INT J TUBERC LUNG DIS 11(4):412–416 © 2007 The Union Outcomes of tuberculosis patients who start antiretroviral therapy under routine programme conditions in Malawi S. D. Makombe,*A. D. Harries,* †‡ J. K-L. Yu, § M. Hochgesang, ¶ E. Mhango, # R. Weigel, # O. Pasulani,** †† M. Fitzgerald,** †† E. J. Schouten, ‡‡§§ E. Libamba* * Clinical HIV Unit, Ministry of Health, Lilongwe, † Family Health International, Malawi Country Office, Lilongwe, Malawi; ‡ London School of Hygiene and Tropical Medicine, London, UK; § Taiwan Medical Mission, Mzuzu Central Hospital, Mzuzu, ¶ US Centres for Disease Control and Prevention, Malawi Office, Lilongwe, # Lighthouse Clinic, Lilongwe, Malawi; ** Médecins sans Frontieres, Brussels, Belgium; †† Thyolo District Hospital, SUMMARY Thyolo, ‡‡ Ministry of Health, Lilongwe, §§ Management Sciences for Health, Lilongwe, Malawi SETTING: Public sector facilities in Malawi providing anti- retroviral therapy (ART) to human immunodeficiency virus (HIV) positive patients, including those with tuber- culosis (TB). OBJECTIVES: To compare 6-month and 12-month cohort treatment outcomes of HIV-positive TB patients and HIV- positive non-TB patients treated with ART. DESIGN: Retrospective data collection using ART patient master cards and ART patient registers. RESULTS: Between July and September 2005, 7905 pa- tients started ART, 6967 with a non-TB diagnosis and 938 with a diagnosis of active TB. 6-month cohort out- comes of non-TB and TB patients censored on 31 March 2006 showed significantly more TB patients alive and on ART (77%) compared with non-TB patients (71%) (P  0.001). Between January and March 2005, 4580 patients started ART, 4179 with a non-TB diagnosis and 401 with a diagnosis of active TB. 12-month cohort out- comes of non-TB and TB patients censored on 31 March 2006 showed significantly more TB patients alive and on ART (74%) compared with non-TB patients (66%) (P  0.001). Other outcomes of default and transfer out were also significantly less frequent in TB compared with non- TB patients. CONCLUSION: HIV-positive TB patients on ART in Malawi have generally good treatment outcomes, and more patients need to access this HIV treatment. KEY WORDS: tuberculosis; antiretroviral therapy; treat- ment outcomes; Malawi WITH THE START of the World Health Organiza- tion’s (WHO’s) ‘3 by 5’ initiative, many resource-poor countries have started scaling up antiretroviral ther- apy (ART) for their human immunodeficiency virus (HIV) infected communities. Although the target was not reached in 2005, excellent progress was made. In Africa, for example, 840 000 patients were started on ART by December 2005. 1 HIV-positive patients with tuberculosis (TB) are all potentially eligible for ART, because they are in either WHO Clinical Stage 3 (pulmonary tuberculosis [PTB]) or Stage 4 (extra-pulmonary tuberculosis [EPTB]). 2 In principle, HIV-positive TB patients should benefit from ART, which leads to a reduction in HIV-related mor- tality and HIV-related recurrence of TB disease. Reports on small numbers of patients treated in the UK, 3 Tai- wan 4 and Thailand 5 indicate a good outcome in HIV- positive TB patients treated with ART, with the report from Taiwan showing similar responses between HIV- infected TB and non-TB patients. 4 To our knowledge there have been no reports on outcomes of HIV-infected TB patients treated with ART in the routine health sys- tem in sub-Saharan Africa. Every 3 months, the HIV Unit of the Malawian Min- istry of Health and its partners conduct supervisory and monitoring visits to all sites in the country that are deliv- ering ART in the public sector. Data are collected on numbers and characteristics of patients starting ART and their outcomes. We used these structured visits to obtain additional information on outcomes of patients with TB who had been started on ART, and we com- pared their outcomes with those for non-TB patients. METHODS Background of ART and anti-tuberculosis treatment ART scale-up in Malawi The process of ART scale-up has already been described in previous articles, 6,7 and only the main elements will Correspondence to: Professor A D Harries, Family Health International, Malawi Country Office, Arwa House, 3rd Floor, P O Box 30455, Lilongwe 3, Malawi. Tel: (265) 1 754 936. Fax: (265) 1 774 307. e-mail: adharries@malawi.net Article submitted 16 August 2006. Final version accepted 15 November 2006. [A version in French of this article is available from the Editorial Office in Paris and from the Union website www.iuatld.org]