Impact of Combination Antiretroviral Therapy Initiation on Adherence to Antituberculosis Treatment

ABSTRACT

Background: Healthcare workers are often reluctant to start combination antiretroviral therapy (ART) in patients receiving tuberculosis (TB) treatment because of the fear of high pill burden; immune reconstitution inflammatory syndrome; and side-effects.Object To quantify changes in adherence to tuberculosis treatment following ART initiation.Design: A prospective observational cohort study of ART-naive individuals with baseline CD4 count between 50 cells/mm3 and 350 cells/mm3 at start of TB treatment at a primary care clinic in Johannesburg; South Africa. Adherence to TB treatment was measured by pill count;self-report; and electronic Medication Event Monitoring System (eMEMS) before and after initiation of ART.Results: ART tended to negatively affect adherence to TB treatment; with an 8% - 10% decrease in the proportion of patients adherent according to pill count and an 18% - 22% decrease in the proportion of patients adherent according to eMEMS in the first month following ART initiation; independent of the cut-off used to define adherence (90%; 95% or 100%). Reasons for non-adherence were multi factorial; and employment was the only predictor for optimal adherence (adjusted odds ratio 4.11; 95% confidence interval 1.06-16.0).Conclusion: Adherence support in the period immediately following ART initiation could optimise treatment outcomes for people living with TB and HIV