Brief Report: Differentiated Service Delivery Framework for People With Multidrug-Resistant Tuberculosis and HIV Coinfection-Reference-Cited by-同舟云学术

Brief Report: Differentiated Service Delivery Framework for People With Multidrug-Resistant Tuberculosis and HIV Coinfection

Published:2024-05-01 Issue:1 Volume:96 Page:34-39
ISSN:1525-4135
Container-title:JAIDS Journal of Acquired Immune Deficiency Syndromes
language:en
Short-container-title:

Author:

Reis Karl¹^ORCID,Wolf Allison²,Perumal Rubeshan³,Seepamore Boitumelo³⁴,Guzman Kevin²,Ross Jesse²,Cheung Ying Kuen K.⁵,Amico K. Rivet⁶,Brust James C. M.⁷,Padayatchi Nesri³,Friedland Gerald⁸,Naidoo Kogieleum³,Daftary Amrita³⁹,Zelnick Jennifer¹⁰,O'Donnell Max²³¹¹

Affiliation:

1. Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY;

2. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York City, NY;

3. CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa;

4. School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa;

5. Department of Biostatistics, Columbia University Irving Medical Center, New York City, NY;

6. University of Michigan School of Public Health, Ann Arbor, MI;

7. Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY;

8. Department of Medicine (Infections Diseases), Yale University School of Medicine, New Haven, CT;

9. Dahdaleh Institute of Global Health Research, School of Global Health, York University, Toronto, Canada;

10. Graduate School of Social Work, Touro University, New York City, NY; and

11. Department of Epidemiology, Columbia University Irving Medical Center, New York City, NY.

Abstract

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.

Funder

Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases

Publisher

Ovid Technologies (Wolters Kluwer Health)

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