title: Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Treatment among Co-Infected Persons in South Africa, 2008-2010.
abstract: BACKGROUND
  Adherence to tuberculosis (TB) treatment and antiretroviral therapy (ART) reduces morbidity and mortality among persons co-infected with TB/HIV. We measured adherence and determined factors associated with non-adherence to concurrent TB treatment and ART among co-infected persons in two provinces in South Africa.
  
  
  METHODS
  A convenience sample of 35 clinics providing integrated TB/HIV care was included due to financial and logistic considerations. Retrospective chart reviews were conducted among persons who received concurrent TB treatment and ART and who had a TB treatment outcome recorded during 1 January 2008-31 December 2010. Adherence to concurrent TB and HIV treatment was defined as: (1) taking ≥80% of TB prescribed doses by directly observed therapy (DOT) as noted in the patient card; and (2) taking >90% ART doses as documented in the ART medical record during the concurrent treatment period (period of time when the patient was prescribed both TB treatment and ART). Risk ratios (RRs) and 95% confidence intervals (CIs) were used to identify factors associated with non-adherence.
  
  
  RESULTS
  Of the 1,252 persons receiving concurrent treatment, 138 (11.0%) were not adherent. Non-adherent persons were more likely to have extrapulmonary TB (RR: 1.71, 95% CI: 1.12 to 2.60) and had not disclosed their HIV status (RR: 1.96, 95% CI: 1.96 to 3.76).
  
  
  CONCLUSIONS
  The majority of persons with TB/HIV were adherent to concurrent treatment. Close monitoring and support of persons with extrapulmonary TB and for persons who have not disclosed their HIV status may further improve adherence to concurrent TB and antiretroviral treatment.
authors.affiliation: Tuberculosis HIV/AIDS Treatment Support and Integrated Therapy (THAT'SIT), Johannesburg, South Africa and Foundation for Professional Development, Pretoria, South Africa.
authors.forename: Ernesha
authors.initials: E
authors.lastname: Webb Mazinyo
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.|Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kim
authors.affiliation: Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa.
authors.forename: Sikhethiwe
authors.initials: S
authors.lastname: Masuku
authors.affiliation: Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa.
authors.forename: Joey L
authors.initials: JL
authors.lastname: Lancaster
authors.affiliation: Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa.
authors.forename: Ronel
authors.initials: R
authors.lastname: Odendaal
authors.affiliation: Tuberculosis HIV/AIDS Treatment Support and Integrated Therapy (THAT'SIT), Johannesburg, South Africa and Foundation for Professional Development, Pretoria, South Africa.
authors.forename: Margot
authors.initials: M
authors.lastname: Uys
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Laura Jean
authors.initials: LJ
authors.lastname: Podewils
authors.affiliation: Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council, Pretoria, South Africa.
authors.forename: Martie L
authors.initials: ML
authors.lastname: Van der Walt
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy*; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D013019:South Africa; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy*
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents