infection and collaborative activities in this field.
One key challenge is the fear that patients and health workers have about contracting TB while working in the TB clinic.  SOPs have been put in place to reduce the likelihood of nosocomial infection, and as a result staff and clients are gaining the confidence to participate actively in the clinic.

Some of the logistical challenges include:  

• Lack of space:  the clinic is currently operating out of a small semi permanent area, and a larger space would enable the clinic to see more patients.
  
• Training:  it would be useful to have more medical workers trained in how to offer advanced clinical care for integrated HIV/TB.
• Limited lab facilities:  it would be useful to have space and equipment for more sophisticated diagnosis, such as a TB culture facility.