Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township

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dc.contributor.authorLawn, Stephenen_ZA
dc.contributor.authorCampbell, Lucyen_ZA
dc.contributor.authorKaplan, Richarden_ZA
dc.contributor.authorLittle, Francescaen_ZA
dc.contributor.authorMorrow, Carlen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorIeDEA-Southern Africaen_ZA
dc.date.accessioned2015-11-11T11:53:06Z
dc.date.available2015-11-11T11:53:06Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: Delays in the initiation of antiretroviral therapy (ART) in patients with HIV-associated tuberculosis (TB) are associated with increased mortality risk. We examined the timing of ART among patients receiving care provided by non-integrated TB and ART services in Cape Town, South Africa. METHODS: In an observational cohort study, we determined the overall time delay between starting treatment for TB and starting ART in patients treated in Gugulethu township between 2002 and 2008. For patients referred from TB clinics to the separate ART clinic, we quantified and identified risk factors associated with the two component delays between starting TB treatment, enrolment in the ART clinic and subsequent initiation of ART. RESULTS: Among 893 TB patients studied (median CD4 count, 81 cells/muL), the delay between starting TB treatment and starting ART was prolonged (median, 95 days; IQR = 49-155). Delays were shorter in more recent calendar periods and among those with lower CD4 cell counts. However, the median delay was almost three-fold longer for patients referred from separate TB clinics compared to patients whose TB was diagnosed in the ART clinic (116 days versus 41 days, respectively; P < 0.001). In the most recent calendar period, the proportions of patients with CD4 cell counts < 50 cells/muL who started ART within 4 weeks of TB diagnosis were 11.1% for patients referred from TB clinics compared to 54.6% of patients with TB diagnosed in the ART service (P < 0.001). CONCLUSIONS: Delays in starting ART were prolonged, especially for patients referred from separate TB clinics. Non-integration of TB and ART services is likely to be a substantial obstacle to timely initiation of ART.en_ZA
dc.identifier.apacitationLawn, S., Campbell, L., Kaplan, R., Little, F., Morrow, C., Wood, R., & (2011). Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14855en_ZA
dc.identifier.chicagocitationLawn, Stephen, Lucy Campbell, Richard Kaplan, Francesca Little, Carl Morrow, Robin Wood, and "Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township." <i>BMC Infectious Diseases</i> (2011) http://hdl.handle.net/11427/14855en_ZA
dc.identifier.citationLawn, S. D., Campbell, L., Kaplan, R., Little, F., Morrow, C., & Wood, R. (2011). Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township. BMC infectious diseases, 11(1), 258.en_ZA
dc.identifier.ris TY - Journal Article AU - Lawn, Stephen AU - Campbell, Lucy AU - Kaplan, Richard AU - Little, Francesca AU - Morrow, Carl AU - Wood, Robin AU - IeDEA-Southern Africa AB - BACKGROUND: Delays in the initiation of antiretroviral therapy (ART) in patients with HIV-associated tuberculosis (TB) are associated with increased mortality risk. We examined the timing of ART among patients receiving care provided by non-integrated TB and ART services in Cape Town, South Africa. METHODS: In an observational cohort study, we determined the overall time delay between starting treatment for TB and starting ART in patients treated in Gugulethu township between 2002 and 2008. For patients referred from TB clinics to the separate ART clinic, we quantified and identified risk factors associated with the two component delays between starting TB treatment, enrolment in the ART clinic and subsequent initiation of ART. RESULTS: Among 893 TB patients studied (median CD4 count, 81 cells/muL), the delay between starting TB treatment and starting ART was prolonged (median, 95 days; IQR = 49-155). Delays were shorter in more recent calendar periods and among those with lower CD4 cell counts. However, the median delay was almost three-fold longer for patients referred from separate TB clinics compared to patients whose TB was diagnosed in the ART clinic (116 days versus 41 days, respectively; P < 0.001). In the most recent calendar period, the proportions of patients with CD4 cell counts < 50 cells/muL who started ART within 4 weeks of TB diagnosis were 11.1% for patients referred from TB clinics compared to 54.6% of patients with TB diagnosed in the ART service (P < 0.001). CONCLUSIONS: Delays in starting ART were prolonged, especially for patients referred from separate TB clinics. Non-integration of TB and ART services is likely to be a substantial obstacle to timely initiation of ART. DA - 2011 DB - OpenUCT DO - 10.1186/1471-2334-11-258 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township TI - Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township UR - http://hdl.handle.net/11427/14855 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14855
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-11-258
dc.identifier.vancouvercitationLawn S, Campbell L, Kaplan R, Little F, Morrow C, Wood R, et al. Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township. BMC Infectious Diseases. 2011; http://hdl.handle.net/11427/14855.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2011 Lawn et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherantiretroviral therapy (ART)en_ZA
dc.subject.otherHIV-associated tuberculosis (TB)en_ZA
dc.titleDelays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African townshipen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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