Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo.
Background. We assessed the impact of WHO's 2010 guidelines that removed the requirement of CD4 count before ART, on timely initiation of ART among HIV/TB patients in the Democratic Republic of Congo (DRC). Methods. Data collected to monitor implementation of provider initiated HIV testing and counseling (PITC) and linkage to HIV care from 65 and 13 TB clinics in Kinshasa and Kisangani, respectively, between November 2010 and June 2013. Results. Prior to the WHO's 2010 guidelines, in Kinshasa, 79.1% (401/507) of HIV/TB patients referred for HIV services were initiated on ART in clinics with onsite ART services compared to 50.0% (63/123) in clinics without. Following the implementation of the new guidelines, 89.8% (714/795) and 93.0% (345/371) of HIV/TB patients referred for HIV services were initiated on ART, respectively, in clinics with onsite and without onsite ART services. Similarly, in Kisangani, 69.7% (53/120) and 36.4% (16/44) in clinics with and without onsite ART service, respectively, were initiated on ART prior to the 2010 guidelines and 88.8% (135/152) and 72.6% (106/146), respectively, after the new guidelines. Conclusion. Though implementation of the 2010 guidelines increased the proportion of HIV/TB patients initiated on ART substantially, it remained below the 100% target, particularly in clinics without onsite ART services.
Division of Epidemiology, College of Public Health, The Ohio State University, 304 Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210-1351, USA; Department of Epidemiology, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB No. 7435, Chapel Hill, NC 27599-7435, USA.
Marcel
0000-0003-2110-2631
M
Yotebieng
School of Public Health, The University of Kinshasa, Kinshasa, Congo.
Martine
M
Tabala
Department of Epidemiology, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB No. 7435, Chapel Hill, NC 27599-7435, USA; School of Public Health, The University of Kinshasa, Kinshasa, Congo.
Marie Louise
ML
Batumbula
School of Public Health, The University of Kinshasa, Kinshasa, Congo.
Landry
L
Wenzi
School of Public Health, The University of Kinshasa, Kinshasa, Congo.
Emmanuel
E
Basaki
School of Public Health, The University of Kinshasa, Kinshasa, Congo.
Eugenie
E
Mungoyo
School of Public Health, The University of Kinshasa, Kinshasa, Congo.
Richard
R
Mangala
Department of Epidemiology, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB No. 7435, Chapel Hill, NC 27599-7435, USA; School of Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room No. 348, CB No. 7240, Chapel Hill, NC 27599-7240, USA.
Frieda
F
Behets