Abstract
SETTING: Treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) in South Africa have suffered as centralized, in-patient treatment programs struggle to cope with rising prevalence and human immunodeficiency virus (HIV) co-infection rates. A new treatment model is needed to expand treatment capacity and improve MDR-TB and HIV outcomes. OBJECTIVE: To describe the design and preliminary results of an integrated, home-based MDR-TB-HIV treatment program created in rural KwaZulu-Natal. METHOD: In 2008, a decentralized center was established to provide out-patient MDR-TB and HIV treatment. Nurses, community health workers and family supporters have been trained to administer injections, provide adherence support and monitor adverse reactions in patients' homes. Physicians assess clinical response, adherence and the severity of adverse reactions to MDR-TB and HIV treatment at monthly follow-up visits. Treatment outcomes are assessed by monthly cultures and CD4 and viral load every 6 months. RESULTS: Of 80 patients initiating MDR-TB treatment from February 2008 to April 2010, 66 were HIV-coi nfected. Retention has been high (only 5% defaults, 93% of visits attended), and preliminary outcomes have been favorable (77% cured/still on treatment, 82% undetectable viral load). Few patients have required escalation of care (9%), had severe adverse events (8%) or died (6%). CONCLUSION: Integrated, home-based treatment for MDR-TB and HIV is a promising treatment model to expand capacity and achieve improved outcomes in rural, resource-poor and high HIV prevalent settings.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 998-1004 |
| Number of pages | 7 |
| Journal | International Journal of Tuberculosis and Lung Disease |
| Volume | 16 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 1 2012 |
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Keywords
- AIDS
- Community-based treatment
- HIV/AIDS
- Multidrug-resistant tuberculosis
- Program development
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Infectious Diseases
Cite this
Integrated, home-based treatment for MDR-TB and HIV in rural South Africa : An alternate model of care. / Brust, James C.M.; Shah, N. S.; Scott, M.; Chaiyachati, K.; Lygizos, M.; Van Der Merwe, T. L.; Bamber, S.; Radebe, Z.; Loveday, M.; Moll, A. P.; Margot, B.; Lalloo, U. G.; Friedland, G. H.; Gandhi, N. R.
In: International Journal of Tuberculosis and Lung Disease, Vol. 16, No. 8, 01.08.2012, p. 998-1004.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Integrated, home-based treatment for MDR-TB and HIV in rural South Africa
T2 - An alternate model of care
AU - Brust, James C.M.
AU - Shah, N. S.
AU - Scott, M.
AU - Chaiyachati, K.
AU - Lygizos, M.
AU - Van Der Merwe, T. L.
AU - Bamber, S.
AU - Radebe, Z.
AU - Loveday, M.
AU - Moll, A. P.
AU - Margot, B.
AU - Lalloo, U. G.
AU - Friedland, G. H.
AU - Gandhi, N. R.
PY - 2012/8/1
Y1 - 2012/8/1
N2 - SETTING: Treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) in South Africa have suffered as centralized, in-patient treatment programs struggle to cope with rising prevalence and human immunodeficiency virus (HIV) co-infection rates. A new treatment model is needed to expand treatment capacity and improve MDR-TB and HIV outcomes. OBJECTIVE: To describe the design and preliminary results of an integrated, home-based MDR-TB-HIV treatment program created in rural KwaZulu-Natal. METHOD: In 2008, a decentralized center was established to provide out-patient MDR-TB and HIV treatment. Nurses, community health workers and family supporters have been trained to administer injections, provide adherence support and monitor adverse reactions in patients' homes. Physicians assess clinical response, adherence and the severity of adverse reactions to MDR-TB and HIV treatment at monthly follow-up visits. Treatment outcomes are assessed by monthly cultures and CD4 and viral load every 6 months. RESULTS: Of 80 patients initiating MDR-TB treatment from February 2008 to April 2010, 66 were HIV-coi nfected. Retention has been high (only 5% defaults, 93% of visits attended), and preliminary outcomes have been favorable (77% cured/still on treatment, 82% undetectable viral load). Few patients have required escalation of care (9%), had severe adverse events (8%) or died (6%). CONCLUSION: Integrated, home-based treatment for MDR-TB and HIV is a promising treatment model to expand capacity and achieve improved outcomes in rural, resource-poor and high HIV prevalent settings.
AB - SETTING: Treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) in South Africa have suffered as centralized, in-patient treatment programs struggle to cope with rising prevalence and human immunodeficiency virus (HIV) co-infection rates. A new treatment model is needed to expand treatment capacity and improve MDR-TB and HIV outcomes. OBJECTIVE: To describe the design and preliminary results of an integrated, home-based MDR-TB-HIV treatment program created in rural KwaZulu-Natal. METHOD: In 2008, a decentralized center was established to provide out-patient MDR-TB and HIV treatment. Nurses, community health workers and family supporters have been trained to administer injections, provide adherence support and monitor adverse reactions in patients' homes. Physicians assess clinical response, adherence and the severity of adverse reactions to MDR-TB and HIV treatment at monthly follow-up visits. Treatment outcomes are assessed by monthly cultures and CD4 and viral load every 6 months. RESULTS: Of 80 patients initiating MDR-TB treatment from February 2008 to April 2010, 66 were HIV-coi nfected. Retention has been high (only 5% defaults, 93% of visits attended), and preliminary outcomes have been favorable (77% cured/still on treatment, 82% undetectable viral load). Few patients have required escalation of care (9%), had severe adverse events (8%) or died (6%). CONCLUSION: Integrated, home-based treatment for MDR-TB and HIV is a promising treatment model to expand capacity and achieve improved outcomes in rural, resource-poor and high HIV prevalent settings.
KW - AIDS
KW - Community-based treatment
KW - HIV/AIDS
KW - Multidrug-resistant tuberculosis
KW - Program development
UR - http://www.scopus.com/inward/record.url?scp=84863571387&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84863571387&partnerID=8YFLogxK
U2 - 10.5588/ijtld.11.0713
DO - 10.5588/ijtld.11.0713
M3 - Article
C2 - 22668560
AN - SCOPUS:84863571387
VL - 16
SP - 998
EP - 1004
JO - International Journal of Tuberculosis and Lung Disease
JF - International Journal of Tuberculosis and Lung Disease
SN - 1027-3719
IS - 8
ER -