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    Jan 15, 2021
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    Can We Get More HIV-Positive Tuberculosis Patients on Antiretroviral Treatment in a Rural District of Malawi?

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    Authors
    Zachariah, R
    Teck, R
    Ascurra, O
    Gomani, P
    Manzi, M
    Humblet, P
    Nunn, P
    Salaniponi, F M L
    Harries, A D
    Affiliation
    Medical Department (HIV-TB Operational Research), Brussels Operational Centre, Médecins sans Frontières, Brussels, Belgium. zachariah@internet.lu
    Issue Date
    2005-03
    
    Metadata
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    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.
    Publisher
    International Union Against TB and Lung Disease
    URI
    http://hdl.handle.net/10144/17252
    PubMed ID
    15786885
    Additional Links
    http://www.ingentaconnect.com/content/iuatld/ijtld
    Language
    en
    ISSN
    1027-3719
    Collections
    TB

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