Abstract
SettingA South African township clinic where loss to follow-up during TB treatment may prevent HIV-infected TB patients from receiving life-saving ART.ObjectiveTo determine factors associated with loss to follow-up during TB treatment.DesignRegression analyses of a cohort of ART-eligible TB patients who commenced TB treatment and were followed for 24 weeks.ResultsOf 111 ART-eligible TB patients, 15 (14%) died in the ensuing 24 weeks. Of the remaining 96 TB patients, 11 (11%) were lost to follow-up. All TB patients lost to follow-up did not initiate ART. Of 85 TB patients in follow-up, 62 (73%) initiated ART 56 days after TB diagnosis (median, IQR 33–77 days) and 31 days after initial assessment at an ART clinic (median, IQR: 18–55 days). The median duration from TB diagnosis to initial assessment at an ART clinic was 19 days (IQR: 7–48 days). At 24 weeks, 6 of 85 (7%) TB patients who presented to an ART clinic for assessment were lost to follow-up, compared to 5 of 11 (45%) TB patients who did not present to an ART clinic for assessment. Logistic regression analysis (adjusted odds ratio = 0.1, 95% confidence interval [95% CI]: 0.03–0.66) and our Cox proportional hazards model (hazard ratio = 0.2, 95% CI: 0.04–0.68) confirmed that assessment at an ART clinic during TB treatment reduced loss to follow-up.ConclusionAssessment at antiretroviral clinics for HIV care by trained health-care providers reduces loss to follow-up among HIV-infected patients with TB.
Highlights
In sub-Saharan Africa, tuberculosis (TB) is the most frequent cause of death in HIV-1 infected adults [1]: between 8% and 23% of HIV-infected TB patients die during TB treatment. [2,3] The initiation of antiretroviral treatment (ART) during TB treatment among those with severe immune-suppression improves survival. [4] In HIV-infected TB patients with CD4 counts less than 50 cells/microL, initiation of ART 1–3 weeks after commencing TB treatment reduces mortality and/or the development of AIDS by 34–68%, compared to initiating ART later during TB treatment. [5,6,7].timely initiation of ART during TB treatment is a priority
We reviewed TB patients’ hospital and ART charts, the Western Cape’s electronic tuberculosis register (ETR.net) [15] and Cape Town’s electronic eKapa ART database to record those who presented to an ART clinic for assessment, as well as those who initiated ART
During TB treatment, 95% of TB patients received trimethoprim-sulfamethoxazole chemoprophylaxis, 57% experienced clinical deterioration and 41% required hospital admission. 85 of 96 (89%) TB patients were alive and in care at completion of TB treatment, 79 of whom were assessed at an ART clinic within 19 days of TB diagnosis
Summary
In sub-Saharan Africa, tuberculosis (TB) is the most frequent cause of death in HIV-1 infected adults [1]: between 8% and 23% of HIV-infected TB patients die during TB treatment. [2,3] The initiation of antiretroviral treatment (ART) during TB treatment among those with severe immune-suppression improves survival. [4] In HIV-infected TB patients with CD4 counts less than 50 cells/microL, initiation of ART 1–3 weeks after commencing TB treatment reduces mortality and/or the development of AIDS by 34–68%, compared to initiating ART later during TB treatment. [5,6,7].timely initiation of ART during TB treatment is a priority. [4] In HIV-infected TB patients with CD4 counts less than 50 cells/microL, initiation of ART 1–3 weeks after commencing TB treatment reduces mortality and/or the development of AIDS by 34–68%, compared to initiating ART later during TB treatment. [8] Up to 9% of HIV-infected TB patients are lost to follow-up during TB treatment, [9,10] precluding initiation of ART. Identifying those at risk of loss to follow-up is essential. We performed a secondary analysis of a recently described prospective cohort of HIV-infected TB patients [11,12] in order to determine factors associated with loss to follow-up during TB treatment
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