High uptake of antiretroviral therapy among HIV-positive TB patients receiving co-located services in Swaziland

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Pathmanathan, Ishani ; Pasipamire, Munyaradzi ; Pals, Sherri ; Dokubo, E. Kainne ; Preko, Peter ; Ao, Trong ; Mazibuko, Sikhathele ; Ongole, Janet ; Dhlamini, Themba ; Haumba, Samson
• Description:
  Background
  
  Swaziland has the highest adult HIV prevalence and second highest rate of TB/HIV coinfection globally. Recently, the Ministry of Health and partners have increased integration and co-location of TB/HIV services, but the timing of antiretroviral therapy (ART) relative to TB treatment—a marker of program quality and predictor of outcomes—is unknown.
  
  Methods
  
  We conducted a retrospective analysis of programmatic data from 11 purposefully-sampled facilities to evaluate timely ART provision for HIV-positive TB patients enrolled on TB treatment between July-November 2014. Timely ART was defined as within two weeks of TB treatment initiation for patients with CD4<50/μL or missing, and within eight weeks otherwise. Descriptive statistics were estimated and logistic regression used to assess factors independently associated with timely ART.
  
  Results
  
  Of 466 HIV-positive TB patients, 51.5% were male, median age was 35 (interquartile range [IQR]: 29–42), and median CD4 was 137/μL (IQR: 58–268). 189 (40.6%) were on ART prior to, and five (1.8%) did not receive ART within six months of TB treatment initiation. Median time to ART after TB treatment initiation was 15 days (IQR: 14–28). Almost 90% started ART within eight weeks, and 45.5% of those with CD4<50/μL started within two weeks. Using thresholds for “timely ART” according to baseline CD4 count, 73.3% of patients overall received timely ART after TB treatment initiation. Patients with CD4 50-200/μL or ≥200/μL had significantly higher odds of timely ART than patients with CD4<50/μL, with adjusted odds ratios of 11.5 (95% confidence interval [CI]: 5.0–26.6) and 9.6 (95% CI: 4.6–19.9), respectively. TB cure or treatment completion was achieved by 71.1% of patients at six months, but this was not associated with timely ART.
  
  Conclusions
  
  This study demonstrates the relative success of integrated and co-located TB/HIV services in Swaziland, and shows that timely ART uptake for HIV-positive TB patients can be achieved in resource-limited, but integrated settings. Gaps remain in getting patients with CD4<50/μL to receive ART within the recommended two weeks post TB treatment initiation.
  
  
• Subjects:
  Adolescent Adult Anti-HIV Agents Coinfection Delivery Of Health Care Eswatini Female HIV Infections Humans Male Medication Adherence Middle Aged Retrospective Studies Tuberculosis, Pulmonary Young Adult

  More +
• Source:
  PLoS One. 13(5).
• Pubmed ID:
  29768503
• Pubmed Central ID:
  PMC5955520
• Document Type:
  Journal Article
• Place as Subject:
  Eswatini
• Volume:
  13
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:298934523c3762a3f429aeb5e55c910c8f22f289ffce277060e7e0c5eff1d466
• Download URL:
  https://stacks.cdc.gov/view/cdc/56531/cdc_56531_DS1.pdf
• File Type:
  [PDF - 822.55 KB ]