AEGiS-15IAC: Initiating and providing antiretroviral therapy for TB/HIV coinfected patients in a rural tuberculosis directly observed therapy program in South Africa: The Sizonqoba study.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Initiating and providing antiretroviral therapy for TB/HIV coinfected patients in a rural tuberculosis directly observed therapy program in South Africa: The Sizonqoba study.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrB1014)

Gandhi NR, Moll A, Pawinski R, Jack C, Lalloo U, Friedland G
Yale University School of Medicine, New Haven, Connecticut, United States

BACKGROUND: Tuberculosis(TB) is the leading cause of death among HIV+ patients worldwide. In the province of KwaZulu Natal, South Africa, 2/3 of new TB patients are HIV+. Although TB treatment programs use WHO Directly Observed Therapy Short Course (DOTS) strategy, the annual case fatality rate among HIV/TB coinfected patients remains 40%. Introduction of antiretroviral therapy(ART) using the TB DOT infrastructure could be an effective, safe and efficient strategy to increase ART access and improve TB and HIV outcomes in resource poor settings.

METHODS: Observational treatment study among 100 patients with active TB and HIV in rural resource-poor KwaZulu Natal. TB patients offered HIV counseling and testing, and if positive, receive once-daily ddI, 3TC and efavirenz with TB meds by home-based DOT 5 days/week and self administration 2 days/week. Patients are followed for 12 months for HIV and TB clinical outcomes, drug toxicity, hospitalizations, mortality, CD4 & viral load change, and development of viral resistance.

RESULTS: Strengthening of TB DOTS program completed with recruitment of 2 program coordinators and 120 volunteer home-based DOT supporters. Community awareness meetings and training courses in HIV, HIV-TB coinfection and ART held. Supply of ART secured. Since 10/2003, patients are being enrolled with a target of 50 by 6/2004. Of the first patients, half were women, mean age 34.5 years, all WHO Stage 3/4 TB and mean CD4 cell count 55 cells/mm³. Strategy appears feasible and successful in initial patients and has resulted in selection of this site as a pilot site for South African national ART rollout. Conclusion Existing TB DOTS programs provide a logical infrastructure to introduce ART into rural resource-poor settings. Integration of TB and HIV treatment requires additional resources and creates challenges, but may also increase access to ART, reduce mortality and improve outcomes for both TB and HIV disease.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Directly Observed Therapy, Tuberculosis, HIV Infections, CD4 Lymphocyte Count, Rural Population, South Africa, Humans, Female, therapy, organization & administration

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