What Works for Women and Girls

in a 65% decline in mortality and the TB incidence rate was lower in the HAART group.HAART improved survival and decreased TB incidence to a level similar to that achievedin developed countries during the early years of HAART. In August 2003, the hospitalstarted providing HAART to patients. All HIV-positive patients who visited the clinicsince January 2003 were followed and treated for opportunistic infections. Patients whowere followed from January 2003 to August 2003 were the “pre-HAART cohort” andpatients followed from August 2003 to August 2005 were the “HAART cohort.” The lastday of pre-HAART followed was April 1, 2004. After April 1, 2004 all patients of thishospital who met the Ethiopian HAART treatment guidelines had access to HAART atthis hospital. Pre-HAART patients who joined the HAART group contributed persontimeto both cohorts at different periods. A cohort of 90 men and 95 women, or a totalof 185 patients were followed prior to accessing HAART. A cohort of 102 men and 78women, for a total cohort of 180 patients were followed in the HAART cohort. At theend of the pre-HAART period, 10 patients (5.4%) were lost to follow-up; 8 (4.3%) weretransferred to another health institution; 47 (25.4%) died and 120 (64.9%) were underregular follow-up. The pre-HAAART mortality rate was 58.1 per 100 person-years ofobservation. TB incidence rate with HAART was reduced by almost 90%. Communityagents visited patients on a monthly basis in the patient’s home. Community agentsreceived training and had completed secondary school. Community agents reported thepatient’s status to the hospital following each visit to the patient’s home (Jerene et al.,2006). (Gray III) (TB, treatment, Ethiopia)A multi-center cohort study in Spain of 2,238 HIV-seroconverters compared TB incidencein pre-HAART and HAART eras and found that the risk of developing TB was70% lower in the HAART era than in the pre-HAART era (Muga et al., 2007). (Gray IV)(TB, treatment, Spain)Among a cohort of 346 patients receiving HAART in Cape Town, South Africa TB incidencewas highest among patients with CD4 counts under 100 and those with WHOclinical stage 3 or 4 disease. Risk for TB was independently associated with CD4 count,and WHO stage 3 or 4 disease. Incidence of TB continued to decrease during the first 5years of HAART (Lawn et al., 2005). (Gray IV) (TB, treatment, South Africa)From February 2003 through January 2004, 2,342 patients were registered for TBtreatment in Ubon-ratchathani, Thailand. Of these, 225 (10%) were confirmed asHIV-positive prior to their TB diagnosis, and of the remaining 2,117 patients, 680 agreedto be tested for HIV, and 104/680 (15%) were found to be HIV-positive. The 329 (14%)TB patients with confirmed HIV diagnoses were followed prospectively to assess theimpact of HAART on TB treatment outcomes. Among the 290 TB patients with knownoutcomes, 71 were on HAART and 219 were not. Death during TB treatment occurredin 7% (5 of 71) on HAART and 43% (94 of the 219) not on HAART. Antiretroviraltherapy was associated with a significant reduction in deaths among those on HAARTprior to initiating TB treatment (Akksilp et al., 2007). (Gray IV) (TB, HIV testing, treatment,Thailand)WHAT WORKS FOR WOMEN AND GIRLS275