BackgroundAdherence to tuberculosis (TB) treatment and antiretroviral therapy (ART) reduces morbidity and mortality among persons co-infected with TB/HIV. We measured adherence and determined factors associated with non-adherence to concurrent TB treatment and ART among co-infected persons in two provinces in South Africa.MethodsA convenience sample of 35 clinics providing integrated TB/HIV care was included due to financial and logistic considerations. Retrospective chart reviews were conducted among persons who received concurrent TB treatment and ART and who had a TB treatment outcome recorded during 1 January 2008–31 December 2010. Adherence to concurrent TB and HIV treatment was defined as: (1) taking ≥80% of TB prescribed doses by directly observed therapy (DOT) as noted in the patient card; and (2) taking >90% ART doses as documented in the ART medical record during the concurrent treatment period (period of time when the patient was prescribed both TB treatment and ART). Risk ratios (RRs) and 95% confidence intervals (CIs) were used to identify factors associated with non-adherence.ResultsOf the 1,252 persons receiving concurrent treatment, 138 (11.0%) were not adherent. Non-adherent persons were more likely to have extrapulmonary TB (RR: 1.71, 95% CI: 1.12 to 2.60) and had not disclosed their HIV status (RR: 1.96, 95% CI: 1.96 to 3.76).ConclusionsThe majority of persons with TB/HIV were adherent to concurrent treatment. Close monitoring and support of persons with extrapulmonary TB and for persons who have not disclosed their HIV status may further improve adherence to concurrent TB and antiretroviral treatment.

Background Tuberculosis (TB) is amongst the top five causes of death in women of childbearing age (15-�44 years). Little is known about treatment of pregnant women with drug-resistant TB (DR-TB). Treatment for pregnant women remains challenging and more complex in DR-TB/HIV co-infection, where an evidence-based guide to clinical practice is limited. The study reviewed treatment and pregnancy outcomes and birth outcomes of their newborn in a cohort of pregnant women with DR-TB from three MDR-TB hospitals during 2010 and 2018. Design/Methods Data were extracted from: TB register and patient clinic notes using a standardized case record form. Information on DR-TB treatment, pregnancy and Adverse Drug Events (ADEs) of twenty-six pregnant women treated with individualized second-line TB medications were captured. The frequency of favourable and adverse outcomes regarding disease and pregnancy were evaluated. Results The mean age was 29 years (SD ±5.1), with the minimum and maximum age of 21 and 40 years, respectively. Eleven (42.3%) were previously treated with first-line TB drugs, 11 (42.3%) never treated before and 4 (15.4%) were previously treated for DR-TB. Of the 26 women, 15 (57.7%) had at least one ADE, but most had more than one ADE. Seventeen women were successfully treated, and 22 live births recorded. Live birth outcome was significantly associated with trimester of initiation of DR-TB treatment (p = 0.036). The proportion of live births for the pregnancy trimester when DR-TB treatment was initiated, were 60.0%, 90.9% and 100.0%, for first, second and third trimester, respectively.

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Background Healthcare personnel (HCP) in high TB burdened countries continue to be at high risk of occupational TB due to inadequate implementation of Tuberculosis Infection Prevention and Control (TB-IPC) measures, lack of understanding of the context and relevance to local settings. Such transmission in the healthcare workplace has prompted the development and dissemination of numerous guidelines for strengthening TB-IPC for use in settings globally. However, a growing body of literature points to lack of involvement of the HCP in the conceptualization and development of guidelines and programmes seeking to improve TB-IPC in high burden countries generally. Objectives The aim of this study is to identify factors affecting and influencing the adoption of TB-IPC measures in heath settings and the recognised research field exploring the inclusion of the HCP in decision making when designing these guidelines, in relation to appropriateness of the guidelines to the local context. Methods A scoping review methodology was selected for this study to gain insight into the relevant research evidence identifying and mapping key elements in the TB-IPC measures in relation to HCP as implementors. Results Studies in this review refer to factors related to HCP’s knowledge of TB-IPC, perception regarding occupational risks, behaviours, and their role against a background of structural resource constraints, and guidelines adherence. They report several challenges in the TB-IPC implementation and adherence particularly eliciting recommendations from HCP for improved TB-IPC practices. Conclusion Research on the enablers and barriers to TB-IPC implementation needs to go beyond mere documenting factors affecting and influencing adoption of TB-IPC measures in heath settings. There is an urgent need for research on participation of the implementers in the decision making when developing TB-IPC guidelines. Finally, when designing the TB-IPC guidelines, factors to be considered should be the appropriateness of the guidelines to the local context.