ArticleBMC infectious diseases2011
Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township.
Article in BMC infectious diseases, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.
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Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Is co-location of services with HIV care associated with improved HIV care outcomes? A systematic review.AIDS care · 2019Pooled it
- Reframing TB Care: A Perspective on Multimorbidity-Centered Care for People with TB.Tropical medicine and infectious disease · 2026Article
- Article
- Delayed Antiretroviral Therapy (ART) Initiation among Hospitalized Adults in a Resource-Limited Settings: A Challenge to the Global Target of ART for 90% of HIV-Infected Individuals.AIDS research and treatment · 2019Article
- Effect of PEPFAR funding policy change on HIV service delivery in a large HIV care and treatment network in Nigeria.PloS one · 2019Article
- Integrating HIV care and treatment into tuberculosis clinics in Lusaka, Zambia: results from a before-after quasi-experimental study.BMC infectious diseases · 2018Article
- Improving management of tuberculosis in people living with HIV in South Africa through integration of HIV and tuberculosis services: a proof of concept study.BMC health services research · 2018Article
- The impact of rural residence and HIV infection on poor tuberculosis treatment outcomes in a large urban hospital: a retrospective cohort analysis.International journal for equity in health · 2018Article
- High uptake of antiretroviral therapy among HIV-positive TB patients receiving co-located services in Swaziland.PloS one · 2018Article
- Delay in the Provision of Antiretroviral Therapy to HIV-infected TB Patients in Nigeria.Universal journal of public health · 2017Article
- Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems.Current HIV/AIDS reports · 2016Review
- Article
- Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo.Tuberculosis research and treatment · 2016Article
- Integrated therapy for HIV and tuberculosis.AIDS research and therapy · 2016Review
- The impact of HIV status and antiretroviral treatment on TB treatment outcomes of new tuberculosis patients attending co-located TB and ART services in South Africa: a retrospective cohort study.BMC infectious diseases · 2015Article
- The Impact of Implementation Fidelity on Mortality Under a CD4-Stratified Timing Strategy for Antiretroviral Therapy in Patients With Tuberculosis.American journal of epidemiology · 2015Article
- Clinical management of concurrent diabetes and tuberculosis and the implications for patient services.The lancet. Diabetes & endocrinology · 2014Review
- The impact of HAART initiation timing on HIV-TB co-infected patients, a retrospective cohort study.BMC infectious diseases · 2014Article
- Delayed antiretroviral therapy despite integrated treatment for tuberculosis and HIV infection.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2014Observational
- Antiretroviral therapy uptake among adult tuberculosis patients newly diagnosed with HIV in Nyanza Province, Kenya.Public health action · 2013Article
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
backgroundDelays in the initiation of antiretroviral therapy (ART) in patients with HIV-associated tuberculosis (TB) are associated with increased mortality risk. We examined the timing of ART among patients receiving care provided by non-integrated TB and ART services in Cape Town, South Africa.
methodsIn an observational cohort study, we determined the overall time delay between starting treatment for TB and starting ART in patients treated in Gugulethu township between 2002 and 2008. For patients referred from TB clinics to the separate ART clinic, we quantified and identified risk factors associated with the two component delays between starting TB treatment, enrolment in the ART clinic and subsequent initiation of ART.
resultsAmong 893 TB patients studied (median CD4 count, 81 cells/μL), the delay between starting TB treatment and starting ART was prolonged (median, 95 days; IQR = 49-155). Delays were shorter in more recent calendar periods and among those with lower CD4 cell counts. However, the median delay was almost three-fold longer for patients referred from separate TB clinics compared to patients whose TB was diagnosed in the ART clinic (116 days versus 41 days, respectively; P < 0.001). In the most recent calendar period, the proportions of patients with CD4 cell counts < 50 cells/μL who started ART within 4 weeks of TB diagnosis were 11.1% for patients referred from TB clinics compared to 54.6% of patients with TB diagnosed in the ART service (P < 0.001).
conclusionsDelays in starting ART were prolonged, especially for patients referred from separate TB clinics. Non-integration of TB and ART services is likely to be a substantial obstacle to timely initiation of ART.
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