Our findings suggest the need of strengthening the reference systems between TB and HIV programs. Despite having a small number of HIV positive patients, we detected a delay between HIV positive result and HIV program enrollment and ART initiation, and we did not find evidence of HIV program enrollment in five patients. The HIV and TB program in Peru are partially integrated but care for both infections is provided in different facilities. Obtaining an appointment at referral hospitals in Lima, where HIV diagnosis is confirmed and managed, can take long and that could be contributing to the delays found . Stigma has been cited in other settings as a cause that discouraged rapid linkage to care of recently diagnosed HIV-positive individuals . Prompt linkage to care for early ART initiation is important to achieve rapid virologic suppression and reduce mortality [30, 31]. A better integration of both programs could reduce barriers [32–34] for timely care and facilitate the initiation of ART. Decentralizing HIV care to peripheral health facilities where TB is managed may facilitate geographical access. Yet, if peripheral facilities are located at the patient’s neighborhoods it may increase stigma and fear of disclosure of HIV diagnosis.