ABSTRACT
BACKGROUND: Understanding relationships between HIV and multidrug-resistant TB (MDR-TB) is crucial for ensuring successful MDR-TB outcomes.METHODS: We used a cross-sectional analysis to evaluate sociodemographic and clinical characteristics as correlates of antiretroviral therapy (ART) use, having an HIV viral load (VL) result, and HIV viral suppression in a cross-sectional sample of people with HIV (PWH) and MDR-TB enrolled in a cluster-randomized trial of nurse case management to improve MDR-TB outcomes.RESULTS: Among 1,479 PWH, the mean age was 37.1 years; 809 (54.7%) were male, and 881 (59.6%) were taking ART. Housing location, employment status, and CD4 count differed significantly between those taking vs. those not taking ART. Among the 881 taking ART, 681 (77.3%) had available HIV VL results. Housing location, CD4 count, and prior history of TB differed significantly between those with and without a VL result. Among the 681 with a VL result, 418 (61.4%) were virally suppressed. Age, education level, CD4 count, TB history, housing location, and ART type differed significantly between those with and without viral suppression.CONCLUSION: PWH presenting for MDR-TB treatment with a history of TB, taking a protease inhibitor, or living in a township may risk poor MDR-TB outcomes.
Subject(s)
Anti-HIV Agents , HIV Infections , Tuberculosis, Multidrug-Resistant , Tuberculosis , Humans , Male , Adult , Female , Anti-HIV Agents/therapeutic use , South Africa/epidemiology , Cross-Sectional Studies , Tuberculosis/drug therapy , HIV Infections/drug therapy , HIV Infections/epidemiology , CD4 Lymphocyte Count , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiologyABSTRACT
SETTING: KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection. OBJECTIVE: To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital. DESIGN: A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation. RESULTS: Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites. CONCLUSION: Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.
Subject(s)
Antitubercular Agents/therapeutic use , Community Health Services/organization & administration , Hospitalization , Tuberculosis, Multidrug-Resistant/drug therapy , Adult , Anti-HIV Agents/therapeutic use , Cohort Studies , Female , HIV Infections/complications , HIV Infections/drug therapy , Health Services Accessibility , Home Care Services/organization & administration , Humans , Male , Models, Theoretical , Prospective Studies , South Africa , Treatment OutcomeABSTRACT
This study investigates the experiences of doctors who perform elective surgical procedures in an area of South Africa with a high incidence of HIV and AIDS. A qualitative study approach was adopted. Interviews were individually conducted with 15 doctors. The transcribed interviews were read four times; each with a different data-collection purpose; and follow-up interviews were carried out when it was necessary to complete the data set. Surgical doctors from two semi-urban hospitals and one rural hospital in northern KwaZulu-Natal province took part in the study. The analysis of the interviews rendered four areas of concern in the experiences of doctors who perform surgery on HIV/AIDS patients. These were: personal factors; patient factors; factors relating to the structure of the health system; and factors concerning protocols for the treatment of patients with HIV or AIDS. Although the doctors were altruistic in their approaches to operating on HIV/AIDS patients; they commonly mentioned the increased levels of stress they experience as a result of a multiplicity of issues surrounding the treatment and care of an HIV/AIDS patient specifically. The public health system has not made special arrangements to deal with the increased patient loads in hospitals as a result of the HIV epidemic; and this will have to be addressed as the number of HIV/AIDS patients increases
