51. Re-inventing adherence: toward a patient-centered model of care for drug-resistant tuberculosis and HIV
- Author
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Mike Frick, Amrita Daftary, David R. Bangsberg, Naressa Naidu, M. Garretson, Petros Isaakidis, J. L. Davis, J.C.M. Brust, Gerald Friedland, K. R. Amico, Nesri Padayatchi, Allison Wolf, John Z. Metcalfe, Jennifer Zelnick, M. Senthilingam, Yael Hirsch-Moverman, and Max R. O'Donnell
- Subjects
0301 basic medicine ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tuberculosis ,030106 microbiology ,Treatment outcome ,Human immunodeficiency virus (HIV) ,Medication adherence ,HIV Infections ,patient-centered care ,Cardiorespiratory Medicine and Haematology ,medicine.disease_cause ,Microbiology ,Article ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Rare Diseases ,Patient Education as Topic ,Clinical Research ,Patient-Centered Care ,Tuberculosis, Multidrug-Resistant ,Behavioral and Social Science ,medicine ,Humans ,030212 general & internal medicine ,Continuum of care ,Intensive care medicine ,Directly Observed Therapy ,business.industry ,Coinfection ,Drug resistant tuberculosis ,drug-resistant TB ,Evaluation of treatments and therapeutic interventions ,HIV ,Multidrug-Resistant ,medicine.disease ,Infectious Diseases ,Orphan Drug ,Good Health and Well Being ,6.1 Pharmaceuticals ,HIV/AIDS ,Antimicrobial Resistance ,business ,Infection ,Patient centered - Abstract
BackgroundDespite 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.ObjectiveTo review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support.DiscussionCurrent 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.ConclusionIt 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.
- Published
- 2016