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Free Content Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: an alternate model of care [Perspectives]

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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-co-infected. 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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Keywords: AIDS; HIV/AIDS; community-based treatment; multidrug-resistant tuberculosis; program development

Document Type: Research Article

Affiliations: 1: Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA 2: University of Pennsylvania, Philadelphia, Pennsylvania, USA 3: Yale University School of Medicine, New Haven, Connecticut, USA 4: University of Colorado, Denver, Colorado, USA 5: Philanjalo, Tugela Ferry, South Africa 6: Umzinyathi District Department of Health, Dundee, South Africa 7: Health Systems Research Unit, Medical Research Council, Cape Town, South Africa; and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa 8: KwaZulu-Natal Department of Health, Pietermartizburg, South Africa 9: Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Publication date: 01 August 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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