• Neel R Gandhi, Anthony P Moll, Umesh Lalloo, Robert Pawinski, Kimberly Zeller, Pravi Moodley, Eugene Meyer, Gerald Friedland, and Tugela Ferry Care and Research (TFCaRes) Collaboration.
• Yale University School of Medicine, New Haven, CT, USA. neelgandhi@alumni.williams.edu
• J. Acquir. Immune Defic. Syndr. 2009 Jan 1; 50 (1): 37-43.

BackgroundTuberculosis (TB) is the leading cause of death among HIV-infected patients worldwide. In KwaZulu-Natal, South Africa, 80% of TB patients are HIV coinfected, with high treatment default and mortality rates. Integrating TB and HIV care may be an effective strategy for improving outcomes for both diseases.MethodsProspective operational research study treating TB/HIV-coinfected patients in rural KwaZulu-Natal with once-daily antiretroviral (ARV) therapy concurrently with TB therapy by home-based, modified directly observed therapy. Patients were followed for 12 months after ARV initiation.ResultsOf 119 TB/HIV-coinfected patients enrolled, 67 (56%) were female, mean age was 34.0 years, and median CD4 count was 78.5 cells per cubic millimeter. After 12 months on ARVs, mean CD4 count increase was 211 cells per cubic millimeter, and 88% had an undetectable viral load; 84% completed TB treatment. Thirteen patients (11%) died; 10 (77%) with multidrug-resistant or extensively drug-resistant TB. There were few severe adverse events or immune reconstitution events. Adherence was high with 93% of study visits attended and 99% of ARV doses taken.ConclusionsIntegration of TB and HIV treatment in a rural setting using concurrent home-based therapy resulted in excellent adherence and TB and HIV outcomes. This model may result in successful management of both diseases in other rural resource-poor settings.

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