Effectiveness of early initiation of antiretroviral therapy in adults with HIV associated tuberculosis in Lesotho in 2012.
Background Today Africa is confronted with a huge burden of Human Immunodeficiency Virus (HIV) associated tuberculosis (TB). In 2010, 77% of the TB in Lesotho was HIV associated. The problem is intensified by many factors, such as the timing of initiation of antiretroviral therapy (ART), separation of HIV and TB services that discourages people from seeking care and the policies governing the treatment of HIV and TB. Aim The aim of this study is to compare the effectiveness of late versus early commencement of ART in adults living with HIV associated TB in Lesotho in 2012. Method An observational, analytic cross-sectional study design was conducted. Three out of 17 hospitals were randomly selected and data for patients with HIV-associated TB who had completed TB therapy during the study period (January to March 2012) was extracted from the hospitals’ TB registers. Results Of the 247 adults living with HIV associated TB, 80 (32%) were started on ART early (4 weeks or less), 100 (41%) were started late (after 4 weeks) and 67 (27%) received no ART at all. The unadjusted results show that early initiators were 6 times more likely to have a successful TB outcome (OR 6.2: 95%CI: 3.7 to 27.5) relative to the group who had no ART. The difference was statistically significant (p<0.001). Interestingly those who commenced ART late also were six times more likely to have a successful TB outcome (OR 5.6: 95% CI: 2.8 to 11.2) relative to the group who had no ART. Discussion This study provides evidence that in Lesotho, early initiation of ART in adults living with HIV associated TB has not been fully implemented. Only a third were commenced on ART early after starting TB treatment. This study demonstrated however, that even those who commenced ART late performed much better than those who were not prescribed ART. This therefore highlighted that successful TB treatment outcomes were not dependent on when ART was initiated. Recommendations The Lesotho Ministry of Health should ensure early initiation of ART in people living with HIV associated TB in order to improve their TB outcomes.