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.
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 TBpatients (≥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: Diane V Havlir; Michelle A Kendall; Prudence Ive; Johnstone Kumwenda; Susan Swindells; Sarojini S Qasba; Anne F Luetkemeyer; Evelyn Hogg; James F Rooney; Xingye Wu; Mina C Hosseinipour; Umesh Lalloo; Valdilea G Veloso; Fatuma F Some; N Kumarasamy; Nesri Padayatchi; Breno R Santos; Stewart Reid; James Hakim; Lerato Mohapi; Peter Mugyenyi; Jorge Sanchez; Javier R Lama; Jean W Pape; Alejandro Sanchez; Aida Asmelash; Evans Moko; Fred Sawe; Janet Andersen; Ian Sanne Journal: N Engl J Med Date: 2011-10-20 Impact factor: 91.245
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Authors: B Odume; I Pathmanathan; S Pals; K Dokubo; D Onotu; O Obinna; D Anand; J Okuma; E Okpokoro; S Dutt; E Ekong; N Chukwurah; P Dakum; H Tomlinson Journal: Univers J Public Health Date: 2017