Grant: Travel Awards - Institute Community Support

Adherence to antiretroviral therapy (ART) and second-line anti tuberculosis (TB) treatment is essential to achieve positive outcomes among patients who are co-infected with HIV and multi or extensively drug-resistant TB (M/XDR-TB), the most drug-resistant forms of TB. Preliminary research from South Africa has shown that co-infected patients are less adherent to treatment for drug-resistant TB as compared to ART. In this study, we examined patient-related challenges to adherence using qualitative methods. In 2012-13, we conducted 6 focus groups with 23 adults receiving treatment for drug-resistant TB at a specialist TB hospital; 17 patients were also taking ART. Focus group participants expressed a preference for HIV treatment because they perceived it was more tolerable and involved fewer pills. Having been exposed to HIV counseling and education, they were more committed to taking ART. They perceived the outcomes and side effects associated with treatment for drug-resistant TB to be comparatively worse. TB was a publicly notifiable condition and provoked clinical as well as social isolation. Treatment intake was supervised by health care workers without adequate communication with or involvement of patients. These issues exacerbated patients' negative experiences with TB related care and appeared to influence their adherence to TB treatment. To improve adherence, we must develop new, more effective and more tolerable medication regimens for drug-resistant TB. For the first time, such improved regimens are on the horizon. In addition and equally important, we must develop a coordinated model of health care that promotes patient involvement, empowerment, and treatment education for HIV and for TB. A comprehensive approach that addresses the clinical and social impacts of HIV-TB co-infection will enhance population health within high-burden countries such as South Africa, and inform the management of other HIV-related co-morbidities in countries such as Canada.