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.

Keywords:

• adherence
• HIV/AIDS
• drug-resistant tuberculosis
• co-infection
• qualitative methods

Acknowledgements

The authors are grateful to the study participants, study site, Ms. Z. Gwamanda, Ms. N. Depargo, Centre for the AIDS Programme of Research (CAPRISA) at University of KwaZulu-Natal and Canadian Institutes of Health Research Social Research Centre for HIV Prevention at University of Toronto, for their research contributions and support.

Funding

Amrita Daftary was supported by the Canadian Institutes of Health Research [ZNF-107572]. Nesri Padayatchi was supported by the Columbia University-Southern African Fogarty AIDS International Training and Research Program [grant number D43TW000231-16S1]. CAPRISA was established as part of the Comprehensive International Program of Research on AIDS [CIPRA; grant number AI51794] from the US National Institutes of Health (NIH). Max O'Donnell was supported by the NIH National Institute of Allergy and Infectious Disease [NIAID; grant number 5K23AI098479], Albert Einstein Center for Global Health & Clinical and Translational Research Institute and Stony-Wold Herbert Fund.

Notes

1. Quotes are linked to participants’ gender. Additional characteristics have been withheld to maintain confidentiality and anonymity, given our small sample and narrow time frame.

Additional information

Funding

Funding:Amrita Daftary was supported by the Canadian Institutes of Health Research [ZNF-107572]. Nesri Padayatchi was supported by the Columbia University-Southern African Fogarty AIDS International Training and Research Program [grant number D43TW000231-16S1]. CAPRISA was established as part of the Comprehensive International Program of Research on AIDS [CIPRA; grant number AI51794] from the US National Institutes of Health (NIH). Max O'Donnell was supported by the NIH National Institute of Allergy and Infectious Disease [NIAID; grant number 5K23AI098479], Albert Einstein Center for Global Health & Clinical and Translational Research Institute and Stony-Wold Herbert Fund.