York professor studies drug-resistant tuberculosis (DRTB)-HIV care among patients in South Africa

Researchers led by York University assistant professor of global health Amrita Daftary in the School of Health Policy & Management in the Faculty of Health, recently published a study that describes experiences of drug-resistant tuberculosis (DRTB)-HIV care among patients in KwaZulu-Natal province, South Africa.

The study, "Dynamic needs and challenges of people with drug-resistant tuberculosis and HIV in South Africa: a qualitative study" was published in The Lancet.

Amrita Daftary

Amrita Daftary

The researchers state there is little evidence of patient acceptability for drug-resistant tuberculosis (DRTB) care in the context of new treatment regimens and HIV co-infection. The study aims to address the lack of this evidence and describe experiences of DRTB-HIV care among patients in KwaZulu-Natal province, South Africa.

Research conducted highlights the need for information, patient agency and social protections in DRTB care and treatment, and for decentralized, community peer-support, and differentiated care models that might be ameliorative and help to maximize the promise of new regimens for DRTB.

"This study fills a gap in the evidence around patient acceptability for new DRTB treatment regimens, particularly in the context of HIV co-infection," said Daftary, who is a faculty member with the Dahdaleh Institute for Global Health Research. "Drawing on in-depth qualitative methods and a conceptual framework for chronic illness, this study chronologizes challenges and coping strategies among patients receiving bedaquiline-based treatment for multi DRTB or extensively DRTB and concurrent antiretroviral treatment in the high-burden setting of KwaZulu-Natal, South Africa.”

Daftary led this seminal qualitative study, which was nested into a broader study about adherence in people living with drug resistant TB and HIV. The research reflects a longstanding close collaboration with the Centre for the AIDS Programme of Research in South Africa, where Daftary has worked since 2005, and Columbia University Medical Centre. Other contributors are leading actors in the TB and HIV research community coming to the problem of TB from a multiple disciplinary lens, and with extensive experience working in South Africa.

As people with DRTB and HIV undergo disruptive, life-altering experiences, the authors conclude that the lack of information, agency, and social protections in DRTB care and treatment causes wider-reaching challenges for patients compared with HIV. Based on the study, recommendations include establishing a decentralized, community, peer-support, and differentiated care models which can help maximize the promise of new regimens.

Daftary delivered a presentation titled "Elevating the Social Science Gaze on Tuberculosis" on March 24, World Tuberculosis Day, at the Dahdaleh Institute for Global Health Research. For more information on that presentation, visit the event website.

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