Evidence map›Paper›PMID 33053186›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021

Electronic Dose Monitoring Identifies a High-Risk Subpopulation in the Treatment of Drug-resistant Tuberculosis and Human Immunodeficiency Virus.

Jennifer R Zelnick, Amrita Daftary, Christina Hwang, Amy S Labar, Resha Boodhram, Bhavna Maharaj, Allison K Wolf, Shinjini Mondal, K Rivet Amico, Catherine Orrell and 4 more

Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05633056 (Adaptive Evaluation of mHealth and Conventional Adherence Support Interventions to Optimize Outcome With New Treatment Regimens for Drug-resistant Tuberculosis and HIV in South Africa), which is not on this map. Cited by 17 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05633056 narecruitingnot on this mapstarted 2023, after this paper: background citation

Adaptive Evaluation of mHealth and Conventional Adherence Support Interventions to Optimize Outcome With New Treatment Regimens for Drug-resistant Tuberculosis and HIV in South Africa

TypeinterventionalSponsorColumbia UniversityRan2023 to 2029Enrolled360ConditionsMulti Drug Resistant Tuberculosis, HIV InfectionsArmsAdherence support intevention
3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Review
  5. Treatment Adherence With an Oral 9-Month Regimen for Rifampicin-Resistant Tuberculosis in South Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
    Observational
  6. Article
  7. Article
  8. Experiences of key populations in multidrug-resistant TB and HIV.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2025
    Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Observational
  15. Article
  16. Article
  17. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 10 institutions in 3 countries.

Jennifer R ZelnickGraduate School of Social Work, Touro College and University System, New York, New York, USA.
Amrita DaftaryDahdaleh Institute of Global Health Research, School of Global Health, York University, Toronto, Canada.
Christina HwangDepartment of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA.
Amy S LabarVagelos College of Physician and Surgeons, Columbia University, New York, New York, USA.
Resha BoodhramCenter 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.
Bhavna MaharajCenter 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.
Allison K WolfDivision of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York, USA.
Shinjini MondalDepartment of Family Medicine, McGill University, Montreal, Canada.
K Rivet AmicoUniversity of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Catherine OrrellDesmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa.
Boitumelo SeepamoreUniversity of Kwazulu-Natal, Durban, South Africa.
Gerald FriedlandYale School of Medicine, New Haven, Connecticut, USA.
Nesri PadayatchiCenter 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.
Max R O'DonnellCenter 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.
South African Medical Research Council · ZAColumbia University Irving Medical Center · USCentre for Global Health Research · CAColumbia University · USDesmond Tutu HIV Foundation · ZAMcGill University · CATouro College · USUniversity of KwaZulu-Natal · ZAUniversity of Michigan–Ann Arbor · USYale University · US

Funding

Novel Reporter Phages to Detect Complex TB Drug Resistance and PersistenceR01AI114900 · NIAID · ALBERT EINSTEIN COLLEGE OF MEDICINE, INC · PI Michelle H Larsen, Max O'Donnell · 2015 to 2026
$7.2M
Promoting Engagement in the Drug Resistant TB/HIV Care Continuum in South AfricaR01AI124413 · NIAID · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI O'DONNELL, MAX, PADAYATCHI, NESRI · 2016 to 2020
$2.7M
Impact of a multimodal intervention to reduce dual stigma and improve treatment outcomes in HIV/Drug-resistant TB co-infected patients in KwaZulu-Natal, South AfricaR21TW011077 · FIC · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI AMICO, KATHY RIVET, O'DONNELL, MAX · 2018 to 2019
$414k
FIC NIH HHS R21 TW011077NIAID NIH HHS R01 AI114900NIAID NIH HHS R01 AI124413
6 · The paper itself

Abstract

backgroundIn 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.

methodsA 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 (<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.

resultsFrom December 2016-February 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-challenged patients struggled to prioritize treatment and lacked support, and dual-adherence-challenged patients experienced higher rates of detectable HIV viral load and mortality than more adherent patients.

conclusionsEDM 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.

Indexed as

HIV InfectionsTuberculosis, Multidrug-ResistantAntitubercular AgentsElectronicsHIVHumansProspective StudiesSouth AfricaAntitubercular Agentsadherencedrug-resistant TB/HIVmixed-methodsperson-centered careSouth Africa

Identifiers

PMID33053186
PMCPMC8492155
OpenAlexW3092803385

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.