18 results on '"Padayatchi, Nesri"'
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2. Acceptability, feasibility, and impact of a pilot tuberculosis literacy and treatment counselling intervention: a mixed methods study
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Law, Stephanie, Seepamore, Boitumelo, Oxlade, Olivia, Sikhakhane, Nondumiso, Dawood, Halima, Chetty, Sheldon, Padayatchi, Nesri, Menzies, Dick, and Daftary, Amrita
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- 2021
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3. Major depression and household food insecurity among individuals with multidrug-resistant tuberculosis (MDR-TB) in South Africa
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Tomita, Andrew, Ramlall, Suvira, Naidu, Thirusha, Mthembu, Sbusisiwe Sandra, Padayatchi, Nesri, and Burns, Jonathan K.
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- 2019
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4. High incidence and persistence of hepatitis B virus infection in individuals receiving HIV care in KwaZulu-Natal, South Africa
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Msomi, Nokukhanya, Naidoo, Kogieleum, Yende-Zuma, Nonhlanhla, Padayatchi, Nesri, Govender, Kerusha, Singh, Jerome Amir, Abdool-Karim, Salim, Abdool-Karim, Quarraisha, and Mlisana, Koleka
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- 2020
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5. Similar Antibody Responses Against Severe Acute Respiratory Syndrome Coronavirus 2 in Individuals Living Without and with Human Immunodeficiency Virus on Antiretroviral Therapy during the First South African Infection Wave
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Snyman, Jumari, Hwa, Shi Hsia, Krause, Robert, Muema, Daniel, Reddy, Tarylee, Ganga, Yashica, Karim, Farina, Leslie, Alasdair, Sigal, Alex, Ndung'U, Thumbi, Archary, Moherndran, Dullabh, Kaylesh J., Goulder, Philip, Harling, Guy, Harrichandparsad, Rohen, Herbst, Kobus, Jeena, Prakash, Khoza, Thandeka, Klein, Nigel, Kloverpris, Henrik, Madansein, Rajhmun, Marakalala, Mohlopheni, Mazibuko, Matilda, Moshabela, Mosa, Mthabela, Ntombifuthi, Naidoo, Kogie, Ndhlovu, Zaza, Nyamande, Kennedy, Padayatchi, Nesri, Patel, Vinod, Smit, Theresa, Steyn, Adrie, and Wong, Emily
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Microbiology (medical) ,COVID-19 Vaccines ,Population ,HIV Infections ,Antibodies, Viral ,Neutralization ,South Africa ,Immunity ,Major Article ,Medicine ,Potency ,Humans ,antibodies ,Seroconversion ,education ,education.field_of_study ,biology ,business.industry ,SARS-CoV-2 ,Antibody titer ,COVID-19 ,HIV ,neutralization ,Virology ,Immunoglobulin A ,Infectious Diseases ,AcademicSubjects/MED00290 ,Infectious disease (medical specialty) ,Immunoglobulin G ,Antibody Formation ,biology.protein ,Antibody ,business - Abstract
Background There is limited understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis in African populations with a high burden of infectious disease comorbidities such as human immunodeficiency virus (HIV). The kinetics, magnitude, and duration of virus-specific antibodies and B-cell responses in people living with HIV (PLWH) in sub-Saharan Africa have not been fully characterized. Methods We longitudinally followed SARS-CoV-2–infected individuals in Durban, KwaZulu-Natal, South Africa, and characterized SARS-CoV-2 receptor-binding domain-specific immunoglobulin (Ig) M, IgG, and IgA weekly for 1 month and at 3 months post-diagnosis. Thirty of 72 (41.7%) were PLWH, 25/30 (83%) of whom were on antiretroviral therapy (ART) with full HIV suppression. Plasma neutralization was determined using a live virus neutralization assay, and antibody-secreting cell population frequencies were determined by flow cytometry. Results Similar seroconversion rates, time to peak antibody titer, peak magnitude, and durability of anti–SARS-CoV-2 IgM, IgG, and IgA were observed in people not living with HIV and PLWH with complete HIV suppression on ART. In addition, similar potency in a live virus neutralization assay was observed in both groups. Loss of IgA was significantly associated with age (P = .023) and a previous diagnosis of tuberculosis (P = .018). Conclusions Similar antibody responses and neutralization potency in people not living with HIV and PLWH on stable ART in an African setting suggest that coronavirus disease 2019 (COVID-19) natural infections may confer comparable antibody immunity in these groups. This provides hope that COVID-19 vaccines will be effective in PLWH on stable ART.
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- 2022
6. Adherence Measured Using Electronic Dose Monitoring is Associated with Emergent Antiretroviral Resistance and Poor Outcomes in People with Human Immunodeficiency Virus/AIDS and Multidrug-Resistant Tuberculosis.
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Bateman, Mark, Wolf, Allison, Chimukangara, Benjamin, Brust, James C M, Lessells, Richard, Amico, Rivet, Boodhram, Resha, Singh, Nalini, Orrell, Catherine, Friedland, Gerald, Naidoo, Kogieleum, Padayatchi, Nesri, and O'Donnell, Max R
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CLINICAL drug trials ,HIV infections ,DRUG delivery systems ,NEVIRAPINE ,STATISTICS ,SEQUENCE analysis ,GENETIC mutation ,SCIENTIFIC observation ,CONFIDENCE intervals ,SUBSTANCE abuse ,VIRAL load ,BLOOD plasma ,MULTIPLE regression analysis ,AGE distribution ,ANTIRETROVIRAL agents ,RNA ,ACQUISITION of data ,TREATMENT effectiveness ,RISK assessment ,SEX distribution ,ANTITUBERCULAR agents ,DRUG monitoring ,MULTIDRUG resistance ,PUBLIC hospitals ,GENOMES ,DESCRIPTIVE statistics ,QUESTIONNAIRES ,MEDICAL records ,PATIENT compliance ,STATISTICAL models ,POLYMERASE chain reaction ,ANALYTICAL chemistry techniques ,DATA analysis software ,LOGISTIC regression analysis ,ODDS ratio ,BODY mass index ,AIDS-related opportunistic infections ,LONGITUDINAL method ,LOPINAVIR-ritonavir ,PROPORTIONAL hazards models - Abstract
Background Medication adherence is known to challenge treatment of human immunodeficiency virus (HIV)/AIDS and multidrug-resistant tuberculosis (MDR-TB). We hypothesized that adherence using electronic dose monitoring (EDM) would identify an antiretroviral therapy (ART) adherence threshold for emergent ART resistance and predict treatment outcomes in patients with MDR-TB and HIV on ART and bedaquiline-containing TB regimens. Methods A prospective cohort of adults with MDR-TB and HIV on ART and initiating MDR-TB treatment with bedaquiline were enrolled at a public hospital in KwaZulu-Natal, South Africa (PRAXIS Study). Participants received separate EDM devices that measure adherence to bedaquiline and ART (nevirapine or lopinavir/ritonavir). Adherence was calculated cumulatively over 6 months. Participants were followed through completion of MDR-TB treatment. HIV genome sequencing was performed at baseline and 2 and 6 months on samples with HIV RNA ≥1000 copies/mL. Results From November 2016 through February 2018, 198 persons with MDR-TB and HIV were enrolled and followed (median, 17.2 months; interquartile range, 12.2–19.6). Eleven percent had baseline ART resistance mutations, and 7.5% developed emergent ART resistance at 6 months. ART adherence was independently associated with ART resistance and mortality. Modeling identified a significant (P <.001), linear association between ART adherence and emergent resistance, suggesting a strong association without a specific threshold. Conclusions Our findings highlight the need for ART resistance testing, especially in patients with MDR-TB and HIV, which is currently not the standard of care in resource-limited settings. Despite short follow-up duration, reduced ART adherence was significantly associated with emergent resistance and increased mortality. Clinical Trials Registration NCT03162107. [ABSTRACT FROM AUTHOR]
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- 2022
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7. Neurocognitive functioning in MDR-TB patients with and without HIV in KwaZulu-Natal, South Africa.
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Ramlall, Suvira, Lessells, Richard J., Naidu, Thirusha, Sandra Mthembu, Sbusisiwe, Padayatchi, Nesri, Burns, Jonathan K., and Tomita, Andrew
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SUBSTANCE-induced disorders ,PATIENT compliance ,MULTIDRUG-resistant tuberculosis ,HIV-positive persons ,POISSON regression - Abstract
Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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8. High Rates of Drug-induced Liver Injury in People Living With HIV Coinfected With Tuberculosis (TB) Irrespective of Antiretroviral Therapy Timing During Antituberculosis Treatment: Results From the Starting Antiretroviral Therapy at Three Points in TB Trial
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Naidoo, Kogieleum, Hassan-Moosa, Razia, Mlotshwa, Philile, Yende-Zuma, Nonhlanhla, Govender, Dhineshree, Padayatchi, Nesri, and Abdool-Karim, Salim S S
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DRUG therapy for tuberculosis ,HEPATOTOXICOLOGY -- Risk factors ,AGE distribution ,ANTITUBERCULAR agents ,CONFIDENCE intervals ,HEPATITIS B ,HEPATOTOXICOLOGY ,HIV infections ,LIVER function tests ,LONGITUDINAL method ,STATISTICS ,DATA analysis ,ANTIRETROVIRAL agents ,DISEASE incidence ,DESCRIPTIVE statistics ,CD4 lymphocyte count ,MIXED infections - Abstract
Background New onset or worsening drug-induced liver injury challenges coinfected patients on antiretroviral therapy (ART) initiation during antituberculosis (TB) treatment. Methods Post hoc analysis within a randomized trial, the Starting Antiretroviral Therapy at Three Points in Tuberculosis trial, was conducted. Patients were randomized to initiate ART either early or late during TB treatment or after TB treatment completion. Liver enzymes were measured at baseline, 6-month intervals, and when clinically indicated. Results Among 642 patients enrolled, the median age was 34 years (standard deviation, 28–40), and 17.6% had baseline CD4+ cell counts <50 cells/mm
3 . Overall, 146/472 patients (52, 47, and 47: early, late, and sequential arms) developed new-onset liver injury following TB treatment initiation. The incidence of liver injury post-ART initiation in patients with CD4+ cell counts <200 cells/mm3 and ≥200 cells/ mm3 was 27.4 (95% confidence interval [CI], 18.0–39.8), 19.0 (95% CI, 10.9–30.9), and 18.4 (95% CI, 8.8–33.8) per 100 person-years, and 32.1 (95% CI, 20.1–48.5), 11.8 (95% CI, 4.3–25.7), and 28.2 (95% CI, 13.5–51.9) per 100 person-years in the early, late integrated, and sequential treatment arms, respectively. Severe and life-threatening liver injury occurred in 2, 7, and 3 early, late, and sequential treatment arm patients, respectively. Older age and hepatitis B positivity predicted liver injury. Conclusions High incidence rates of liver injury among cotreated human immunodeficiency virus (HIV)–TB coinfected patients were observed. Clinical guidelines and policies must provide guidance on frequency of liver function monitoring for HIV–TB coinfected patients. [ABSTRACT FROM AUTHOR]- Published
- 2020
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9. Spatiotemporal Clustering of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis Is Associated With Human Immunodeficiency Virus Status and Drug-Susceptibility Patterns in KwaZulu-Natal, South Africa.
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Wolf, Allison, Padayatchi, Nesri, Naidoo, Kogieleum, Master, Iqbal, Mathema, Barun, and O'Donnell, Max R
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CLUSTER analysis (Statistics) , *INFECTIOUS disease transmission , *GENE mapping , *HEALTH status indicators , *HIV , *MEDICAL care use , *PUBLIC health - Abstract
Using an open-access spatiotemporal analytics program, we mapped spatiotemporal heterogeneity loci in tuberculosis (TB) cases (clusters) and dynamic changes, and characterized the drug-resistant TB clustering risk using routine microbiological data from KwaZulu-Natal, South Africa. The data may provide insight into transmission dynamics and support efficient deployment of public health resources. [ABSTRACT FROM AUTHOR]
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- 2020
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10. Primary capreomycin resistance is common, and associated with early mortality in extensively drug-resistant tuberculosis (XDR-TB) patients in KwaZulu-Natal, South Africa
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O’Donnell, Max R., Pillay, Melendhran, Pillay, Manormoney, Werner, Lise, Master, Iqbal, Wolf, Allison, Mathema, Barun, Coovadia, Yacoob M, Mlisana, Koleka, Horsburgh, C. Robert, and Padayatchi, Nesri
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Adult ,Male ,Genotype ,Anti-HIV Agents ,Extensively Drug-Resistant Tuberculosis ,Drug Resistance, Microbial ,HIV Infections ,Mycobacterium tuberculosis ,Article ,Cohort Studies ,South Africa ,Drug Resistance, Multiple, Bacterial ,Humans ,Female ,Capreomycin ,Antibiotics, Antitubercular ,Retrospective Studies - Abstract
Capreomycin is a key antimycobacterial drug in treatment of extensively drug-resistant tuberculosis (XDR-TB). Drug-susceptibility testing (DST) for capreomycin is not routinely performed in newly diagnosed XDR-TB in South Africa. We performed this study to assess the prevalence, clinical significance, and molecular epidemiology of capreomycin resistance in newly diagnosed patients with XDR-TB in KwaZulu-Natal, South Africa.Retrospective cohort study of consecutive patients with XDR-TB admitted to a TB referral hospital without previous XDR-TB treatment. A subset of isolates had extended DST (including capreomycin), mutational analysis, and IS6110 restriction fragment length polymorphism assays.A total of 216 eligible patients with XDR-TB were identified. The majority were treated with capreomycin (72%), were young (median age: 35.5 years), and were female (56%). One hundred five (76%) were HIV+, and 109 (66%) were on antiretroviral therapy. A subset of 52 patients had full DST. A total of 47/52 (90.4%) patients with XDR-TB were capreomycin resistant. Capreomycin-resistant patients experienced worse mortality and culture conversion than capreomycin susceptible, although this difference was not statistically significant. The A1401G mutation in the rrs gene was associated with capreomycin resistance. The majority of capreomycin-resistant strains were F15/LAM4/KZN lineage (80%), and clustering was common in these isolates (92.5%).Capreomycin resistance is common in patients with XDR-TB in KwaZulu-Natal, is predominantly because of ongoing province-wide transmission of a highly resistant strain, and is associated with high mortality. Capreomycin should be included in routine DST in all patients with XDR-TB. New drug regimens that do not include injectable agents should be operationally tested as empiric treatment in XDR-TB.
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- 2015
11. Effect of Antiretroviral Therapy on Treatment Outcomes in a Prospective Study of Extensively Drug-Resistant Tuberculosis (XDR-TB) HIV Coinfection Treatment in KwaZulu-Natal, South Africa.
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Yuengling, Katharine A. MPH, Padayatchi, Nesri MD, Wolf, Allison MPH, Mathema, Barun PhD, MPH, Brown, Tyler MD, Horsburgh, C. Robert MD, and O'Donnell, Max R. MD, MPH
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Background: Extensively drug-resistant tuberculosis (XDR-TB)/HIV coinfection has been associated with high mortality and poor TB outcomes. We performed a prospective study to comprehensively characterize a cohort of patients with XDR-TB. Methods: Adult patients with XDR-TB were enrolled at treatment initiation at a TB referral hospital in KwaZulu-Natal Province, South Africa, and followed through the end of treatment. Clinical data, questionnaires, adherence data, and sputum were collected monthly. Whole genome sequencing was performed on baseline Mycobacterium tuberculosis (MTB) isolates. Treatment outcomes were defined using standard definitions. Results: One hundred five patients with XDR-TB (76.1% HIV-infected) were enrolled from August 2009 to July 2011. Among HIV-coinfected patients, 82.5% were on antiretroviral therapy initially and 93.8% cumulatively over the study period. At 24 months, 31.4% had a successful outcome and 68.6% had an unsuccessful outcome with 41% mortality. Antiretroviral therapy was associated with improved mortality in HIV-coinfected patients (P = 0.05), as was TB culture conversion (P < 0.0001). On whole genome sequencing, most strains were LAM4/KZN lineage (68%), with few single nucleotide polymorphism differences. Conclusions: Despite improved HIV care, treatment outcomes and mortality were only modestly improved compared with previous South African XDR-TB/HIV treatment cohorts. Of note, this study was completed before the introduction of new antimycobacterial agents (eg, bedaquiline and delamanid). As new TB drugs and regimens become available, it is important to monitor treatment to ensure that benefits seen in clinical trials are reproduced in high-burden, low-resource settings. [ABSTRACT FROM AUTHOR]
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- 2018
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12. Integrating patients’ perspectives into integrated TB/HIV healthcare
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Daftary, Amrita and Padayatchi, Nesri
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Adult ,Male ,Health Knowledge, Attitudes, Practice ,Patients ,Attitude of Health Personnel ,HIV Infections ,Trust ,Truth Disclosure ,Article ,Interviews as Topic ,South Africa ,Young Adult ,Humans ,Tuberculosis ,Prospective Studies ,Cooperative Behavior ,Qualitative Research ,Patient Care Team ,Coinfection ,Delivery of Health Care, Integrated ,Patient Preference ,Professional-Patient Relations ,Middle Aged ,Female ,Interdisciplinary Communication ,Perception - Abstract
Escalating rates of tuberculosis-human immunodeficiency virus (TB-HIV) co-infection call for improved coordination of TB and HIV health care services in high-burden countries such as South Africa. Patient perspectives, however, are poorly understood in the context of current integration efforts.Under a qualitative research framework, we interviewed 40 HIV-positive adult TB patients and eight key-informant health care workers across three clinics in KwaZulu-Natal Province to explore non-clinical and non-operational aspects of TB-HIV health care.Qualitative analysis highlighted critical social and ethical considerations for the concurrent delivery of TB and HIV care. Co-infected patients navigating between TB and HIV programs are exposed to missed opportunities for TB and HIV service integration, fragmented or vertical care for their dual infections and contrasting experiences within TB and HIV clinics. These intersecting issues appear to affect patients' health-related decisions, particularly nondisclosure of HIV status to non-HIV health care workers and their preferences for integrated health care.Our study highlights the imperative to address service fragmentation, HIV medical confidentiality and provider mistrust within the health care system, and the cultural differences associated with TB and HIV disease control.
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- 2013
13. High Treatment Failure and Default Rates for Patients with MDR TB in KwaZulu-Natal, South Africa, 2000–2003
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Brust, James C.M., Gandhi, Neel R., Carrara, Henri, Osburn, Garth, and Padayatchi, Nesri
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Adult ,Male ,Chi-Square Distribution ,Time Factors ,Antitubercular Agents ,HIV Infections ,Middle Aged ,Risk Assessment ,Article ,Medication Adherence ,South Africa ,Young Adult ,Logistic Models ,Sex Factors ,Risk Factors ,Tuberculosis, Multidrug-Resistant ,Odds Ratio ,Prevalence ,Humans ,Female ,Treatment Failure ,Developing Countries ,Program Evaluation ,Retrospective Studies - Abstract
Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant public health threat in South Africa.To describe treatment outcomes and determine risk factors associated with unfavorable outcomes among MDR-TB patients admitted to the provincial TB referral hospital in KwaZulu-Natal Province, South Africa.Retrospective observational study of MDR-TB patients admitted from 2000 to 2003.Of 1209 MDR-TB patients with documented treatment outcomes, 491 (41%) were cured, 35 (3%) completed treatment, 208 (17%) failed treatment, 223 (18%) died and 252 (21%) defaulted. Of the total number of patients with known human immunodeficiency virus (HIV) status, 52% were HIV-infected. Treatment failure, death and default each differed in their risk factors. Greater baseline resistance (aOR 2.3-3.0), prior TB (aOR 1.7), and diagnosis in 2001, 2002 or 2003 (aOR 1.9-2.3) were independent risk factors for treatment failure. HIV co-infection was a risk factor for death (aOR 5.6), and both HIV (aOR 2.0) and male sex (aOR 1.9) were risk factors for treatment default.MDR-TB treatment outcomes in KwaZulu-Natal were substantially worse than those published from other MDR-TB cohorts. Interventions such as concurrent antiretroviral therapy and decentralized MDR-TB treatment should be considered to improve MDR-TB outcomes in this high HIV prevalence setting.
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- 2010
14. Improved Early Results for Patients with Extensively Drug Resistant Tuberculosis and HIV in South Africa
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O'Donnell, Max R, Padayatchi, Nesri, Master, Iqbal, Osburn, Garth, and Horsburgh, C. Robert
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Adult ,Male ,AIDS-Related Opportunistic Infections ,Antitubercular Agents ,HIV Infections ,Microbial Sensitivity Tests ,Middle Aged ,Article ,South Africa ,Treatment Outcome ,Antiretroviral Therapy, Highly Active ,Tuberculosis, Multidrug-Resistant ,HIV-1 ,Humans ,Female ,Proportional Hazards Models ,Retrospective Studies - Abstract
A public tuberculosis (TB) referral hospital in KwaZulu-Natal, South Africa.To present treatment outcomes of patients with extensively drug-resistant tuberculosis (XDR-TB) patients and human immunodeficiency virus (HIV) coinfection with and without highly active antiretroviral therapy.Retrospective cohort study. Eligible patients had drug susceptibility testing that met a consensus definition for XDR-TB, and agreed to treatment. Therapy was based on drug susceptibilities, available medications and patient tolerance.Overall, 60 XDR-TB patients initiated therapy with a median number of 5.5 drugs. Of these, 43 (72%) were HIV-positive, and 21 (49%) were on antiretroviral therapy; 29 HIV-infected patients (67%) had available CD4 counts, with a median CD4 count of 200.5 cells/mm(3) (standard deviation 127.4 cells/mm(3)). Of 60 patients, 31 (52%) had adverse events (AEs), and 17/60 patients (28%) had severe AEs. During follow-up, 12/60 (20%) experienced sputum culture conversion, while 25/60 (42%) patients died. None of the following was significantly associated with mortality: HIV status, previous MDR diagnosis or severe AEs.In this study, it was possible to treat HIV-XDR-TB coinfected patients and prolong survival in a resource-limited setting. We highlight the challenges in treatment, including high frequencies of AEs and death. Expanded identification of cases, prompt referral for treatment, and attention to management of comorbidities may facilitate successful treatment of XDR-TB in HIV-infected patients.
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- 2009
15. Social constraints to TB/HIV healthcare: Accounts from coinfected patients in South Africa.
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Daftary, Amrita and Padayatchi, Nesri
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HIV prevention , *MEDICAL care , *TUBERCULOSIS prevention , *GROUNDED theory , *HEALTH services accessibility , *INTERVIEWING , *RESEARCH methodology , *RESEARCH funding , *SOUND recordings , *SOCIAL stigma , *COMORBIDITY , *QUALITATIVE research , *JUDGMENT sampling , *SOCIOECONOMIC factors , *THEMATIC analysis , *PATIENTS' attitudes , *DESCRIPTIVE statistics , *PSYCHOLOGY - Abstract
There is a growing imperative to improve the coordination and collaboration of tuberculosis (TB) and HIV healthcare services in response to escalating rates of TB/HIV coinfection. Patient-specific challenges associated with the delivery of TB/HIV care have been minimally explored in this regard. As part of a larger study conducted in South Africa, this article highlights coinfected patients' experiences with TB and HIV healthcare in light of their broader social environments. Qualitative, in-depth interviews were conducted with 40 adult, coinfected patients (24 women and 16 men) and eight key-informant healthcare workers at three urban/peri-urban, ambulatory, public health clinics in the high-burden province of KwaZulu-Natal. Transcribed interviews were analyzed under a modified grounded theory approach to capture subjective meanings of healthcare experience subsequent to patients' codiagnosis with TB and HIV. Emerging analytic themes highlighted critical sociomedical constraints to TB/HIV care in relation to patients' income and employment, eligibility for social assistance and antiretroviral treatment, fears around illness disclosure, social and material support, and treatment adherence. Patients' healthcare experiences were bound by their poor access to essential resources, multiple life responsibilities, disparate gender roles, limits within the healthcare system, and the stigmatizing social symbolism of their illness. Overlapping social inequalities perpetuated coinfected patients' experiences with stigma and collectively mediated their health decisions around disclosure, adherence, and retention in medical care. The study urges a contextualized understanding of the social challenges associated with TB/HIV healthcare and helps inform more patient-sensitive and socially responsive interventions against the co-epidemic. [ABSTRACT FROM PUBLISHER]
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- 2012
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16. Brief Report: Differentiated Service Delivery Framework for People With Multidrug-Resistant Tuberculosis and HIV Coinfection.
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Reis, Karl, Wolf, Allison, Perumal, Rubeshan, Seepamore, Boitumelo, Guzman, Kevin, Ross, Jesse, Cheung, Ying Kuen K., Amico, K. Rivet, Brust, James C. M., Padayatchi, Nesri, Friedland, Gerald, Naidoo, Kogieleum, Daftary, Amrita, Zelnick, Jennifer, and O'Donnell, Max
- Abstract
Introduction: For people living with HIV/AIDS, care is commonly delivered through differentiated service delivery (DSD). Although people with multidrug-resistant tuberculosis (MDR-TB) and HIV/AIDS experience severe treatment-associated challenges, there is no DSD model to support their treatment. In this study, we defined patterns of medication adherence and characterized longitudinal barriers to inform development of an MDR-TB/HIV DSD framework. Methods: Adults with MDR-TB and HIV initiating bedaquiline (BDQ) and receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa, were enrolled and followed through the end of MDR-TB treatment. Electronic dose monitoring devices measured BDQ and ART adherence. Longitudinal focus groups were conducted and transcripts analyzed thematically to describe discrete treatment stage-specific and cross-cutting treatment challenges. Results: Two hundred eighty-three participants were enrolled and followed through treatment completion (median 17.8 months [interquartile range 16.5–20.2]). Thirteen focus groups were conducted. Most participants (82.7%, 234/283) maintained high adherence (mean BDQ adherence 95.3%; mean ART adherence 85.5%), but an adherence-challenged subpopulation with <85% cumulative adherence (17.3%, 49/283) had significant declines in mean weekly BDQ adherence from 94.9% to 39.9% (P < 0.0001) and mean weekly ART adherence from 83.9% to 26.6% (P < 0.0001) over 6 months. Psychosocial, behavioral, and structural obstacles identified in qualitative data were associated with adherence deficits in discrete treatment stages and identified potential stage-specific interventions. Conclusions: A DSD framework for MDR-TB/HIV should intensify support for adherence-challenged subpopulations, provide multimodal support for adherence across the treatment course, and account for psychosocial, behavioral, and structural challenges linked to discrete treatment stages. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Neurocognitive Impairment Risk Among Individuals With Multiple Drug–Resistant Tuberculosis and Human Immunodeficiency Virus Coinfection: Implications for Systematic Linkage to and Retention of Care in Tuberculosis/Human Immunodeficiency Virus Treatment
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Tomita, Andrew, Ramlall, Suvira, Naidu, Thirusha, Mthembu, Sbusisiwe Sandra, Padayatchi, Nesri, and Burns, Jonathan K.
- Abstract
Although neurocognitive impairment (NCI) is a well-recognized challenge in human immunodeficiency virus (HIV), there is little evidence regarding it among individuals with multiple drug-resistant tuberculosis (MDR-TB) within HIV endemic sub-Saharan Africa. The extent of NCI risk, particularly HIV-associated neurocognitive disorders (HAND) risk, was investigated in 200 microbiologically confirmed inpatients with MDR-TB at a TB-specialist hospital in KwaZulu-Natal Province, South Africa. Within this population, the prevalence of HIV coinfection, major depressive episode, and substance use disorder was 89.50%, 10.50%, and 7.00%, respectively. After excluding individuals with major depressive episode/substance use disorder and monoinfection (i.e., MDR-TB without HIV), the prevalence of HAND risk was 43.5%. Older and low-income individuals had significantly greater odds of HAND risk, whereas those with family members/relatives who work(ed) in the health services had lower odds. The role of timely linkage to and retention of care in TB/HIV treatment to offset cognitive decline in MDR-TB/HIV coinfected individuals needs to be investigated further. [ABSTRACT FROM AUTHOR]
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- 2019
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18. Primary Capreomycin Resistance Is Common and Associated With Early Mortality in Patients With Extensively Drug-Resistant Tuberculosis in KwaZulu-Natal, South Africa.
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O'Donnell, Max R., Pillay, Melendhran, Pillay, Manormoney, Werner, Lise, Master, Iqbal, Wolf, Allison, Mathema, Barun, Coovadia, Yacoob M., Mlisana, Koleka, Horsburgh, Charles Robert, and Padayatchi, Nesri
- Published
- 2015
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