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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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dc.contributor Medical Department (HIV-TB Operational Research), Brussels Operational Centre, Médecins sans Frontières, Brussels, Belgium. zachariah@internet.lu
dc.creator Zachariah, R
dc.creator Teck, R
dc.creator Ascurra, O
dc.creator Gomani, P
dc.creator Manzi, M
dc.creator Humblet, P
dc.creator Nunn, P
dc.creator Salaniponi, F M L
dc.creator Harries, A D
dc.date 2005-03
dc.date.accessioned 2017-01-31T07:09:10Z
dc.date.available 2017-01-31T07:09:10Z
dc.identifier Can 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.
dc.identifier 1027-3719
dc.identifier 15786885
dc.identifier http://hdl.handle.net/10144/17252
dc.identifier http://fieldresearch.msf.org/msf/handle/10144/17252
dc.identifier International Journal of Tuberculosis and Lung Disease
dc.identifier.uri http://dspace.mediu.edu.my:8181/xmlui/handle/10144/17252
dc.description 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.
dc.language en
dc.publisher International Union Against TB and Lung Disease
dc.relation http://www.ingentaconnect.com/content/iuatld/ijtld
dc.rights Archived on this site with the kind permission of the International Union Against TB and Lung Disease, http://www.iuatld.org
dc.title Can We Get More HIV-Positive Tuberculosis Patients on Antiretroviral Treatment in a Rural District of Malawi?


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