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.
Subject(s)
Ambulatory Care/organization & administration , Anti-HIV Agents/therapeutic use , Antitubercular Agents/therapeutic use , Coinfection , Delivery of Health Care, Integrated/organization & administration , HIV Infections/drug therapy , Home Care Services/organization & administration , Rural Health Services/organization & administration , Tuberculosis, Multidrug-Resistant/drug therapy , Adult , Anti-HIV Agents/adverse effects , Antitubercular Agents/adverse effects , Attitude of Health Personnel , CD4 Lymphocyte Count , Caregivers , Feasibility Studies , Female , HIV Infections/diagnosis , HIV Infections/epidemiology , Health Knowledge, Attitudes, Practice , Humans , Male , Medication Adherence , Organizational Objectives , Patient Care Team/organization & administration , Program Development , Program Evaluation , Social Support , South Africa/epidemiology , Time Factors , Treatment Outcome , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/epidemiology , Viral LoadABSTRACT
A patient with hypercalcaemia due to a parathyroid adenoma, and hypertrophic cardiomyopathy (HCM) is described. Although both conditions are common, it is suggested that the association between HCM and parathyroid hypercalcaemia may be more frequent than is accounted for by coincidence.
