HIV and TB: Drug Resistance and Clinical Management Case Book - a book co-authored by two academics from the Africa Centre for Health and Population Studies - has been presented to frontline health workers at a workshop in northern KwaZulu-Natal.

The Centre's Dr Richard Lessells and Dr Tulio de Oliveira wrote the book with the University of Pretoria's Dr Theresa Rossouw.

According to de Oliveira, the aim of the book was to create awareness and understanding of the issues related to the management of HIV and TB drug resistance. 'We felt this is important given the increasingly complex case mix facing frontline health care workers in South Africa with the rapid scale-up of antiretroviral therapy and the ongoing epidemic of drug-resistant TB.'

'Among the top challenges of the HIV and TB epidemics are issues related to patient adherence to their antiretroviral and anti-TB drug regimens and the absence of reliable tools to measure adherence,' said de Oliveira.

The workshop was attended by 52 clinicians, senior nurses and pharmacists based in five hospitals in the uMkhanyakude District. Also present were HIV and TB specialists from the Africa Centre, the Centre for the AIDS Programme of Research in South Africa (CAPRISA), King Edward VIII Hospital in Durban, and representatives from Botswana.

The event facilitated a discussion of common clinical management challenges related to the management of HIV and TB drug resistance and treatment failure within a rural district with a huge dual burden of HIV and TB. The factors that contribute to suboptimal adherence were explored in group discussion sessions and the importance of thinking beyond patient factors and thinking more broadly about health system factors and community factors were emphasised.

The complexities of the management of co-infections, especially involving multidrug-resistant and extensively drug-resistant TB (pulmonary and extra-pulmonary) and HIV with high-level resistance to the standard first-line regimens, were also discussed. All these challenges were explored in the context of primary health care clinics and district hospitals where there are still critical shortages of human resources and limited access to advanced diagnostic and monitoring facilities.

Dr Hervey Vaughan-Williams, District Family Physician at the uMkhanyakude Health District Office, said: 'I think it was a great success on a number of levels, not least the number of District staff attracted to attend. Gatherings such as these are valuable both for District staff education and bonding between institutions, which is invaluable in times of stress or crisis, as well as enriching the working environment.'

A total of 250 copies of the book, published by the Medical Research Council (MRC), were given free-of-charge to the five hospitals to be distributed to clinicians; nurses and pharmacists involved in managing HIV and TB cases at the hospitals and primary health care clinics.

'The book is a compilation of informative clinical cases from South Africa that together highlight some of the major challenges that clinicians face in the management of HIV and TB drug resistance and that also illustrate some of the important lessons to be learnt in trying to limit the spread of drug resistance in our programmes and communities,' said de Oliveira.

The book was published under an open source licence and is thus freely available in print and also in electronic form at the Southern African Treatment Resistance Network (SATuRN) website ( The free distribution of the book was made possible through the generous support of the European Commission, CDC and the Wellcome Trust.

The HIV & TB Drug Resistance Clinical Management Case Book is free for download at our website

News date: 2013-03-16


Publication cited

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