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
