Can We Get More HIV-Positive Tuberculosis Patients on Antiretroviral Treatment in a Rural District of Malawi?

Hdl Handle:
http://hdl.handle.net/10144/17252
Title:
Can We Get More HIV-Positive Tuberculosis Patients on Antiretroviral Treatment in a Rural District of Malawi?
Authors:
Zachariah, R; Teck, R; Ascurra, O; Gomani, P; Manzi, M; Humblet, P; Nunn, P; Salaniponi, F M L; Harries, A D
Journal:
International Journal of Tuberculosis and Lung Disease
Abstract:
The World Health Organization (WHO) has set a target of treating 3 million people with antiretroviral treatment (ART) by 2005. In sub-Saharan Africa, HIV-positive tuberculosis (TB) patients could significantly contribute to this target. ART (stavudine/lamivudine/nevirapine) was initiated in Thyolo district, Malawi, in April 2003, and all HIV-positive TB patients were considered eligible and offered ART. Despite this, only 44 (13%) of 352 TB patients were eventually started on ART by the end of November 2003. Most TB patients leave hospital after 2 weeks to complete the initial phase of anti-tuberculosis treatment (rifampicin-based) in the community, and ART is offered to HIV-positive TB patients after they have started the continuation phase of treatment (isoniazid/ ethambutol). ART is only offered at hospital, while the majority of TB patients take their continuation phase of anti-tuberculosis treatment from health centres. HIV-positive TB patients therefore find it difficult to access ART. In this paper, we discuss a series of options to increase the uptake of ART among HIV-positive TB patients. The main options are: 1) to hospitalise HIV-positive TB patients with a view to starting ART in the continuation phase in hospital; 2) to decentralise ART delivery so ART can be delivered at health centres; 3) to replace nevirapine with efavirenz so ART can be started earlier in the initial phase of anti-tuberculosis treatment. Decentralisation of ART from hospitals to health centres would greatly improve ART access.
Affiliation:
Medical Department (HIV-TB Operational Research), Brussels Operational Centre, Médecins sans Frontières, Brussels, Belgium. zachariah@internet.lu
Publisher:
International Union Against TB and Lung Disease
Issue Date:
Mar-2005
URI:
http://hdl.handle.net/10144/17252
PubMed ID:
15786885
Additional Links:
http://www.ingentaconnect.com/content/iuatld/ijtld
Language:
en
ISSN:
1027-3719
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorZachariah, R-
dc.contributor.authorTeck, R-
dc.contributor.authorAscurra, O-
dc.contributor.authorGomani, P-
dc.contributor.authorManzi, M-
dc.contributor.authorHumblet, P-
dc.contributor.authorNunn, P-
dc.contributor.authorSalaniponi, F M L-
dc.contributor.authorHarries, A D-
dc.date.accessioned2008-01-31T14:43:42Z-
dc.date.available2008-01-31T14:43:42Z-
dc.date.issued2005-03-
dc.identifier.citationCan We Get More HIV-Positive Tuberculosis Patients on Antiretroviral Treatment in a Rural District of Malawi? 2005, 9 (3):238-47 Int. J. Tuberc. Lung Dis.en
dc.identifier.issn1027-3719-
dc.identifier.pmid15786885-
dc.identifier.urihttp://hdl.handle.net/10144/17252-
dc.description.abstractThe World Health Organization (WHO) has set a target of treating 3 million people with antiretroviral treatment (ART) by 2005. In sub-Saharan Africa, HIV-positive tuberculosis (TB) patients could significantly contribute to this target. ART (stavudine/lamivudine/nevirapine) was initiated in Thyolo district, Malawi, in April 2003, and all HIV-positive TB patients were considered eligible and offered ART. Despite this, only 44 (13%) of 352 TB patients were eventually started on ART by the end of November 2003. Most TB patients leave hospital after 2 weeks to complete the initial phase of anti-tuberculosis treatment (rifampicin-based) in the community, and ART is offered to HIV-positive TB patients after they have started the continuation phase of treatment (isoniazid/ ethambutol). ART is only offered at hospital, while the majority of TB patients take their continuation phase of anti-tuberculosis treatment from health centres. HIV-positive TB patients therefore find it difficult to access ART. In this paper, we discuss a series of options to increase the uptake of ART among HIV-positive TB patients. The main options are: 1) to hospitalise HIV-positive TB patients with a view to starting ART in the continuation phase in hospital; 2) to decentralise ART delivery so ART can be delivered at health centres; 3) to replace nevirapine with efavirenz so ART can be started earlier in the initial phase of anti-tuberculosis treatment. Decentralisation of ART from hospitals to health centres would greatly improve ART access.en
dc.language.isoenen
dc.publisherInternational Union Against TB and Lung Disease-
dc.relation.urlhttp://www.ingentaconnect.com/content/iuatld/ijtld-
dc.rightsArchived on this site with the kind permission of the International Union Against TB and Lung Disease, http://www.iuatld.orgen
dc.subject.meshAnti-HIV Agentsen
dc.subject.meshAntiretroviral Therapy, Highly Activeen
dc.subject.meshAntitubercular Agentsen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshDrug Utilizationen
dc.subject.meshHIV Seropositivityen
dc.subject.meshHumansen
dc.subject.meshLamivudineen
dc.subject.meshMalawien
dc.subject.meshNational Health Programsen
dc.subject.meshNevirapineen
dc.subject.meshPrevalenceen
dc.subject.meshRural Populationen
dc.subject.meshStavudineen
dc.subject.meshTuberculosisen
dc.subject.meshWorld Health Organizationen
dc.titleCan We Get More HIV-Positive Tuberculosis Patients on Antiretroviral Treatment in a Rural District of Malawi?en
dc.contributor.departmentMedical Department (HIV-TB Operational Research), Brussels Operational Centre, Médecins sans Frontières, Brussels, Belgium. zachariah@internet.luen
dc.identifier.journalInternational Journal of Tuberculosis and Lung Diseaseen
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