Time to initiation of antiretroviral therapy among patients with HIV-associated tuberculosis in Cape Town, South Africa

Lawn, Stephen D; Campbell, Lucy; Kaplan, Richard; Boulle, Andrew; Cornell, Morna; Kerschberger, Bernhard; Morrow, Carl; Little, Francesca; Egger, Matthias; Wood, Robin (2011). Time to initiation of antiretroviral therapy among patients with HIV-associated tuberculosis in Cape Town, South Africa. Journal of acquired immune deficiency syndromes JAIDS, 57(2), pp. 136-140. Philadelphia, Pa.: Lippincott Williams & Wilkins 10.1097/QAI.0b013e3182199ee9

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We studied the time interval between starting tuberculosis treatment and commencing antiretroviral treatment (ART) in HIV-infected patients (n = 1433; median CD4 count 71 cells per microliter, interquartile range: 32-132) attending 3 South African township ART services between 2002 and 2008. The overall median delay was 2.66 months (interquartile range: 1.58-4.17). In adjusted analyses, delays varied between treatment sites but were shorter for patients with lower CD4 counts and those treated in more recent calendar years. During the most recent period (2007-2008), 4.7%, 19.7%, and 51.1% of patients started ART within 2, 4, and 8 weeks of tuberculosis treatment, respectively. Operational barriers must be tackled to permit further acceleration of ART initiation as recommended by 2010 WHO ART guidelines.

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