CAPRISA 003: Timing of Antiretroviral Initiation in HIV-TB Co-infected Patients—The SAPiT Trial

Abstract

This chapter describes the rationale for CAPRISA’s focus on HIV-TB co-infected patients; how the SAPiT trial evolved from prior studies undertaken by the team; the study design and important lessons from the conduct of this study. The importance of TB as a common opportunistic infection associated with advancing HIV disease providing an opportunity to efficiently identify patients with AIDS who would most benefit from access to antiretroviral treatment initiation in a context where knowledge of HIV status was low and access to ARV treatment was limited is underscored. The challenges in undertaking this study are described as well as the key factors that enabled us to successfully generate the scientific evidence for integration of TB and HIV services. It describes how chance encounters and strategic collaborations resulted in scientific results that changed local and international guidelines for managing TB-HIV co-infected patients. In addition to providing a synopsis of the key findings of the SAPiT study and key references for further reading, this chapter concludes with a sequential study of implementation of integration of HIV and TB treatment services in public sector health facilities highlighting the iterative nature of the knowledge generation process.