Delayed antiretroviral therapy despite integrated treatment for tuberculosis and HIV infection

Monita R. Patel, M. Nana, M. Yotebieng, M. Tabala, F. Behets, A. Van Rie

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


SETTING: Five primary health care clinics in Kinshasa, Democratic Republic of Congo. OBJECTIVE: To examine timing and predictors of delayed initiation of antiretroviral therapy (ART) during anti-tuberculosis treatment. DESIGN: Prospective observational cohort of adult patients receiving integrated treatment for tuberculosis (TB) and human immunodeficiency virus (HIV) who are expected to initiate ART at 1 month if CD4 count is <100 cells/mm3 or if patient is World Health Organization (WHO) Clinical Stage 4 for reasons other than extra-pulmonary TB, at 2 months if CD4 count is 100- 350 cells/mm3, or at completion of anti-tuberculosis treatment if subsequently CD4 count is ≤350 cells/mm3 or patient has WHO Clinical Stage 4. RESULTS : Of 492 patients, 235 (47.8%) experienced delayed initiation of ART: 171 (72.8%) initiated ART late, after a median delay of 12 days (interquartile range [IQR] 4-27) and 64 (27.2%) never initiated ART. Contraindication to any antiretroviral drug (aOR 2.91, 95%CI 1.22-6.95), lower baseline CD4 count (aOR 1.20, 95%CI 1.08-1.33/100 cells/mm3), TB drug intolerance (aOR 1.93, 95%CI 1.23-3.02) and nondisclosure of HIV infection (aOR 1.50, 95%CI 1.03-2.18) predicted delayed ART initiation. CONCLUSION: Despite fully integrated treatment, half of all patients experienced delayed ART initiation. Pragmatic approaches to ensure timely ART initiation in those at risk of delayed ART initiation are needed.

Original languageEnglish (US)
Pages (from-to)694-699+i
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number6
StatePublished - Jun 1 2014
Externally publishedYes


  • Delay
  • HIV
  • Integration
  • Predictors
  • TB

ASJC Scopus subject areas

  • Medicine(all)


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