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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Adherence in the treatment of patients with extensively drug-resistant tuberculosis and HIV in South Africa: A prospective cohort study
Journal of Acquired Immune Deficiency Syndromes, Volume 67, No. 1, Year 2014
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Description
Objective: Extensively drug-resistant tuberculosis (XDR-TB)/HIV coinfection is difficult to treat with frequent adverse drug reactions and associated with high mortality. Adherence to antiretroviral therapy (ARV) and second-line TB medications may reduce mortality, prevent amplification of drug resistance, and improve outcomes. Methods: Prospective cohort study of XDR-TB patients on treatment in KwaZulu-Natal, South Africa. Adherence to ARV and TB medications was assessed separately at baseline and monthly. Knowledge, attitudes, and beliefs were assessed at baseline. Optimal adherence was defined as self-report of taking all pills in the previous 7 days; missing any pills was defined as suboptimal adherence. Primary outcome was optimal adherence 6 months after initiation of XDR-TB treatment to TB medications, ARV, and both ("dual adherence"). Results: One hundred four XDR-TB patients (79.8% HIV coinfected, 84.3% on ARV at enrollment) were enrolled and followed monthly (median 8 visits; interquartile range: 4-12). Six-month optimal adherence was higher for ARV (88.2%) than TB medications (67.7%) (P < 0.001). Low educational attainment, male gender, and year of enrollment were independently associated with dual suboptimal adherence. At baseline, participants indicated that XDR-TB was curable (76.0%), HIV and TB were linked (81.7%), and ARV improves TB outcomes (72.1%). Baseline knowledge, attitudes, and beliefs did not predict subsequent adherence. Conclusions: Medication adherence was significantly higher for ARV than for TB medications in this cohort. Short-course treatment regimens for drug-resistant TB with lower pill burden may increase adherence and improve outcomes in XDR-TB/HIV. Programmatic support for dual adherence is critical in the treatment of drug-resistant TB and HIV. © 2014 by Lippincott Williams & Wilkins.
Authors & Co-Authors
O'Donnell, Max R.
United States, New York
Columbia University Irving Medical Center
United States, New York
Mailman School of Public Health
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
Wolf, Allison K.
United States, New York
Columbia University Irving Medical Center
Werner, Lise
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
Horsburgh, Charles Robert
United States, Boston
School of Public Health
Padayatchi, Nesri
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
South Africa, Durban
University of Kwazulu-natal
Statistics
Citations: 55
Authors: 5
Affiliations: 5
Identifiers
Doi:
10.1097/QAI.0000000000000221
ISSN:
15254135
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa
Participants Gender
Male