Research

Antiretroviral treatment uptake in patients with HIV-associated TB attending co-located TB and ART services

Mweete Debra Nglazi, Richard Kaplan, Judy Caldwell, Neshaan Peton, Stephen D Lawn, Robin Wood, Linda-Gail Bekker

Abstract


Background. Delivery of integrated care for patients with HIV-associated TB is challenging. We assessed the uptake and timing of antiretroviral treatment (ART) among eligible patients attending a primary care service with co-located ART and TB clinics.

Methods. In a retrospective cohort study, all HIV-associated TB patients (≥18 years old) who commenced TB treatment in 2010 were included. Data were analysed using basic descriptive statistics and log-binomial regression analysis.

Results. Of a total of 497 patients diagnosed with HIV-associated TB, 274 were eligible to start ART for the first time (median CD4 count, 159 cells/µl). ART was started during TB treatment by 220 (80.3%) patients. Among the 54 (19.7%) who did not start ART, 23 (42.6%) were either lost to follow-up (LTFU) or died before enrolling for ART; 12 (22.2%) were either LTFU or died after enrolling but before starting ART; 5 (9.3%) were transferred out; and 14 (25.9%) only started ART after completion of TB treatment. The median delay between starting TB treatment and starting ART was 51 days (IQR 29 - 77). Overall, only 58.6% of patients started ART within 8 weeks of TB treatment, and 12.7% of those with CD4 counts <50 cells/µl started ART within 2 weeks.

Conclusions. In a setting with co-located TB and ART clinics, delays to starting ART were substantial, and one-fifth of eligible patients did not start ART during TB treatment. Co-location of services alone is insufficient to permit timely initiation of ART; further measures need to be implemented to facilitate integrated treatment.

Authors' affiliations

Mweete Debra Nglazi, Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, and International Union against Tuberculosis and Lung Disease, Paris, France

Richard Kaplan, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Judy Caldwell, Department of City Health, City of Cape Town

Neshaan Peton, Provincial Government of the Western Cape, Cape Town

Stephen D Lawn, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London

Robin Wood, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town

Linda-Gail Bekker, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town

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Keywords

Pre-ART; TB; HIV; Uptake; losses; Cape Town

Cite this article

South African Medical Journal 2012;102(12):936-939. DOI:10.7196/SAMJ.6024

Article History

Date submitted: 2012-05-30
Date published: 2012-10-22

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