title: Re-inventing adherence: toward a patient-centered model of care for drug-resistant tuberculosis and HIV.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: M R
authors.initials: MR
authors.lastname: O'Donnell
authors.affiliation: 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.
authors.forename: A
authors.initials: A
authors.lastname: Daftary
authors.affiliation: Treatment Action Group, New York, USA.
authors.forename: M
authors.initials: M
authors.lastname: Frick
authors.affiliation: 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.
authors.forename: Y
authors.initials: Y
authors.lastname: Hirsch-Moverman
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: K R
authors.initials: KR
authors.lastname: Amico
authors.affiliation: University of Cape Town, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Senthilingam
authors.affiliation: Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA.
authors.forename: A
authors.initials: A
authors.lastname: Wolf
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA.
authors.forename: J Z
authors.initials: JZ
authors.lastname: Metcalfe
authors.affiliation: Médecins Sans Frontières, Mumbai, India.
authors.forename: P
authors.initials: P
authors.lastname: Isaakidis
authors.affiliation: Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Davis
authors.affiliation: Touro College Graduate School of Social Work, New York, New York, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Zelnick
authors.affiliation: Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: J C M
authors.initials: JC
authors.lastname: Brust
authors.affiliation: Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Naidu
authors.affiliation: Division of Pulmonary Allergy and Critical Care Medicine, Columbia University Medical Center, New York, USA.
authors.forename: M
authors.initials: M
authors.lastname: Garretson
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: Centre for the AIDS Programme of Research in South Africa, South African Medical Research Council TB HIV Pathogenesis Extramural Unit, Durban, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Padayatchi
authors.affiliation: Yale University School of Public Health, New Haven, Connecticut, USA; Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: G
authors.initials: G
authors.lastname: Friedland
mesh_terms: D060085:Coinfection / Q000188:drug therapy; D023801:Directly Observed Therapy; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D055118:Medication Adherence; D010353:Patient Education as Topic; D018802:Patient-Centered Care / Q000379:methods*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*