M R O'Donnell1, A Daftary2, M Frick3, Y Hirsch-Moverman4, K R Amico5, M Senthilingam6, A Wolf7, J Z Metcalfe8, P Isaakidis9, J L Davis7, J R Zelnick10, J C M Brust11, N Naidu12, M Garretson7, D R Bangsberg13, N Padayatchi12, G Friedland14. 1. Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa. 2. Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 3. Treatment Action Group, New York, USA. 4. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York, USA. 5. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA. 6. University of Cape Town, Cape Town, South Africa. 7. Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA. 8. Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA. 9. Médecins Sans Frontières, Mumbai, India. 10. Touro College Graduate School of Social Work, New York, New York, USA. 11. Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA. 12. Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa. 13. Harvard Medical School, Boston, Massachusetts, USA. 14. Yale University School of Public Health, New Haven, Connecticut, USA; Yale University School of Medicine, New Haven, Connecticut, USA.
Abstract
BACKGROUND: Despite renewed focus on molecular tuberculosis (TB) diagnostics and new antimycobacterial agents, treatment outcomes for patients co-infected with drug-resistant TB and human immunodeficiency virus (HIV) remain dismal, in part due to lack of focus on medication adherence as part of a patient-centered continuum of care. OBJECTIVE: To review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support. DISCUSSION: Current national TB control programs rely heavily on directly observed therapy (DOT) as the centerpiece of treatment delivery and adherence support. Medication adherence and care for drug-resistant TB-HIV could be improved by fully implementing team-based patient-centered care, empowering patients through counseling and support, maintaining a rights-based approach while acknowledging the responsibility of health care systems in providing comprehensive care, and prioritizing critical research gaps. CONCLUSION: It is time to re-invent our understanding of adherence in drug-resistant TB and HIV by focusing attention on the complex clinical, behavioral, social, and structural needs of affected patients and communities.
BACKGROUND: Despite renewed focus on molecular tuberculosis (TB) diagnostics and new antimycobacterial agents, treatment outcomes for patients co-infected with drug-resistant TB and human immunodeficiency virus (HIV) remain dismal, in part due to lack of focus on medication adherence as part of a patient-centered continuum of care. OBJECTIVE: To review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support. DISCUSSION: Current national TB control programs rely heavily on directly observed therapy (DOT) as the centerpiece of treatment delivery and adherence support. Medication adherence and care for drug-resistant TB-HIV could be improved by fully implementing team-based patient-centered care, empowering patients through counseling and support, maintaining a rights-based approach while acknowledging the responsibility of health care systems in providing comprehensive care, and prioritizing critical research gaps. CONCLUSION: It is time to re-invent our understanding of adherence in drug-resistant TB and HIV by focusing attention on the complex clinical, behavioral, social, and structural needs of affected patients and communities.
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