barriers to initiation of antiretrovirals during antituberculosis therapy in africa障碍在非洲发起公开的抗逆转录病毒药物的治疗.pdfVIP

Barriers to Initiation of Antiretrovirals during Antituberculosis Therapy in Africa 1 1,2,3 1,2,3,4,5 1 Dominique J. Pepper *, Suzaan Marais , Robert J. Wilkinson , Feriyl Bhaijee , Virginia De Azevedo6, Graeme Meintjes1,2,3,4 1 Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa, 2 Infectious Diseases Unit, GF Jooste Hospital, Cape Town, South Africa, 3 Department of Medicine, University of Cape Town, Cape Town, South Africa, 4 Division of Medicine, Imperial College London, United Kingdom, 5 MRC National Institute for Medical Research, Mill Hill, London, United Kingdom, 6 City Health, Cape Town, South Africa Abstract 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 ass