. 2016 Apr;20(4):430-4.

doi: 10.5588/ijtld.15.0360.

Re-inventing adherence: toward a patient-centered model of care for drug-resistant tuberculosis and HIV

M R O'Donnell¹, A Daftary², M Frick³, Y Hirsch-Moverman⁴, K R Amico⁵, M Senthilingam⁶, A Wolf⁷, J Z Metcalfe⁸, P Isaakidis⁹, J L Davis⁷, J R Zelnick¹⁰, J C M Brust¹¹, N Naidu¹², M Garretson⁷, D R Bangsberg¹³, N Padayatchi¹², G Friedland¹⁴

Affiliations

¹ Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa.
² Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
³ Treatment Action Group, New York, USA.
⁴ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York, USA.
⁵ Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
⁶ University of Cape Town, Cape Town, South Africa.
⁷ Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA.
⁸ Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA.
⁹ Médecins Sans Frontières, Mumbai, India.
¹⁰ Touro College Graduate School of Social Work, New York, New York, USA.
¹¹ Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA.
¹² Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa.
¹³ Harvard Medical School, Boston, Massachusetts, USA.
¹⁴ Yale University School of Public Health, New Haven, Connecticut, USA; Yale University School of Medicine, New Haven, Connecticut, USA.

PMID: 26970149
PMCID: PMC4863995
DOI: 10.5588/ijtld.15.0360

Re-inventing adherence: toward a patient-centered model of care for drug-resistant tuberculosis and HIV

M R O'Donnell et al. Int J Tuberc Lung Dis. 2016 Apr.

. 2016 Apr;20(4):430-4.

doi: 10.5588/ijtld.15.0360.

Authors

Affiliations

¹ Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa.
² Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
³ Treatment Action Group, New York, USA.
⁴ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York, USA.
⁵ Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
⁶ University of Cape Town, Cape Town, South Africa.
⁷ Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA.
⁸ Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA.
⁹ Médecins Sans Frontières, Mumbai, India.
¹⁰ Touro College Graduate School of Social Work, New York, New York, USA.
¹¹ Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA.
¹² Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa.
¹³ Harvard Medical School, Boston, Massachusetts, USA.
¹⁴ Yale University School of Public Health, New Haven, Connecticut, USA; Yale University School of Medicine, New Haven, Connecticut, USA.

PMID: 26970149
PMCID: PMC4863995
DOI: 10.5588/ijtld.15.0360

Abstract

Background: Despite renewed focus on molecular tuberculosis (TB) diagnostics and new antimycobacterial agents, treatment outcomes for patients co-infected with drug-resistant TB and human immunodeficiency virus (HIV) remain dismal, in part due to lack of focus on medication adherence as part of a patient-centered continuum of care.

Objective: To review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support.

Discussion: Current national TB control programs rely heavily on directly observed therapy (DOT) as the centerpiece of treatment delivery and adherence support. Medication adherence and care for drug-resistant TB-HIV could be improved by fully implementing team-based patient-centered care, empowering patients through counseling and support, maintaining a rights-based approach while acknowledging the responsibility of health care systems in providing comprehensive care, and prioritizing critical research gaps.

Conclusion: It is time to re-invent our understanding of adherence in drug-resistant TB and HIV by focusing attention on the complex clinical, behavioral, social, and structural needs of affected patients and communities.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

**Figure**
The continuum of DR-TB/HIV care defines the processes and linkages that comprise optimal care for MDR-/XDR-TB/HIV. The y-axis represents patients retained in care; the x-axis represents the stages of the continuum; the arrows represent the linkages in the continuum. The box below defines tasks and processes that occur at each stage. TB = tuberculosis; HIV = human immunodeficiency virus; DR-TB = drug-resistant TB; VL = viral load; DST = drug susceptibility testing; MDR-TB = multidrug-resistant TB; XDR-TB = extensively drug-resistant TB. This image can be viewed online in colour at http://www.ingentaconnect.com/content/iuatld/ijtld/2016/00000020/00000004/art00004

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Re-inventing adherence: toward a patient-centered model of care for drug-resistant tuberculosis and HIV

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Re-inventing adherence: toward a patient-centered model of care for drug-resistant tuberculosis and HIV

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