{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T02:20:22Z","timestamp":1793931622412,"version":"4.8.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI124413\u201301"],"award-info":[{"award-number":["R01AI124413\u201301"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21TW011077-21"],"award-info":[{"award-number":["R21TW011077-21"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In generalized drug-resistant tuberculosis (DR-TB) human immunodeficiency virus (HIV) epidemics, identifying subpopulations at high risk for treatment failure and loss to care is critically important to improve treatment outcomes and prevent amplification of drug resistance. We hypothesized that an electronic dose-monitoring (EDM) device could empirically identify adherence-challenged patients and that a mixed-methods approach would characterize treatment challenges.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A prospective study of patients with DR-TB HIV on antiretroviral therapy (ART) initiating bedaquiline-containing regimens in KwaZulu-Natal, South Africa. Separate EDM devices measured adherence for bedaquiline and ART. Patients with low adherence (&amp;lt;85%) to both bedaquiline and ART were identified as high risk for poor outcomes. Baseline survey, study visit notes, and focus group discussions characterized treatment challenges.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From December 2016\u2013February 2018, 32 of 198 (16%) enrolled patients with DR-TB HIV were identified as dual-adherence challenged. In a multivariate model including baseline characteristics, only receiving a disability grant was significantly associated with dual nonadherence at 6 months. Mixed-methods identified treatment barriers including alcohol abuse, family conflicts, and mental health issues. Compared with adherent patients, dual-adherence\u2013challenged patients struggled to prioritize treatment and lacked support, and dual-adherence\u2013challenged patients experienced higher rates of detectable HIV viral load and mortality than more adherent patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>EDM empirically identified a subpopulation of patients with DR-TB HIV with dual-adherence challenges early in treatment. Mixed-methods revealed intense psychosocial, behavioral, and structural barriers to care in this subpopulation. Our data support developing differential, patient-centered, adherence support interventions focused on psychosocial and structural challenges for subpopulations of at-risk DR-TB HIV patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1557","type":"journal-article","created":{"date-parts":[[2020,10,10]],"date-time":"2020-10-10T04:29:39Z","timestamp":1602304179000},"page":"e1901-e1910","source":"Crossref","is-referenced-by-count":26,"title":["Electronic Dose Monitoring Identifies a High-Risk Subpopulation in the Treatment of Drug-resistant Tuberculosis and Human Immunodeficiency Virus"],"prefix":"10.1093","volume":"73","author":[{"given":"Jennifer R","family":"Zelnick","sequence":"first","affiliation":[{"name":"Graduate School of Social Work, Touro College and University System, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrita","family":"Daftary","sequence":"additional","affiliation":[{"name":"Dahdaleh Institute of Global Health Research, School of Global Health, York University, Toronto, Canada"},{"name":"Center for the AIDS Programme of Research in South Africa, Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit (CAPRISA MRC-HIV-TB), Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy S","family":"Labar","sequence":"additional","affiliation":[{"name":"Vagelos College of Physician and Surgeons, Columbia University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Resha","family":"Boodhram","sequence":"additional","affiliation":[{"name":"Center for the AIDS Programme of Research in South Africa, Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit (CAPRISA MRC-HIV-TB), Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavna","family":"Maharaj","sequence":"additional","affiliation":[{"name":"Center for the AIDS Programme of Research in South Africa, Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit (CAPRISA MRC-HIV-TB), Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison K","family":"Wolf","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinjini","family":"Mondal","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, McGill University, Montreal, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K Rivet","family":"Amico","sequence":"additional","affiliation":[{"name":"University of Michigan School of Public Health, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Orrell","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boitumelo","family":"Seepamore","sequence":"additional","affiliation":[{"name":"University of Kwazulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Friedland","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesri","family":"Padayatchi","sequence":"additional","affiliation":[{"name":"Center for the AIDS Programme of Research in South Africa, Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit (CAPRISA MRC-HIV-TB), Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max R","family":"O\u2019Donnell","sequence":"additional","affiliation":[{"name":"Center for the AIDS Programme of Research in South Africa, Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit (CAPRISA MRC-HIV-TB), Durban, South Africa"},{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA"},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"2021100522425131000_CIT0001","volume-title":"Global tuberculosis report 2019","author":"World Health Organization","year":"2019"},{"key":"2021100522425131000_CIT0002","doi-asserted-by":"crossref","first-page":"90","DOI":"10.5588\/ijtld.11.0153","article-title":"Risk factors for mortality among MDR-and XDR-TB patients in a high HIV prevalence setting","volume":"16","author":"Gandhi","year":"2012","journal-title":"Int J Tuberc Lung Dis"},{"key":"2021100522425131000_CIT0003","doi-asserted-by":"crossref","first-page":"416","DOI":"10.3201\/eid1903.120998","article-title":"Treatment outcomes for extensively drug-resistant tuberculosis and HIV co-infection","volume":"19","author":"O\u2019Donnell","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"2021100522425131000_CIT0004","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S2213-2600(18)30235-2","article-title":"Effect of bedaquiline on mortality in South African patients with drug-resistant tuberculosis: a retrospective cohort study","volume":"6","author":"Schnippel","year":"2018","journal-title":"Lancet Respir Med"},{"key":"2021100522425131000_CIT0005","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S2213-2600(18)30280-7","article-title":"Bedaquiline use in South Africa reveals a lifesaving policy in action","volume":"6","author":"Reuter","year":"2018","journal-title":"Lancet Respir Med"},{"key":"2021100522425131000_CIT0006","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1097\/QAD.0000000000001476","article-title":"Individualized antiretroviral therapeutic approaches: less can be more","volume":"31","author":"Katlama","year":"2017","journal-title":"AIDS"},{"key":"2021100522425131000_CIT0007","first-page":"155","volume-title":"HIV prevention, diagnosis, treatment and care for key populations (2016 update)","author":"World Health Organization","year":"2016"},{"key":"2021100522425131000_CIT0008","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1093\/cid\/ciy309","article-title":"Depression and anxiety as risk factors for delayed care-seeking behavior in human immunodeficiency virus\u2013infected Individuals in South Africa","volume":"67","author":"Rane","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2021100522425131000_CIT0009","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1186\/s12879-019-4317-4","article-title":"Treatment outcomes and antiretroviral uptake in multidrug-resistant tuberculosis and HIV co-infected patients in Sub Saharan Africa: a systematic review and meta-analysis","volume":"19","author":"Chem","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2021100522425131000_CIT0010","doi-asserted-by":"crossref","first-page":"e238","DOI":"10.1371\/journal.pmed.0040238","article-title":"Patient adherence to tuberculosis treatment: a systematic review of qualitative research","volume":"4","author":"Munro","year":"2007","journal-title":"PLoS Med"},{"key":"2021100522425131000_CIT0011","doi-asserted-by":"crossref","first-page":"e0147397","DOI":"10.1371\/journal.pone.0147397","article-title":"Psycho-socio-economic issues challenging multidrug resistant tuberculosis patients: a systematic review","volume":"11","author":"Thomas","year":"2016","journal-title":"PLoS One"},{"key":"2021100522425131000_CIT0012","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12889-019-8035-z","article-title":"\u201cA very humiliating illness\u201d: a qualitative study of patient-centered care for rifampicin-resistant tuberculosis in South Africa","volume":"20","author":"Furin","year":"2020","journal-title":"BMC Public Health"},{"key":"2021100522425131000_CIT0013","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1080\/17441692.2014.934266","article-title":"Preferential adherence to antiretroviral therapy over tuberculosis treatment: a qualitative study of drug-resistant TB\/HIV co-infected patients in South Africa","volume":"9","author":"Daftary","year":"2014","journal-title":"Glob Public Health"},{"key":"2021100522425131000_CIT0014","doi-asserted-by":"crossref","first-page":"e1002595","DOI":"10.1371\/journal.pmed.1002595","article-title":"Adherence interventions and outcomes of tuberculosis treatment: a systematic review and meta-analysis of trials and observational studies","volume":"15","author":"Alipanah","year":"2018","journal-title":"PLoS Med"},{"key":"2021100522425131000_CIT0015","doi-asserted-by":"crossref","first-page":"430","DOI":"10.5588\/ijtld.15.0360","article-title":"Re-inventing adherence: toward a patient-centered model of care for drug-resistant tuberculosis and HIV","volume":"20","author":"O\u2019Donnell","year":"2016","journal-title":"Int J Tuberc Lung Dis"},{"key":"2021100522425131000_CIT0016","doi-asserted-by":"crossref","first-page":"e122","DOI":"10.2196\/mhealth.9031","article-title":"Acceptability and feasibility of real-time antiretroviral therapy adherence interventions in rural Uganda: mixed-method pilot randomized controlled trial","volume":"6","author":"Musiimenta","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"key":"2021100522425131000_CIT0017","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1007\/s10461-010-9799-4","article-title":"Real-time adherence monitoring for HIV antiretroviral therapy","volume":"14","author":"Haberer","year":"2010","journal-title":"AIDS Behav"},{"key":"2021100522425131000_CIT0018","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1186\/s13063-020-04324-z","article-title":"Electronic pillbox-enabled self-administered therapy versus standard directly observed therapy for tuberculosis medication adherence and treatment outcomes in Ethiopia (SELFTB): protocol for a multicenter randomized controlled trial","volume":"21","author":"Manyazewal","year":"2020","journal-title":"Trials"},{"key":"2021100522425131000_CIT0019","doi-asserted-by":"crossref","first-page":"e001018","DOI":"10.1136\/bmjgh-2018-001018","article-title":"Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities","volume":"3","author":"Subbaraman","year":"2018","journal-title":"BMJ Glob Health"},{"key":"2021100522425131000_CIT0020","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1186\/s12879-018-3080-2","article-title":"Pilot evaluation of a second-generation electronic pill box for adherence to bedaquiline and antiretroviral therapy in drug-resistant TB\/HIV co-infected patients in KwaZulu-Natal, South Africa","volume":"18","author":"Bionghi","year":"2018","journal-title":"BMC Infect Dis"},{"key":"2021100522425131000_CIT0021","doi-asserted-by":"crossref","first-page":"e201","DOI":"10.1016\/S2352-3018(19)30035-9","article-title":"Antiretroviral switching and bedaquiline treatment of drug-resistant tuberculosis HIV co-infection","volume":"6","author":"O\u2019Donnell","year":"2019","journal-title":"Lancet HIV"},{"key":"2021100522425131000_CIT0022","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1146\/annurev.soc.22.1.129","article-title":"Focus groups","volume":"22","author":"Morgan","year":"1996","journal-title":"Annu Rev Sociol"},{"key":"2021100522425131000_CIT0023","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1086\/507526","article-title":"Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression","volume":"43","author":"Bangsberg","year":"2006","journal-title":"Clin Infect Dis"},{"key":"2021100522425131000_CIT0024","article-title":"The importance of adherence in tuberculosis treatment clinical trials and its relevance in explanatory and pragmatic trials","volume":"16:e1002884","author":"Vernon","year":"2019","journal-title":"PLoS Med"},{"key":"2021100522425131000_CIT0025","first-page":"887","article-title":"Focus groups: strategic articulations of pedagogy, politics, and inquiry.","volume-title":"The Sage handbook of qualitative research","author":"Kamberelis","year":"2005","edition":"3"},{"key":"2021100522425131000_CIT0026","volume-title":"Qualitative interviewing: the art of hearing data","author":"Rubin","year":"2004","edition":"2"},{"key":"2021100522425131000_CIT0027","doi-asserted-by":"crossref","DOI":"10.4135\/9781848608191","volume-title":"Qualitative research practice","author":"Seale","year":"2004"},{"key":"2021100522425131000_CIT0028","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"key":"2021100522425131000_CIT0029","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1080\/09540121.2015.1046417","article-title":"Social support and mental health among adults prior to HIV counseling and testing in Durban, South Africa","volume":"27","author":"Drain","year":"2015","journal-title":"AIDS Care"},{"key":"2021100522425131000_CIT0030","doi-asserted-by":"crossref","first-page":"852","DOI":"10.5588\/ijtld.16.0584","article-title":"Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic","volume":"21","author":"Sweetland","year":"2017","journal-title":"Int J Tuberc Lung Dis"},{"key":"2021100522425131000_CIT0031","doi-asserted-by":"crossref","first-page":"73","DOI":"10.5588\/ijtld.19.0080","article-title":"The impact of alcohol use on tuberculosis treatment outcomes: a systematic review and meta-analysis","volume":"24","author":"Ragan","year":"2020","journal-title":"Int J Tuberc Lung Dis"},{"key":"2021100522425131000_CIT0032","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11469-017-9769-4","article-title":"Criterion validity of self-reports of alcohol, cannabis, and methamphetamine use among young men in Cape Town, South Africa","volume":"16","author":"Arfer","year":"2018","journal-title":"Int J Ment Health Addict"},{"key":"2021100522425131000_CIT0033","volume-title":"South Africa: universal disability grant","author":"Strijdom","year":"2016"},{"key":"2021100522425131000_CIT0034","doi-asserted-by":"crossref","first-page":"64","DOI":"10.7448\/IAS.18.2.19408","article-title":"Adolescent girls and young women: key populations for HIV epidemic control","volume":"18","author":"Dellar","year":"2015","journal-title":"J Int AIDS Soc"},{"key":"2021100522425131000_CIT0035","volume-title":"Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations\u20142016 update","author":"World Health Organization","year":"2016"},{"key":"2021100522425131000_CIT0036","doi-asserted-by":"crossref","first-page":"e560","DOI":"10.1016\/S2352-3018(18)30148-6","article-title":"The cascade of HIV care among key populations in Indonesia: a prospective cohort study","volume":"5","author":"Januraga","year":"2018","journal-title":"Lancet HIV"},{"key":"2021100522425131000_CIT0037","doi-asserted-by":"crossref","first-page":"e1002444","DOI":"10.1371\/journal.pmed.1002444","article-title":"HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: results from a prospective observational demonstration project","volume":"14","author":"Eakle","year":"2017","journal-title":"PLoS Med"},{"key":"2021100522425131000_CIT0038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/QAI.0000000000001632","article-title":"Using contact patterns to inform HIV interventions in persons who inject drugs in Northern Vietnam","volume":"78","author":"Smith","year":"2018","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2021100522425131000_CIT0039","first-page":"649","article-title":"Risk factors associated with default from multidrug-resistant tuberculosis treatment, South Africa, 1999\u20132001","volume":"10","author":"Holtz","year":"2006","journal-title":"Int J Tuberc Lung Dis"},{"key":"2021100522425131000_CIT0040","doi-asserted-by":"crossref","first-page":"34","DOI":"10.5588\/ijtld.17.0062","article-title":"Depressive symptoms and hazardous\/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho","volume":"21","author":"Hayes-Larson","year":"2017","journal-title":"Int J Tuberc Lung Dis"},{"key":"2021100522425131000_CIT0041","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s00127-019-01669-y","article-title":"Major depression and household food insecurity among individuals with multidrug-resistant tuberculosis (MDR-TB) in South Africa","volume":"54","author":"Tomita","year":"2019","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"2021100522425131000_CIT0042","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5588\/pha.17.0114","article-title":"Training social workers to enhance patient-centered care for drug-resistant TB-HIV in South Africa","volume":"8","author":"Zelnick","year":"2018","journal-title":"Public Health Action"},{"key":"2021100522425131000_CIT0043","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01030-2018","article-title":"Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review","volume":"53","author":"Law","year":"2019","journal-title":"Eur Respir J"},{"key":"2021100522425131000_CIT0044","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/QAD.0b013e3282f366ff","article-title":"Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance","volume":"22","author":"Gardner","year":"2008","journal-title":"AIDS"},{"key":"2021100522425131000_CIT0045","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/s13643-019-1210-6","article-title":"Differentiated models of service delivery for antiretroviral treatment of HIV in sub-Saharan Africa: a rapid review protocol","volume":"8","author":"Long","year":"2019","journal-title":"Syst Rev"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaa1557\/37554580\/ciaa1557.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/7\/e1901\/40511613\/ciaa1557.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/7\/e1901\/40511613\/ciaa1557.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T00:41:17Z","timestamp":1633740077000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/73\/7\/e1901\/5923372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,14]]},"references-count":45,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2020,10,14]]},"published-print":{"date-parts":[[2021,10,5]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa1557","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,10,1]]},"published":{"date-parts":[[2020,10,14]]}}}