Promoting Engagement in the Drug Resistant TB/HIV Care Continuum in South Africa

 描述(申请人提供)：结核病(TB)仍然是全球艾滋病毒携带者发病和死亡的主要原因。在全球范围内，耐多药结核病和广泛耐药结核病这两种最耐药的结核病的发病率在过去15年中大约翻了一番。这种增加的发病率引起的最大关切莫过于南非，在南非，结核病和普遍的艾滋病毒/艾滋病流行之间的相互作用正在造成结核病的“爆炸性”发病率和病例死亡，有可能破坏抗逆转录病毒疗法(ART)所取得的进展。服药依从性是耐多药和广泛耐药结核病(M/XDR-TB)和艾滋病毒治疗结果的关键预测因素，在高负担结核病/艾滋病毒环境中研究不足。在结核病/艾滋病毒护理连续体过渡期间，患者损失频繁，并导致死亡率增加。耐多药/广泛耐药结核病HIV治疗的需求是严峻的，包括超乎寻常的药片负担、严重的不良反应、漫长的治疗、隔离和耻辱，在现代医学中几乎没有类似之处。拟议研究的目标是通过以社区为基础的战略，包括利用社区遵守小组，提高南非耐多药/广泛耐药结核病艾滋病毒患者的依从性和保留率，总体目标是促进患者参与耐多药/广泛耐药结核病艾滋病毒护理的连续不断。虽然这已经为抗逆转录病毒疗法建立了很好的基础，但这是第一次将社区依从性团体干预应用于M/XDR-TB HIV共同感染人群。为了实现这一目标，我们将确定我们对耐药结核病和艾滋病毒患者坚持治疗的理解中的关键实施差距，利用这些数据为以证据和理论为基础的干预措施提供信息，以提高坚持治疗和促进护理的保留，并使用量化的临床结果和对障碍和促进者的影响的定性了解，严格评估混合方法方法的干预措施。在这些研究结束时，我们将解决我们对耐药结核病和艾滋病毒患者坚持治疗的理解中的关键差距，评估新的坚持措施的潜在预测价值，并评估支持坚持治疗的探索性、文化上可接受的和以患者为导向的干预措施的影响。

 DESCRIPTION (provided by applicant): Tuberculosis (TB) remains the leading cause of morbidity and mortality worldwide among people living with HIV. Globally, the incidence of multidrug-resistant tuberculosis and extensively drug resistant tuberculosis, the most drug-resistant forms of TB, has approximately doubled over the past fifteen years. Nowhere has this increased incidence generated more concern than South Africa where interactions between TB and generalized HIV/AIDS epidemics are causing `explosive' TB incidence and case-fatality threatening to undermine the progress reached with antiretroviral therapy (ART). Medication adherence, a key predictor of outcomes in multi-and extensively drug-resistant TB (M/XDR-TB) and HIV treatment, is understudied in high burden TB/HIV settings. Patient losses during transitions in the TB/HIV care continuum are frequent and lead to increased mortality. Demands of M/XDR-TB HIV treatment are severe including extraordinary pill burden, severe adverse effects, lengthy treatment, isolation, and stigma, with few parallels in modern medicine. The goal of the proposed study is to enhance adherence and retention in care for M/XDR- TB HIV patients in South Africa through a community-based strategy, including use of community adherence groups, with the overarching goal of promoting patient engagement in a continuum of M/XDR-TB HIV care. Although well established for ART, this is the first application of a community adherence group intervention to an M/XDR-TB HIV co-infected population. To achieve this goal, we will characterize critical implementation gaps in our understanding of adherence to treatment for drug-resistant TB and HIV, use this data to inform an evidence and theory-based intervention to improve adherence and promote retention in care, and rigorously evaluate the intervention with a mixed methods approach using quantitative clinical outcomes and qualitative understanding of impact on barriers and facilitators At the conclusion of these studies we will have addressed critical gaps in our understanding of adherence to treatment for drug-resistant TB and HIV, evaluated the potentially predictive value of novel adherence measures and assessed the impact of an exploratory, culturally acceptable, and patient-oriented intervention to support adherence.