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About the Authors:
Dominique J. Pepper
* E-mail: [email protected]
Affiliation: Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
Suzaan Marais
Affiliations Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa, Infectious Diseases Unit, GF Jooste Hospital, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
Robert J. Wilkinson
Affiliations Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa, Infectious Diseases Unit, GF Jooste Hospital, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Division of Medicine, Imperial College London, United Kingdom, MRC National Institute for Medical Research, Mill Hill, London, United Kingdom
Feriyl Bhaijee
Affiliation: Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
Virginia De Azevedo
Affiliation: City Health, Cape Town, South Africa
Graeme Meintjes
Affiliations Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa, Infectious Diseases Unit, GF Jooste Hospital, Cape Town, South Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa, Division of Medicine, Imperial College London, United Kingdom
Introduction
Tuberculosis (TB) is frequently encountered in South Africa and is associated with considerable morbidity and mortality. In 2007, the estimated TB incidence in South Africa was 948/100,000 people in the general population[1] – the fifth highest in the world[2]. In the same year, it is estimated that there were 461,000 new TB cases, and that 112,000 TB deaths occurred [1]. Co-infection with human immunodeficiency virus type-1 (HIV-1) is responsible for this high mortality[3]: In South Africa, co-infection occurs in 73% of people diagnosed with TB and 84% of people who die with TB[1].
Restoring immune function with antiretroviral treatment (ART) can reduce the high morbidity and mortality of TB. While considerable debate exists whether ART should be commenced early or late during TB treatment, there is compelling evidence that ART in eligible patients should not be deferred until after TB treatment[4].
The provision of ART to eligible TB patients during TB treatment is clearly a priority for South Africa[5]. While little is known about obstacles to ART initiation during TB treatment, data exists for HIV/AIDS cohorts....