Background: Benefits of starting antiretroviral therapy (ART) early including HIV/TB co-infected individuals has been documented widely. However characteristics and the risk of mortality among HIV/TB patients in the test and treat era has not been evidenced. We therefore sought to bridge this knowledge gap using secondary data at a large HIV clinic in Rwenzori, western Uganda.
Methods: A retrospective cohort review of 521 charts was conducted for all individuals started on TB treatment between June 2016 and June 2017. Time from starting TB treatment to death as documented in registers was the main outcome. TB treatment outcomes including their characteristics were descriptive analysed. Risk of mortality by timing of ART i.e. (within 7, 8-14 and above 14 days) among those who started ART between 2016 and 2018 was assessed using Kaplan Meier curves and estimates measured as per 1000 person years.
Results: A TB treatment success rate of 84% (437/521) and a fifteen percent (14.8%, 77/521) mortality rate were registered at 12 months after starting TB treatment. Males and clients 30 years and above were disproportionately affected; mortality rate (64.9%, 50/77) and (66.8%, 53/77) respectively. Of the 521 registered TB clients, 247 (47.4%) were co-infected with HIV and of these 45.3% (112/247) started ART between 2016 and 2018 while 54/247 (21.9%) were dead by 12 months after TB treatment. Mortality was higher (87%, 47/54) among those who were not on TB treatment at the time of starting ART compared to those who started ART after TB treatment. Pulmonary clinically diagnosed (PCD) and extra pulmonary TB cases contributed 40.7% (22/54) and 16.7% (9/54) of all mortalities registered among HIV/TB cases. Risk of mortality among co-infected clients who started ART within seven days after diagnosis was significantly higher (4.27 person-years, 95%CI: 2.62 - 6.98) compared to those who started 8-14 days (2.37 person-years, 95%CI: 0.59 - 9.46) and beyond 14 days (0.59 person-years, 95%CI: 0.28 - 1.24).
Conclusions: Unmasking TB inflammatory reconstitution syndrome might be the leading cause of mortality among HIV/TB clients starting ART in the Test and Treat era. We recommend earlier diagnosis and treatment of clinically diagnosed TB cases before starting ART.

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