This research will be done primarily in EIdoret, Kenya at Moi University in collaboration with Lameck Diero, MD as an extension of NIH grant # RO1 DA13767. Tuberculosis is the leading cause of death in people living with H1V/A1DS worldwide, one of the earliest opportunistic infections occurring in conjunction with HIV, and is an accelerant for the replication of HIV and subsequent deterioration of the immune system. The intersection of the two epidemics in Sub-Saharan Africa has brought tremendous morbidity and mortality to countries already burdened by poverty and resultant poor health infrastructure. Debate has raged as to the feasibility of the introduction of HIV treatment in the form of ART in these countries. Yet, there already exists an infrastructure for delivery of such care in the form of the TB control systems. Directly observed therapy (DOT) is a crucial part of the recommended WHO strategy for TB control worldwide. DOT is a delivery system of care that ensures TB cure as well as the avoidance of drug resistance. The parallel between TB and HIV, in terms of requiring complex multidrug treatment regimens, suggests the concept of DOT as a delivery system that may be adapted successfully to use in HIV treatment. The parent grant of this F1RCA (Directly Observed HAART for Substance Abusers (DA 13767-01) is addressing use of the DOT care delivery system in HiV infected drug abusers in the United States. This FlRCA is to support a pilot feasibility project of combined DOT for the treatment of TB and HIV in Eldoret, Kenya. The advantages of this approach are multiple: 1.) TB is often the sentinel event that brings HlV infected patients to the health care systems of Kenya. 2.) Infrastructure in Kenya for TB DOT already exists. 3.) HIV seroprevalence in TB cases in Kenya is 60%. 4.) Despite the fact that patients may be cured of their TB, their mortality due to HIV is subsequently increased. Thus, the design of a DOT program that combines TB and HIV treatment not only serves a high-risk population at their point of entry into the health care system but also utilizes and expands an existing health care infrastructure approach (DOT). In addition, the longstanding collaboration between the Moi University Faculty of Health Sciences (MUFHS) and its US collaborating institutions supplies the ideal underpinnings for development of this project in Sub-Saharan Africa where it's potential impact and generalizabiiity is enormous.
