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Safety and Tolerability of Home-Based MDR-TB and HIV Treatment in Rural South Africa

This study evaluates adverse events in a home-based treatment program for multidrug-resistant tuberculosis (MDR-TB) and HIV co-infection in Tugela Ferry, South Africa. Among 91 patients, most experienced mild adverse events, and there were no significant differences in safety outcomes between HIV-positive patients on antiretroviral therapy (ART) and HIV-negative patients. Hypothyroidism was noted as a common issue, yet it was manageable. The findings support the safety and effectiveness of concurrent treatment, demonstrating that home-based care is feasible for co-infected individuals in rural settings.

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Safety and Tolerability of Home-Based MDR-TB and HIV Treatment in Rural South Africa

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  1. Adverse events in an integrated, home-based treatment program for MDR-TB & HIV in Tugela Ferry, South Africa JCM Brust*, NS Shah, TL van derMerwe, S Bamber, A Mngadi, Y Ning, M Heo, AP Moll, M Loveday, UG Lalloo, GH Friedland, and NR Gandhi • Background: • MDR TB treatment has many side effects • >80% of patients with MDR TB in KwaZulu-Natal, South Africa are HIV+ • Safety/tolerability of concurrent ART is unknown. • Treatment increasingly being given in ambulatory care models. • Methods: • 91 patients with confirmed MDR TB, treated in a home-based program in rural KwaZulu-Natal. • Visited daily by injection team. • If HIV+, ART initiated as soon as possible. • Screened monthly for adverse events (AEs) by clinician at decentralized clinic. • Labs drawn monthly. TSH six-monthly • All AEs reviewed retrospectively

  2. Results †n=73 with available TSH • Adverse events common, but generally mild. • No significant differences between HIV+ on ART and HIV-negative • Rarely had to change MDR TB or HIV treatment • Hypothyroidism common and often required replacement therapy. • Nearly all lab adverse events resolved spontaneously on repeat testing.

  3. N=91 • Conclusion: • Concurrent treatment for MDR TB and HIV is safe and generally tolerable. • With supportive care, can complete treatment with good outcomes. • Home-based treatment is a reasonable model, even for co-infected patients in rural area.

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