Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: an alternate model of care.

摘要: Treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) in South Africa have suffered as centralized, inpatient treatment programs struggle to cope with rising prevalence and HIV co-infection rates. A new model is needed expand capacity improve MDR-TB outcomes. We describe the design preliminary results of an integrated, home-based MDR-TB/HIV program created rural KwaZulu-Natal. In 2008, a decentralized center was established provide outpatient treatment. Nurses, community health workers, family supporters been trained administer injections, adherence support, monitor adverse reactions patients’ homes. Physicians assess clinical response, adherence, reaction severity therapy at monthly follow-up visits. are assessed by cultures CD4 viral load every 6 months. Eighty patients initiated from 2/2008–4/2010; 66 were co-infected. Retention has high (only 5% defaults, 93% visits attended) favorable (77% cured/still on treatment, 82% undetectable load). Few required escalation care (9%), had severe events (8%), or died (6%). Integrated, promising achieve improved rural, resource-poor, high-HIV prevalent settings.