BACKGROUND: Tuberculosis (TB) is the leading cause of death among HIV-infected patients worldwide. In KwaZulu-Natal, South Africa, 80% of TB patients are HIV coinfected, with high treatment default and mortality rates. Integrating TB and HIV care may be an effective strategy for improving outcomes for both diseases. METHODS: Prospective operational research study treating TB/HIV-coinfected patients in rural KwaZulu-Natal with once-daily antiretroviral (ARV) therapy concurrently with TB therapy by home-based, modified directly observed therapy. Patients were followed for 12 months after ARV initiation. RESULTS: Of 119 TB/HIV-coinfected patients enrolled, 67 (56%) were female, mean age was 34.0 years, and median CD4 count was 78.5 cells per cubic millimeter. After 12 months on ARVs, mean CD4 count increase was 211 cells per cubic millimeter, and 88% had an undetectable viral load; 84% completed TB treatment. Thirteen patients (11%) died; 10 (77%) with multidrug-resistant or extensively drug-resistant TB. There were few severe adverse events or immune reconstitution events. Adherence was high with 93% of study visits attended and 99% of ARV doses taken. CONCLUSIONS: Integration of TB and HIV treatment in a rural setting using concurrent home-based therapy resulted in excellent adherence and TB and HIV outcomes. This model may result in successful management of both diseases in other rural resource-poor settings.
BACKGROUND:Tuberculosis (TB) is the leading cause of death among HIV-infectedpatients worldwide. In KwaZulu-Natal, South Africa, 80% of TB patients are HIV coinfected, with high treatment default and mortality rates. Integrating TB and HIV care may be an effective strategy for improving outcomes for both diseases. METHODS: Prospective operational research study treating TB/HIV-coinfectedpatients in rural KwaZulu-Natal with once-daily antiretroviral (ARV) therapy concurrently with TB therapy by home-based, modified directly observed therapy. Patients were followed for 12 months after ARV initiation. RESULTS: Of 119 TB/HIV-coinfectedpatients enrolled, 67 (56%) were female, mean age was 34.0 years, and median CD4 count was 78.5 cells per cubic millimeter. After 12 months on ARVs, mean CD4 count increase was 211 cells per cubic millimeter, and 88% had an undetectable viral load; 84% completed TB treatment. Thirteen patients (11%) died; 10 (77%) with multidrug-resistant or extensively drug-resistant TB. There were few severe adverse events or immune reconstitution events. Adherence was high with 93% of study visits attended and 99% of ARV doses taken. CONCLUSIONS: Integration of TB and HIV treatment in a rural setting using concurrent home-based therapy resulted in excellent adherence and TB and HIV outcomes. This model may result in successful management of both diseases in other rural resource-poor settings.
Authors: Suzue Saito; Philani Mpofu; E Jane Carter; Lameck Diero; Kara K Wools-Kaloustian; Constantin T Yiannoutsos; Musick S Beverly; Simon Tsiouris; Geoffrey R Somi; John Ssali; Denis Nash; Batya Elul Journal: J Acquir Immune Defic Syndr Date: 2016-04-01 Impact factor: 3.731
Authors: James H McMahon; Julian H Elliott; Silvia Bertagnolio; Rachel Kubiak; Michael R Jordan Journal: Bull World Health Organ Date: 2013-02-21 Impact factor: 9.408
Authors: Troy D Moon; Janeen R Burlison; Mohsin Sidat; Paulo Pires; Wilson Silva; Manuel Solis; Michele Rocha; Chiqui Arregui; Eric J Manders; Alfredo E Vergara; Sten H Vermund Journal: Retrovirology (Auckl) Date: 2010-04-23
Authors: Kimcheng Choun; Reaksmey Pe; Sopheak Thai; Natalie Lorent; Lutgarde Lynen; Johan van Griensven Journal: Bull World Health Organ Date: 2012-12-12 Impact factor: 9.408