Tuberculosis and HIV--Needed: A New Paradigm for the Control and Management of Linked Epidemics

Simon J. Tsiouris, MD, MPH (corresponding author); Neel R. Gandhi, MD; Wafaa M. El-Sadr, MD, MPH; Gerald Friedland, MD

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In This Article

New Ways of Delivering Integrated Care With Nontraditional Healthcare Providers

A critically important issue to both TB and HIV programs is the availability of adequately trained healthcare workers who will be able to provide the breadth of care necessary for TB/HIV coinfected patients. Given the limited number of clinical providers currently available in resource-poor settings, it is necessary to evaluate the feasibility of using nonprofessional healthcare workers to serve in auxiliary roles, such as treatment supporters or directly observed therapy workers, which provide support to patients' adherence efforts and monitoring for adverse reactions for TB/HIV coinfected patients.

These healthcare workers can be drawn from community or family members, who are a rich source of support available in many resource-limited settings.[24] The use of these facilitators and a community care model has been shown to be effective for delivering TB therapy in other resource-limited settings[25,26,27] and may be associated with favorable clinical and virologic outcomes in patients with both TB and HIV disease in need of treatment.[21,28] Efforts are necessary to determine how to effectively and safely adapt these models to serve for the simultaneous treatment of both TB and HIV.

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