title: ART uptake, its timing and relation to anti-tuberculosis treatment outcomes among HIV-infected TB patients.
abstract: METHODS
  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.
  
  
  METHODS
  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 (adjusted RR 3.43, 95%CI 2.2-5.36). There were no differences in TB treatment outcomes by timing of ART initiation.
  
  
  CONCLUSIONS
  ART uptake is low given the improved treatment outcomes in those put on ART during anti-tuberculosis treatment. Better integration of HIV and TB services is needed to ensure increased coverage and earlier ART uptake.
authors.affiliation: AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe ; Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: K C
authors.initials: KC
authors.lastname: Takarinda
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe.
authors.forename: T
authors.initials: T
authors.lastname: Mutasa-Apollo
authors.affiliation: AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe.
authors.forename: C
authors.initials: C
authors.lastname: Sandy
authors.affiliation: AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe.
authors.forename: T
authors.initials: T
authors.lastname: Murimwa
authors.affiliation: AIDS & TB Unit, Ministry of Health & Child Welfare, Harare, Zimbabwe.
authors.forename: O
authors.initials: O
authors.lastname: Mugurungi
keywords: HIV; Zimbabwe; antiretroviral treatment; tuberculosis