title: Timing and uptake of ART during treatment for active tuberculosis in HIV co-infected adults in Malawi.
abstract: METHODS
  Uptake of antiretroviral therapy (ART) in patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) has historically been low in Malawi. In response, the National TB Programme piloted the initiation of ART 2 weeks after initiation of TB treatment in 2008-2009, a change from the prior policy of 2 months.
  
  
  OBJECTIVE
  To determine at programme level if earlier initiation of ART in co-infected patients receiving TB treatment will increase the uptake and continuation of ART.
  
  
  METHODS
  A prospective observational pilot programme evaluation using routinely collected monitoring data from the first two sites with integrated TB-HIV services in Malawi.
  
  
  RESULTS
  There was wide variability in the ART start time before and after the policy change. Before the policy change, 16% of patients initiated ART by 3 months compared to 24% after the policy change (P < 0.001). The proportion of all co-infected patients on ART increased from 32% before the policy change to 39% after (P < 0.001). Earlier initiation of ART did not increase the occurrence of side effects and did not reduce adherence to TB treatment.
  
  
  CONCLUSIONS
  Earlier initiation of ART in co-infected patients receiving TB treatment improved the uptake and continuation of ART. Malawi ART guidelines in 2011 were changed from initiating ART after 2 months to as soon as possible after starting anti-tuberculosis treatment.
authors.affiliation: Dignitas International, Zomba, Malawi ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: van Lettow
authors.affiliation: Dignitas International, Zomba, Malawi ; Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: A S
authors.initials: AS
authors.lastname: Ginsburg
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: H
authors.initials: H
authors.lastname: Tweya
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: D
authors.initials: D
authors.lastname: Gareta
authors.affiliation: Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi.
authors.forename: J
authors.initials: J
authors.lastname: Njala
authors.affiliation: National Tuberculosis Programme, Lilongwe, Malawi.
authors.forename: H
authors.initials: H
authors.lastname: Kanyerere
authors.affiliation: The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: S
authors.initials: S
authors.lastname: Phiri
authors.affiliation: National Tuberculosis Programme, Lilongwe, Malawi.
authors.forename: I
authors.initials: I
authors.lastname: Idana
keywords: ART initiation; Malawi; TB-HIV co-infection