{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:06:10Z","timestamp":1789596370058,"version":"build-2803163510"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T00:00:00Z","timestamp":1648598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI124413"],"award-info":[{"award-number":["R01AI124413"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI145679"],"award-info":[{"award-number":["R01AI145679"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001873"],"award-info":[{"award-number":["UL1TR001873"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Einstein-Rockefeller-"},{"name":"CUNY CFAR","award":["P30AI124414"],"award-info":[{"award-number":["P30AI124414"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Medication adherence is known to challenge treatment of human immunodeficiency virus (HIV)\/AIDS and multidrug-resistant tuberculosis (MDR-TB). We hypothesized that adherence using electronic dose monitoring (EDM) would identify an antiretroviral therapy (ART) adherence threshold for emergent ART resistance and predict treatment outcomes in patients with MDR-TB and HIV on ART and bedaquiline-containing TB regimens.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A prospective cohort of adults with MDR-TB and HIV on ART and initiating MDR-TB treatment with bedaquiline were enrolled at a public hospital in KwaZulu-Natal, South Africa (PRAXIS Study). Participants received separate EDM devices that measure adherence to bedaquiline and ART (nevirapine or lopinavir\/ritonavir). Adherence was calculated cumulatively over 6 months. Participants were followed through completion of MDR-TB treatment. HIV genome sequencing was performed at baseline and 2 and 6 months on samples with HIV RNA \u22651000 copies\/mL.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From November 2016 through February 2018, 198 persons with MDR-TB and HIV were enrolled and followed (median, 17.2 months; interquartile range, 12.2\u201319.6). Eleven percent had baseline ART resistance mutations, and 7.5% developed emergent ART resistance at 6 months. ART adherence was independently associated with ART resistance and mortality. Modeling identified a significant (P &amp;lt; .001), linear association between ART adherence and emergent resistance, suggesting a strong association without a specific threshold.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our findings highlight the need for ART resistance testing, especially in patients with MDR-TB and HIV, which is currently not the standard of care in resource-limited settings. Despite short follow-up duration, reduced ART adherence was significantly associated with emergent resistance and increased mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration<\/jats:title>\n                  <jats:p>NCT03162107.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciac232","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T11:08:33Z","timestamp":1648465713000},"page":"1489-1496","source":"Crossref","is-referenced-by-count":19,"title":["Adherence Measured Using Electronic Dose Monitoring is Associated with Emergent Antiretroviral Resistance and Poor Outcomes in People with Human Immunodeficiency Virus\/AIDS and Multidrug-Resistant Tuberculosis"],"prefix":"10.1093","volume":"75","author":[{"given":"Mark","family":"Bateman","sequence":"first","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center , New York, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Wolf","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center , New York, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Chimukangara","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Department, National Institutes of Health Clinical Center , Bethesda, Maryland , USA"},{"name":"Centre for the AIDS Programme of Research in South Africa Medical Reseach Council - Human Immunodeficiency Virus - Tuberculosis Pathogenesis and Treatment Research Unit , Durban , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C M","family":"Brust","sequence":"additional","affiliation":[{"name":"Department of Medicine, Albert Einstein College of Medicine , New York, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Lessells","sequence":"additional","affiliation":[{"name":"KwaZulu-Natal Research Innovation and Sequencing Platform, School of Laboratory Medicine & Medical Sciences, University of KwaZulu-Natal , Durban , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rivet","family":"Amico","sequence":"additional","affiliation":[{"name":"Department of Health Behavior & Health Education, School of Public Health, University of Michigan , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Resha","family":"Boodhram","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa Medical Reseach Council - Human Immunodeficiency Virus - Tuberculosis Pathogenesis and Treatment Research Unit , Durban , South 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