ART uptake, its timing and relation to anti-tuberculosis treatment outcomes among HIV-infected TB patients

Setting: All public health facilities in two provinces of Zimbabwe. Objective: To determine, among tuberculosis (TB) patients with human immunodeficiency virus (HIV) registered in 2010, 1) the proportion started on antiretroviral treatment (ART), 2) the timing of ART in relation to the start of anti-tuberculosis treatment, and 3) whether timing of ART influenced anti-tuberculosis treatment outcomes. Design: Retrospective cohort study. Results: Of the 2655 HIV-positive TB patients, 1115 (42%) were documented as receiving ART. Of these, 178 (16%) started ART prior to anti-tuberculosis treatment. Of those who started after anti-tuberculosis treatment, 17% started within 2 weeks, 43% between 2 and 8 weeks and 40% after 8 weeks. Treatment success in the cohort was 82%, with 14% deaths before completion of anti-tuberculosis treatment. Not receiving ART during anti-tuberculosis treatment was associated with lower anti-tuberculosis treatment success (adjusted RR 0.70, 95% CI 0.53-0.91) and more deaths (ad justed RR 3.43, 95% CI 2.2-5.36). There were no differences in TB treatment outcomes by timing of ART initiation. Conclusion: ART uptake is low given the improved treatment outcomes in those put on ART during antit uberculosis treatment. Better integration of HIV and TB services is needed to ensure increased coverage and earlier ART uptake.