Barriers to Initiation of Antiretrovirals during Antituberculosis Therapy in AfricaReportar como inadecuado




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Background

In the developing world, the principal cause of death among HIV-infected patients is tuberculosis TB. The initiation of antiretroviral therapy ART during TB therapy significantly improves survival, however it is not known which barriers prevent eligible TB patients from initiating life-saving ART.

Method

Setting. A South African township clinic with integrated tuberculosis and HIV services. Design. Logistic regression analyses of a prospective cohort of HIV-1 infected adults ≥18 years who commenced TB therapy, were eligible for ART, and were followed for 6 months.

Findings

Of 100 HIV-1 infected adults eligible for ART during TB therapy, 90 TB patients presented to an ART clinic for assessment, 66 TB patients initiated ART, and 15 TB patients died. 34% of eligible TB patients 95%CI: 25–43% did not initiate ART. Male gender and younger age <36 years were associated with failure to initiate ART adjusted odds ratios of 3.7 95%CI: 1.25–10.95 and 3.3 95%CI: 1.12–9.69, respectively. Death during TB therapy was associated with a CD4+ count <100 cells-µL.

Conclusion

In a clinic with integrated services for tuberculosis and HIV, one-third of eligible TB patients – particularly young men – did not initiate ART. Strategies are needed to promote ART initiation during TB therapy, especially among young men.



Autor: Dominique J. Pepper , Suzaan Marais, Robert J. Wilkinson, Feriyl Bhaijee, Virginia De Azevedo, Graeme Meintjes

Fuente: http://plos.srce.hr/



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