Adherence to ART and XDR-TB therapy in Kwa-Zulu Natal province
Adherence to antiretroviral therapy (ART) approached 90% in a 104-person prospective study in KwaZulu-Natal province, South Africa. Adherence to multiple medications for extensively drug-resistant tuberculosis (XDR-TB) was 20% lower.
XDR-TB is TB resistant to isoniazid and rifampin, any
fluoroquinolone, and at least one of three injectable
second-line drugs. By definition, XDR-TB is difficult to
treat. Adverse drug reactions are frequent, and mortality is
high. To get a better understanding of adherence to XDR-TB
medications and to antiretrovirals in a TB/HIV-coinfected
population, researchers conducted this prospective cohort
study in KwaZulu-Natal.
The investigators defined optimal adherence as self-reporting
taking all pills in the previous 7 day. They defined missing
one or more pills as suboptimal adherence. The investigators
separately assessed adherence to TB medications and
antiretrovirals at a baseline measure and then monthly. They
interviewed patients at baseline to assess knowledge,
attitudes, and beliefs about XDR-TB and HIV.
The study involved 104 people with XDR-TB, including 83
(79.8%) with HIV, of whom 70 (84.3%) were taking ART.
Follow-up extended for a median of 8 visits (interquartile
range 4 to 12).
At the baseline interview, three quarters of participants
(76%) stated that XDR-TB is curable, 81.7% knew HIV and TB are
linked, and 72.1% believed ART improves TB outcomes. But
baseline knowledge, attitudes, and beliefs did not predict
adherence to TB drugs or antiretrovirals.
While 88.2% of patients reported 6-month optimal adherence to
ART, 67.7% reported 6-month optimal adherence to TB
medications, a highly significant difference (P <
0.001). Three factors were independently associated with
suboptimal adherence to both antiretrovirals and TB
medications: less education, male gender, and year of
enrollment in the cohort.
“Short-course treatment regimens for drug-resistant TB
with lower pill burden may increase adherence and improve
outcomes in XDR-TB/HIV,” the authors propose. They
believe “programmatic support for dual adherence is
critical in the treatment of drug-resistant TB and
HIV.”
Source: Max R.
O'Donnell, Allison Wolf, Lise Werner, C. Robert Horsburgh,
Nesri Padayatchi. Adherence in the treatment of patients with
extensively drug-resistant tuberculosis and HIV in South
Africa: a prospective cohort study. JAIDS. 2014; 67:
22-29.
For the study abstract
(Downloading the complete article requires a
subscription to JAIDS or an online payment; the abstract is
free.)
For World Health Organization information on XDR-TB
Source:
IAS
