title: Preferential adherence to antiretroviral therapy over tuberculosis treatment: a qualitative study of drug-resistant TB/HIV co-infected patients in South Africa.
abstract: Adherence to antiretroviral therapy (ART) and second-line antituberculosis medications is essential to achieve successful outcomes among individuals co-infected with HIV and multi or extensively drug-resistant TB (M/XDR-TB). In 2012-2013, we designed a qualitative study to explore barriers to adherence in KwaZulu-Natal, South Africa. We conducted six focus groups comprising 23 adults receiving treatment for either MDR-TB (n = 2) or XDR-TB (n = 21); 17 were on concurrent ART. Participants expressed a preference for ART over M/XDR-TB treatment as a result of greater tolerability, lower pill burden and a commitment to ART. Treatment outcomes and the social morbidity associated with M/XDR-TB, characterised by public notification, stigma and social isolation, were perceived to be worse than with HIV. Poor communication, low patient involvement and provider supervision of treatment exacerbated participants' negative experiences with TB care. To improve adherence, it is critical that new regimens for drug-resistant TB be developed with better efficacy, lower pill burden and fewer adverse effects. For the first time, such improved regimens are on the horizon. In parallel and equally important is the implementation of a cohesive approach that promotes patient involvement, empowerment and treatment literacy for HIV and for TB.
authors.affiliation: a ICAP, Mailman School of Public Health , Columbia University , New York , NY , USA.
authors.forename: Amrita
authors.initials: A
authors.lastname: Daftary
authors.forename: Nesri
authors.initials: N
authors.lastname: Padayatchi
authors.forename: Max
authors.initials: M
authors.lastname: O'Donnell
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D000995:Antitubercular Agents / Q000008:administration & dosage*; D054908:Extensively Drug-Resistant Tuberculosis / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D036301:Qualitative Research; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents
keywords: HIV/AIDS; adherence; co-infection; drug-resistant tuberculosis; qualitative methods