Successful integration of tuberculosis and HIV treatment in rural South Africa: the Sizonq'oba study.
BACKGROUND
Tuberculosis (TB) is the leading cause of death among HIV-infected patients worldwide. In KwaZulu-Natal, South Africa, 80% of TB patients are HIV coinfected, with high treatment default and mortality rates. Integrating TB and HIV care may be an effective strategy for improving outcomes for both diseases.


METHODS
Prospective operational research study treating TB/HIV-coinfected patients in rural KwaZulu-Natal with once-daily antiretroviral (ARV) therapy concurrently with TB therapy by home-based, modified directly observed therapy. Patients were followed for 12 months after ARV initiation.


RESULTS
Of 119 TB/HIV-coinfected patients enrolled, 67 (56%) were female, mean age was 34.0 years, and median CD4 count was 78.5 cells per cubic millimeter. After 12 months on ARVs, mean CD4 count increase was 211 cells per cubic millimeter, and 88% had an undetectable viral load; 84% completed TB treatment. Thirteen patients (11%) died; 10 (77%) with multidrug-resistant or extensively drug-resistant TB. There were few severe adverse events or immune reconstitution events. Adherence was high with 93% of study visits attended and 99% of ARV doses taken.


CONCLUSIONS
Integration of TB and HIV treatment in a rural setting using concurrent home-based therapy resulted in excellent adherence and TB and HIV outcomes. This model may result in successful management of both diseases in other rural resource-poor settings.
Gandhi
Neel R
NR
Yale University School of Medicine, New Haven, CT, USA. neelgandhi@alumni.williams.edu
Moll
Anthony P
AP
Lalloo
Umesh
U
Pawinski
Robert
R
Zeller
Kimberly
K
Moodley
Pravi
P
Meyer
Eugene
E
Friedland
Gerald
G
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D019562:Viral Load
D019380:Anti-HIV Agents; D000995:Antitubercular Agents