James C.M. Brust|Nishant K. Shah|Michelle Scott|Krisda H. Chaiyachati|Melissa Lygizos|Theo L. van der Merwe|Sheila Bamber|Z. Radebe|Marian Loveday|Anthony Moll|Bruce Margot|Umesh Lalloo|Gerald Friedland|Neel R. Gandhi
Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: an alternate model of care [Perspectives]
Albert Einstein College of Medicine|Montefiore Medical Center|Albert Einstein College of Medicine|Montefiore Medical Center|University of Pennsylvania|Yale University|University of Colorado Denver|Philanjalo|Philanjalo|South African Medical Research Council|University of KwaZulu-Natal|Philanjalo|University of KwaZulu-Natal|Yale University|Albert Einstein College of Medicine|Montefiore Medical Center
treatment outcomes multidrugresistant tuberculosis mdrtb south africa suffered centralized inpatient treatment programs struggle cope rising prevalence human immunodeficiency virus hiv coinfection rates new treatment model needed expand treatment capacity improve mdrtb hiv outcomesto describe design preliminary results integrated homebased mdrtbhiv treatment program created rural kwazulunatalin 2008 decentralized center established provide outpatient mdrtb hiv treatment nurses community health workers family supporters trained administer injections provide adherence support monitor adverse reactions patients homes physicians assess clinical response adherence severity adverse reactions mdrtb hiv treatment monthly followup visits treatment outcomes assessed monthly cultures cd4 viral load every 6 monthsof 80 patients initiating mdrtb treatment february 2008 april 2010 66 hivcoinfected retention high 5 defaults 93 visits attended preliminary outcomes favorable 77 curedstill treatment 82 undetectable viral load patients required escalation care 9 severe adverse events 8 died 6integrated homebased treatment mdrtb hiv promising treatment model expand capacity achieve improved outcomes rural resourcepoor high hiv prevalent settings