TY - JOUR
T1 - Brief Report
T2 - Differentiated Service Delivery Framework for People With Multidrug-Resistant Tuberculosis and HIV Coinfection
AU - Reis, Karl
AU - Wolf, Allison
AU - Perumal, Rubeshan
AU - Seepamore, Boitumelo
AU - Guzman, Kevin
AU - Ross, Jesse
AU - Cheung, Ying Kuen K.
AU - Amico, K. Rivet
AU - Brust, James C.M.
AU - Padayatchi, Nesri
AU - Friedland, Gerald
AU - Naidoo, Kogieleum
AU - Daftary, Amrita
AU - Zelnick, Jennifer
AU - O'donnell, Max
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Introduction:For people living with HIV/AIDS, care is commonly delivered through differentiated service delivery (DSD). Although people with multidrug-resistant tuberculosis (MDR-TB) and HIV/AIDS experience severe treatment-associated challenges, there is no DSD model to support their treatment. In this study, we defined patterns of medication adherence and characterized longitudinal barriers to inform development of an MDR-TB/HIV DSD framework.Methods:Adults with MDR-TB and HIV initiating bedaquiline (BDQ) and receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa, were enrolled and followed through the end of MDR-TB treatment. Electronic dose monitoring devices measured BDQ and ART adherence. Longitudinal focus groups were conducted and transcripts analyzed thematically to describe discrete treatment stage-specific and cross-cutting treatment challenges.Results:Two hundred eighty-three participants were enrolled and followed through treatment completion (median 17.8 months [interquartile range 16.5-20.2]). Thirteen focus groups were conducted. Most participants (82.7%, 234/283) maintained high adherence (mean BDQ adherence 95.3%; mean ART adherence 85.5%), but an adherence-challenged subpopulation with <85% cumulative adherence (17.3%, 49/283) had significant declines in mean weekly BDQ adherence from 94.9% to 39.9% (P < 0.0001) and mean weekly ART adherence from 83.9% to 26.6% (P < 0.0001) over 6 months. Psychosocial, behavioral, and structural obstacles identified in qualitative data were associated with adherence deficits in discrete treatment stages and identified potential stage-specific interventions.Conclusions:A DSD framework for MDR-TB/HIV should intensify support for adherence-challenged subpopulations, provide multimodal support for adherence across the treatment course, and account for psychosocial, behavioral, and structural challenges linked to discrete treatment stages.
AB - Introduction:For people living with HIV/AIDS, care is commonly delivered through differentiated service delivery (DSD). Although people with multidrug-resistant tuberculosis (MDR-TB) and HIV/AIDS experience severe treatment-associated challenges, there is no DSD model to support their treatment. In this study, we defined patterns of medication adherence and characterized longitudinal barriers to inform development of an MDR-TB/HIV DSD framework.Methods:Adults with MDR-TB and HIV initiating bedaquiline (BDQ) and receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa, were enrolled and followed through the end of MDR-TB treatment. Electronic dose monitoring devices measured BDQ and ART adherence. Longitudinal focus groups were conducted and transcripts analyzed thematically to describe discrete treatment stage-specific and cross-cutting treatment challenges.Results:Two hundred eighty-three participants were enrolled and followed through treatment completion (median 17.8 months [interquartile range 16.5-20.2]). Thirteen focus groups were conducted. Most participants (82.7%, 234/283) maintained high adherence (mean BDQ adherence 95.3%; mean ART adherence 85.5%), but an adherence-challenged subpopulation with <85% cumulative adherence (17.3%, 49/283) had significant declines in mean weekly BDQ adherence from 94.9% to 39.9% (P < 0.0001) and mean weekly ART adherence from 83.9% to 26.6% (P < 0.0001) over 6 months. Psychosocial, behavioral, and structural obstacles identified in qualitative data were associated with adherence deficits in discrete treatment stages and identified potential stage-specific interventions.Conclusions:A DSD framework for MDR-TB/HIV should intensify support for adherence-challenged subpopulations, provide multimodal support for adherence across the treatment course, and account for psychosocial, behavioral, and structural challenges linked to discrete treatment stages.
KW - HIV/AIDS
KW - South Africa
KW - adherence
KW - drug resistance
KW - patient-centered care
KW - tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=85190475733&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85190475733&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000003394
DO - 10.1097/QAI.0000000000003394
M3 - Article
C2 - 38323838
AN - SCOPUS:85190475733
SN - 1525-4135
VL - 96
SP - 34
EP - 39
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 1
ER -
