title: Timing of antiretroviral therapy and effects on tuberculosis treatment outcomes in HIV-co-infected patients in Malawi.
abstract: METHODS
  Queen Elizabeth Central Hospital, Blantyre, Malawi.
  
  
  OBJECTIVE
  To determine 1) the proportion of human immunodeficiency virus (HIV) infected tuberculosis (TB) patients started on antiretroviral therapy (ART), 2) the timing of ART and 3) the effect of the timing on TB treatment outcomes.
  
  
  METHODS
  A retrospective record review of HIV-infected TB patients registered from January to December 2009.
  
  
  RESULTS
  A total of 3376 TB patients were registered, of whom 2665 (79%) were HIV-tested and 2042 (77%) were HIV-infected. A total of 1190 HIV-infected TB patients who were not on ART at the time of starting TB treatment were studied. Of 688 (58%) who started ART, 61% started therapy within 2 months of anti-tuberculosis treatment and 39% started later (≥2 months). Treatment success for patients with TB who started ART within 2 months was higher than for those starting ART later (RR 1.6, 95%CI 1.4-1.8), and death rates were lower (RR 0.25, 95%CI 0.19-0.35).
  
  
  CONCLUSIONS
  Under routine programme conditions in Malawi, a higher proportion of HIV-infected TB patients who started ART did so within 2 months of starting TB treatment, and early ART intervention was associated with better treatment outcomes. This confirms recommendations that co-infected TB patients should start ART early.
authors.affiliation: National Tuberculosis Programme, Ministry of Health, Lilongwe, Malawi.
authors.forename: H S
authors.initials: HS
authors.lastname: Kanyerere
authors.affiliation: National Tuberculosis Programme, Ministry of Health, Lilongwe, Malawi.
authors.forename: J
authors.initials: J
authors.lastname: Mpunga
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi.
authors.forename: H
authors.initials: H
authors.lastname: Tweya
authors.affiliation: Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Edginton
authors.affiliation: Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway.
authors.forename: S G
authors.initials: SG
authors.lastname: Hinderaker
authors.affiliation: HIV and AIDS Department, Ministry of Health, Lilongwe, Malawi.
authors.forename: F
authors.initials: F
authors.lastname: Chimbwandira
authors.affiliation: Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Gonani
authors.affiliation: National Tuberculosis Programme, Ministry of Health, Lilongwe, Malawi.
authors.forename: K
authors.initials: K
authors.lastname: Mbendera
keywords: Malawi; operational research; timing; tuberculosis