Observational studyThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease2014
Delayed antiretroviral therapy despite integrated treatment for tuberculosis and HIV infection.
Observational study in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis.AIDS research and therapy · 2021Pooled it
- Continuous quality improvement interventions to improve long-term outcomes of antiretroviral therapy in women who initiated therapy during pregnancy or breastfeeding in the Democratic Republic of Congo: design of an open-label, parallel, group randomized trial.BMC health services research · 2017Trial
- Global HIV neurology: a comprehensive review.AIDS (London, England) · 2019Review
- Effect of TB/HIV Integration on TB and HIV Indicators in Rural Ugandan Health Facilities.Journal of acquired immune deficiency syndromes (1999) · 2018Article
- Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA [corrected].Open forum infectious diseases · 2018Article
- High uptake of antiretroviral therapy among HIV-positive TB patients receiving co-located services in Swaziland.PloS one · 2018Article
- Tuberculosis Treatment Outcomes Among HIV/TB-Coinfected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network.Journal of acquired immune deficiency syndromes (1999) · 2017Article
- 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
- HIV treatment cascade in tuberculosis patients.Current opinion in HIV and AIDS · 2015Review
- 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
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
settingFive primary health care clinics in Kinshasa, Democratic Republic of Congo.
objectiveTo examine timing and predictors of delayed initiation of antiretroviral therapy (ART) during anti-tuberculosis treatment.
designProspective observational cohort of adult patients receiving integrated treatment for tuberculosis (TB) and human immunodeficiency virus (HIV) who are expected to initiate ART at 1 month if CD4 count is <100 cells/mm(3) or if patient is World Health Organization (WHO) Clinical Stage 4 for reasons other than extra-pulmonary TB, at 2 months if CD4 count is 100-350 cells/mm(3), or at completion of anti-tuberculosis treatment if subsequently CD4 count is ≤ 350 cells/mm(3) or patient has WHO Clinical Stage 4.
resultsOf 492 patients, 235 (47.8%) experienced delayed initiation of ART: 171 (72.8%) initiated ART late, after a median delay of 12 days (interquartile range [IQR] 4-27) and 64 (27.2%) never initiated ART. Contraindication to any antiretroviral drug (aOR 2.91, 95%CI 1.22-6.95), lower baseline CD4 count (aOR 1.20, 95%CI 1.08-1.33/100 cells/mm(3)), TB drug intolerance (aOR 1.93, 95%CI 1.23-3.02) and non-disclosure of HIV infection (aOR 1.50, 95%CI 1.03-2.18) predicted delayed ART initiation.
conclusionDespite fully integrated treatment, half of all patients experienced delayed ART initiation. Pragmatic approaches to ensure timely ART initiation in those at risk of delayed ART initiation are needed.
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