Abstract
Provision of integrated care for human immunodeficiency virus (HIV) co-infected tuberculosis (TB) patients is challenging. Many persons with TB and HIV co-infection are not yet receiving anti-retroviral therapy (ART) and initiation of ART is not always timely. This study investigated ART uptake among HIV co-infected TB patients and its time of initiation in an urban primary health care facility in Ethiopia. A retrospective cohort study was conducted using routine program data. All adult HIV co-infected TB patients registered in a large TB-HIV clinic in Addis Ababa from September, 2008 to August, 2014 were included. Both descriptive and inferential statistics were used to summarize and analyse findings. A total of 993 TB patients were registered in the study period and included. HIV counselling and testing was offered to 738 (74.5%) and HIV testing was performed for 678 (68.3%) patients. Of those tested, 226 (33.3%) were HIV co-infected of whom 125 (57.6%) were started on ART. The median period from commencement of TB treatment to starting of ART was 41 days. ART initiation was delayed beyond the period advised in the National TB-HIV Guideline for 31 (27%) of HIV co-infected TB patients. For 109 (48.2%) of co-infected TB patients the ART status evaluation could not be done due to missing data. A considerable proportion of HIV co-infected TB patients did either not receive ART or started it later than recommended by national guidelines. For better outcomes to HIV co-infected TB patients, the actual implementation of national recommendations on when to start ART needs to be monitored closely. Key words: ART-uptake delay, TB-HIV, primary health facility.
Highlights
The latest insights are that early initiation of antiretroviral treatment (ART) started within 2 weeks of commencing TB treatment, in all human immunodeficiency virus (HIV) co-infected TB patients regardless of CD4 count significantly improves survival (Abdool Karim et al, 2010; Nglazi et al, 2015) and is beneficial for patients with CD4 counts
An average of 40 people living with HIV and TB attend this clinic every year In Ethiopia, HIV co-infected TB patients are referred to ART clinics to be registered and assessed for ART initiation according to the prevailing National TB/HIV guideline
Less than two thirds of HIV co-infected TB patients (57.6%) were started on ART of whom 27% started ART later than recommended per the National Ethiopian, as well as the global guidelines. This is a cause for great concern as the latest global guidelines of WHO and UNAIDS of 2015 advise that all HIV coinfected TB patients should be started on ART within 2 months after start of TB treatment, and those with a CD4 counts of less than 50 be started as soon as possible within 2 weeks (World Health Organization, 2015)
Summary
Screening of all tuberculosis (TB) patients for human immunodeficiency virus (HIV) co-infection and referral of HIV positive patients for antiretroviral treatment (ART) initiation and chronic care services are essential. The latest insights are that early initiation of ART started within 2 weeks of commencing TB treatment, in all HIV co-infected TB patients regardless of CD4 count significantly improves survival (Abdool Karim et al, 2010; Nglazi et al, 2015) and is beneficial for patients with CD4 counts
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