Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: An alternate model of care

James C.M. Brust, N. S. Shah, M. Scott, K. Chaiyachati, M. Lygizos, T. L. Van Der Merwe, S. Bamber, Z. Radebe, M. Loveday, A. P. Moll, B. Margot, U. G. Lalloo, G. H. Friedland, N. R. Gandhi

Research output: Contribution to journalArticle

58 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)998-1004
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume16
Issue number8
DOIs
StatePublished - Aug 1 2012

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Multidrug-Resistant Tuberculosis
South Africa
HIV
Therapeutics
Viral Load
Virus Diseases
Coinfection
Outpatients
Nurses
Physicians

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 journalArticle

Brust, JCM, Shah, NS, Scott, M, Chaiyachati, K, Lygizos, M, Van Der Merwe, TL, Bamber, S, Radebe, Z, Loveday, M, Moll, AP, Margot, B, Lalloo, UG, Friedland, GH & Gandhi, NR 2012, 'Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: An alternate model of care', International Journal of Tuberculosis and Lung Disease, vol. 16, no. 8, pp. 998-1004. https://doi.org/10.5588/ijtld.11.0713
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. / Integrated, home-based treatment for MDR-TB and HIV in rural South Africa : An alternate model of care. In: International Journal of Tuberculosis and Lung Disease. 2012 ; Vol. 16, No. 8. pp. 998-1004.
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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.",
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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.

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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.

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