title: Delayed initiation of anti-retroviral therapy in TB/HIV co-infected patients, Sanyati District, Zimbabwe, 2011-2012.
abstract: BACKGROUND
  Tuberculosis (TB) remains a public health problem and is driven by HIV. Recent studies indicate that anti-retroviral therapy (ART) initiated during the first two months of anti-TB treatment (ATT) reduces risk of HIV morbidity and mortality. In Sanyati district, 14% of TB/HIV co-infected patients were initiated on ART during TB treatment, in 2010. The study was conducted to determine the magnitude and determinants of delay in ART initiation, in TB/HIV co-infected patients.
  
  
  METHODS
  An analytic cross sectional study was conducted at three study sites in Sanyati district. The outcome was delayed ART initiation, being failure to be initiated on ART during the first two months of ATT. Respondents were interviewed using pre-tested questionnaires. Epi-Info was used to generate frequencies, means, odds ratios and 95% confidence intervals. Stratified and logistic regression analysis was done.
  
  
  RESULTS
  Of the 186 respondents, 63% had delayed ART initiation. Median delay from initiation of ATT to ART was 48 days (Q1=20; Q3=82). Risk factors for delayed ART initiation were: being treated for TB first time, AOR=2.23 (p=0.03); initially registered for HIV care outside Sanyati, AOR=3.08 (p<0.01); staying more than 5km from a clinic, AOR=3.29 (p<0.01). Enabling factors for early ART initiation was having a family member on ART, AOR=0.23 (p<0.01).
  
  
  CONCLUSIONS
  Significant delay and barriers to ART initiation were identified. Decentralization of ART initiation should be expedited. ART initiation should be expedited in patients with identified risk factors for delaying ART initiation. Peer support should be strengthened in families and community. Periodic evaluation of magnitude of delay and impact of early ART initiation in TB/HIV patients is recommended.
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Zimbabwe.
authors.forename: Brian Abel
authors.initials: BA
authors.lastname: Maponga
authors.affiliation: Department of Health, Kadoma City Council, Zimbabwe.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chirundu
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Zimbabwe.
authors.forename: Notion Tafara
authors.initials: NT
authors.lastname: Gombe
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Zimbabwe.
authors.forename: Mufuta
authors.initials: M
authors.lastname: Tshimanga
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Zimbabwe.
authors.forename: Donewell
authors.initials: D
authors.lastname: Bangure
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Zimbabwe.
authors.forename: Lucia
authors.initials: L
authors.lastname: Takundwa
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy*; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents
keywords: HIV; Sanyati; Tuberculosis; Zimbabwe; anti-retroviral therapy; delay; initiation