Journal article
Retrospective cohort analysis of antiretroviral therapy initiation timelines and clinical outcomes in adults with HIV and TB disease in KwaZulu-Natal, South Africa
- Abstract:
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Background
We aimed to determine antiretroviral therapy (ART) initiation timing and outcomes in people living with HIV (PLHIV) receiving tuberculosis treatment in KwaZulu-Natal, South Africa.
Methods
We performed a retrospective cohort analysis of routinely collected de-identified data from 62 clinics including PLHIV not already receiving ART aged ≥16 years, starting tuberculosis treatment between October 2016–November 2019. Multivariable Poisson regression models with robust standard errors evaluated associations between timing of ART initiation (after starting tuberculosis treatment) and successful tuberculosis treatment, and 6-month HIV viral load (VL) < 50 copies/mL.
Results
Among 5,548 PLHIV with tuberculosis, 29.8% initiated ART within 15 days (“early”), 36.2% in 16–56 days, 8.7% in 57–210 days, with 25.3% not initiating ART by 7 months. Proportions with successful tuberculosis treatment were similar comparing 16–56 and 57–210 days to early initiation, with a lower likelihood of successful tuberculosis outcome with no ART within 7 months (adjusted risk ratio [aRR] 0.81 [0.77–0.86], p < 0.001). In those with a known VL 6 months post-ART initiation (n = 2,658), initiation within 57–210 days had a lower likelihood of viral suppression (aRR 0.90 [0.82–0.99], p < 0.03).
Conclusion
Although <30% of PLHIV with tuberculosis initiated ART early, this was associated with better tuberculosis outcomes and VL suppression.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 730.8KB, Terms of use)
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- Publisher copy:
- 10.1177/09564624251369565
Authors
+ National Institute for Health and Care Research
More from this funder
- Funder identifier:
- https://ror.org/0187kwz08
- Publisher:
- SAGE Publications
- Journal:
- International Journal of STD & AIDS More from this journal
- Volume:
- 37
- Issue:
- 1
- Pages:
- 14-23
- Publication date:
- 2025-08-21
- Acceptance date:
- 2025-08-04
- DOI:
- EISSN:
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1758-1052
- ISSN:
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0956-4624
- Language:
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English
- Keywords:
- Pubs id:
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2283578
- UUID:
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uuid_1b23b27d-eee2-49fb-b9d5-bd0aa6ab902e
- Local pid:
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pubs:2283578
- Source identifiers:
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3646704
- Deposit date:
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2026-01-09
- ARK identifier:
Terms of use
- Copyright holder:
- Jansen van Vuuren et al
- Copyright date:
- 2025
- Rights statement:
- © The Author(s) 2025. Creative Commons License (CC BY 4.0) This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
- Licence:
- CC Attribution (CC BY)
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