title: Barriers to initiation of antiretrovirals during antituberculosis therapy in 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa. dominiquepepper@gmail.com
authors: Dominique J
authors: DJ
authors: Pepper
authors: Suzaan
authors: S
authors: Marais
authors: Robert J
authors: RJ
authors: Wilkinson
authors: Feriyl
authors: F
authors: Bhaijee
authors: Virginia
authors: V
authors: De Azevedo
authors: Graeme
authors: G
authors: Meintjes
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