@article {Brust:2012:1027-3719:998,
title = "Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: an alternate model of care [Perspectives]",
journal = "The International Journal of Tuberculosis and Lung Disease",
parent_itemid = "infobike://iuatld/ijtld",
publishercode ="iuatld",
year = "2012",
volume = "16",
number = "8",
publication date ="2012-08-01T00:00:00",
pages = "998-1004",
itemtype = "ARTICLE",
issn = "1027-3719",
eissn = "1815-7920",
url = "https://www.ingentaconnect.com/content/iuatld/ijtld/2012/00000016/00000008/art00003",
doi = "doi:10.5588/ijtld.11.0713",
keyword = "program development, AIDS, multidrug-resistant tuberculosis, HIV/AIDS, community-based treatment",
author = "Brust, J. C. M. and Shah, N. S. and Scott, M. and Chaiyachati, K. and Lygizos, M. and van der Merwe, T. L. and Bamber, S. and Radebe, Z. and Loveday, M. and Moll, A. P. and Margot, B. and Lalloo, U. G. and Friedland, G. H. and Gandhi, N. R.",
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-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.",
}