Factors associated with delayed antiretroviral therapy initiation among Tuberculosis/ Human Immunodeficiency Virus co-infected patients in Lupane district, 2015

Abstract

Background: Antiretroviral therapy (ART) should be given to all Human Immunodeficiency Virus (HIV)-positive Tuberculosis (TB) patients within the first eight weeks of commencing anti-tuberculosis treatment (ATT), to reduce risk of mortality. In 2012 and 2013, Lupane district initiated 62% and 37% respectively of TB/ HIV co-infected patients on ART against a target of 100%. The study was conducted to determine the prevalence of delayed ART initiation in 2015 and to identify factors associated with the delays. Methods: An analytic cross sectional study was conducted at seven health facilities in Lupane district. Two hundred and ten study participants were recruited into the study. A checklist was used to assess for quality of care at the health facilities. Key informant interviews were held with program Managers and health workers. Results: Among the 210 patients studied, 19 % (n= 39) delayed ART initiation. The median delay between starting ATT and ART was 23 days (Q1= 18 days, Q3= 30 days). Independent factors associated with ART initiation were marital status; separated (AOR 6.21, 95% CI 1.63-23.71), single (AOR 9.58 95% CI 2.39 – 38.36) and widowed (AOR 14.23 95% CI 1.72 – 117.76), first HIV treatment at health centre (AOR 0.35 95% CI 0.13-0.94), transport cost more than US$1 (AOR 5.69, 95% CI 1.87-17.34), fear of medicine toxicity (AOR 7.68, 95% CI 2.63-22.41), and having a family member on TB treatment (AOR 0.22, 95% CI 0.07-0.67). ART follow up and outreach was not being one at all the facilities. Communication on referred TB/ART patients was not complete between facilities. Conclusion: Intensifying ART preparation, streamlining clinic visit schedule protocols, follow up on defaulting patients and outreach clinics are vital in averting delays. Health workers should communicate on referred ART patients to expedite linkage in care.