Timing and uptake of ART during treatment for active tuberculosis in HIV co-infected adults in Malawi

Malawian policy to invite patients co-infected with tuberculosis (TB) and HIV to start antiretroviral therapy (ART) 2 months after initiating TB treatment changed recently; the new policy shortened the period to 2 weeks instead of 2 months. The objective of this paper is to determine if earlier initiation of ART in co-infected patients receiving TB treatment will increase the uptake and continuation of ART.

The paper underscores that evidence suggests a clear mortality benefit of earlier initiation of ART treatment in co-infected patients. The study relies on data collected in the context of evaluating related programmes. The main findings of the document are that:

• there was wide variability in the ART start time before and after the policy change.
• before the policy change, 16% of patients initiated ART by 3 months compared to 24% after the policy change.
• the proportion of all co-infected patients on ART increased from 32% before the policy change to 39% after.
• earlier initiation of ART did not increase the occurrence of side effects and did not reduce adherence to TB treatment.

The authors conclude that changing the policy would increase the uptake and continuation of ART among TB-HIV co-infected patients on TB treatment and that earlier initiation did not increase mortality. Nevertheless, they emphasise that intensified sensitisation of patients and care providers regarding the risks and benefits of early ART in TB-HIV co-infected patients are still needed.