Barriers to initiation of antiretrovirals during antituberculosis therapy in Africa

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dc.contributor.authorPepper, Dominique Jen_ZA
dc.contributor.authorMarais, Suzaanen_ZA
dc.contributor.authorWilkinson, Robert Jen_ZA
dc.contributor.authorBhaijee, Feriylen_ZA
dc.contributor.authorDe Azevedo, Virginiaen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.date.accessioned2015-12-28T06:47:46Z
dc.date.available2015-12-28T06:47:46Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: 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.en_ZA
dc.identifier.apacitationPepper, D. J., Marais, S., Wilkinson, R. J., Bhaijee, F., De Azevedo, V., & Meintjes, G. (2011). Barriers to initiation of antiretrovirals during antituberculosis therapy in Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/16050en_ZA
dc.identifier.chicagocitationPepper, Dominique J, Suzaan Marais, Robert J Wilkinson, Feriyl Bhaijee, Virginia De Azevedo, and Graeme Meintjes "Barriers to initiation of antiretrovirals during antituberculosis therapy in Africa." <i>PLoS One</i> (2011) http://hdl.handle.net/11427/16050en_ZA
dc.identifier.citationPepper, D. J., Marais, S., Wilkinson, R. J., Bhaijee, F., De Azevedo, V., & Meintjes, G. (2011). Barriers to initiation of antiretrovirals during antituberculosis therapy in Africa. PLoS ONE, 6(5), e19484. doi:10.1371/journal.pone.0019484en_ZA
dc.identifier.ris TY - Journal Article AU - Pepper, Dominique J AU - Marais, Suzaan AU - Wilkinson, Robert J AU - Bhaijee, Feriyl AU - De Azevedo, Virginia AU - Meintjes, Graeme AB - 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. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pone.0019484 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Barriers to initiation of antiretrovirals during antituberculosis therapy in Africa TI - Barriers to initiation of antiretrovirals during antituberculosis therapy in Africa UR - http://hdl.handle.net/11427/16050 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16050
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0019484
dc.identifier.vancouvercitationPepper DJ, Marais S, Wilkinson RJ, Bhaijee F, De Azevedo V, Meintjes G. Barriers to initiation of antiretrovirals during antituberculosis therapy in Africa. PLoS One. 2011; http://hdl.handle.net/11427/16050.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightscredited.en_ZA
dc.rights.holder© 2011 Pepper et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.subject.otherMycobacterium tuberculosisen_ZA
dc.subject.otherHistory of tuberculosisen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherDrug screeningen_ZA
dc.subject.otherHospitalsen_ZA
dc.titleBarriers to initiation of antiretrovirals during antituberculosis therapy in Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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