We investigated the delays in the diagnosis of tuberculosis and/or HIV, their treatment initiation, and factors associated with each delay. All drug-susceptible tuberculosis cases diagnosed in 2014 and 2015 in Colombia, with a confirmed diagnosis of HIV were included. A total of 1909 patients were registered with tuberculosis/HIV co-infection. Seventy-nine percent of patients were men, 50% had sputum smear-negative tuberculosis, culture was done in 50% of cases, 68.5% had <200 CD4 cell count at diagnosis, and 35% had concurrent tuberculosis/HIV diagnosis. Delays in the tuberculosis diagnosis were identified in 54.8% of the patients, and delays in tuberculosis and HIV treatment initiation in 41.8% and 27.4%, respectively. The risk factors associated with delay in tuberculosis diagnosis were age between 15–34 and ≥45 years, and those patients who received tuberculin skin test. The risk factor associated with antiretroviral therapy initiation delay was previously-treated tuberculosis patients after failure. It is necessary to implement strategies for early detection and treatment initiation of HIV and to use rapid test for tuberculosis diagnosis in this population.
GebreegziabherSBBjuneGAYimerSA.Total delay is associated with unfavorable treatment outcome among pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a prospective cohort study. PLoS One2016;
11: e0159579.
2.
OtwombeKNVariavaEHolmesCB, et al.
Predictors of delay in the diagnosis and treatment of suspected tuberculosis in HIV co-infected patients in South Africa. Int J Tuberc Lung Dis2013;
17: 1199–1205.
3.
IlangovanKNagarajaSBAnanthakrishnanR, et al.
TB treatment delays in Odisha, India: is it expected even after these many years of RNTCP implementation?PLoS One2015;
10: e0125465.
4.
PatelMRNanaMYotebiengM, et al.
Delayed antiretroviral therapy despite integrated treatment for tuberculosis and HIV infection. Int J Tuberc Lung Dis2014;
18: 694–699.
5.
da SilvaTPGiacoia-GrippCBWSchmaltzCA, et al.
Risk factors for increased immune reconstitution in response to Mycobacterium tuberculosis antigens in tuberculosis HIV-infected, antiretroviral-naïve patients. BMC Infect Dis2017;
17: 606.
6.
VigneshRSwathirajanCRSolomonSS, et al.
Risk factors and frequency of tuberculosis-associated immune reconstitution inflammatory syndrome among HIV/Tuberculosis co-infected patients in Southern India. Indian J Med Microbiol2017;
35: 279.
7.
OdoneAAmadasiSWhiteRG, et al.
The impact of antiretroviral therapy on mortality in HIV positive people during tuberculosis treatment: a systematic review and meta-analysis. Plos One2014;
129: e112017.
8.
HavlirDVKendallMAIveP, et al.
Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med2011;
365: 1482–1491.
9.
BlancF-XSokTLaureillardD, et al.
Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis. N Engl J Med2011;
365: 1471–1481.
10.
Abdool KarimSSNaidooKGroblerA, et al.
Integration of antiretroviral therapy with tuberculosis treatment. N Engl J Med2011;
365: 1492–1501.
11.
NahidPDormanSEAlipanahN, et al.
Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis2016;
63: e147–e195.
ZachariahRHarriesADIshikawaN, et al.
Operational research in low-income countries: what, why, and how?Lancet Infect Dis2009;
19: 711–717.
14.
ZachariahRFordNDraguezB, et al.
Conducting operational research within a non governmental organization: the example of Médecins Sans Frontières. Int Health2010;
12: 1–8.
15.
CainKPMcCarthyKDHeiligCM, et al.
An algorithm for tuberculosis screening and diagnosis in people with HIV. N Engl J Med. 2010;
362: 707–716.
16.
GetahunHKittikraisakWHeiligCM, et al.
Development of a standardized screening rule for tuberculosis in people living with HIV in resource-constrained settings: individual participant data meta-analysis of observational studies. PLOS Med2011;
8: e1000391.
17.
WHO | Intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings [Internet]. WHO. [cited 9 August 2019]. http://www.who.int/hiv/pub/tb/9789241500708/en/
Ministerio de Salud y Protección Social, Fondo de Población de las Naciones Unidad. Guía de práctica clínica (GPC) basada en la evidencia científica para la atención de la infección por VIH/Sida en adolescentes (con 13 años de edad o más) y adultos. [Internet]. Ministerio de Salud y Protección Social. 2014 [cited 21 December 2017]. http://gpc.minsalud.gov.co/gpc_sites/Repositorio/Otros_conv/GPC_VIH_adolescentes/GPC_Comple_VIHADULTOS_web.pdf
20.
BalchaTTSturegårdEWinqvistN, et al.
Intensified tuberculosis case-finding in HIV-positive adults managed at Ethiopian health centers: diagnostic yield of Xpert MTB/RIF compared with smear microscopy and liquid culture. PLoS One2014;
9: e85478.
RodríguezDAVerdonckKBissellK, et al.
Monitoring delays in diagnosis of pulmonary tuberculosis in eight cities in Colombia. Rev Panam Salud Publica2016;
39: 12–18.
23.
SreeramareddyCTQinZZSatyanarayanaS, et al.
Delays in diagnosis and treatment of pulmonary tuberculosis in India: a systematic review. Int J Tuberc Lung Dis2014;
118: 255–266.
24.
Mueller-UsingSFeldtTSarfoFS, et al.
Factors associated with performing tuberculosis screening of HIV-positive patients in Ghana: LASSO-based predictor selection in a large public health data set. BMC Public Health [Internet]. 2016;
16 [cited 26 December 2017]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944423/
25.
StorlaDGYimerSBjuneGA.A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health2008;
8: 15.
26.
HeuvelingsCCde VriesSGGrevePF, et al.
Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review. Lancet Infect Dis2017;
117: e144–e158.
27.
LundgrenJDBabikerAGGordinF, et al.
Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med2015;
373: 795–807.
28.
LifsonARGrundBGardnerEM, et al.
Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection. AIDS2017;
31: 953–963.
29.
WalkerASPrendergastAJMugyenyiP, et al.
Mortality in the year following antiretroviral therapy initiation in HIV-infected adults and children in Uganda and Zimbabwe. Clin Infect Dis2012;
55: 1707–1718.
30.
HakimJMusiimeVSzubertAJ, et al.
Enhanced prophylaxis plus antiretroviral therapy for advanced HIV infection in Africa. N Engl J Med. 2017;
377: 233–245.
