02742nas a2200433   4500000000100000008004100001260001300042653001000055653002000065653002600085653001500111653001600126653002700142653001100169653003400180653001900214653001100233653001000244653002400254653000900278653001600287653002300303653002500326653001800351653001900369653003800388100001600426700001300442700001400455700001700469700001100486700001500497245010600512300001400618490000700632050001900639520163600658022001402294       2013                            d  c2013 Sep10aAdult10aAnti-HIV Agents10aAntitubercular Agents10aCaregivers10aCoinfection10aFamily Characteristics10aFemale10aHealth Services Accessibility10aHIV Infections10aHumans10aIndia10aInterviews as Topic10aMale10aMiddle Aged10aPatient Compliance10aQualitative Research10aSocial stigma10aSocial Support10aTuberculosis, Multidrug-Resistant1 aIsaakidis P1 aRangan S1 aPradhan A1 aLadomirska J1 aReid T1 aKielmann K00a'I cry every day': experiences of patients co-infected with HIV and multidrug-resistant tuberculosis.  a1128-11330 v18  aISAAKIDIS 20133 a<p><b>OBJECTIVES: </b>To understand patients' challenges in adhering to treatment for MDR-TB/HIV co-infection within the context of their life circumstances and access to care and support.</p><p><b>METHODS: </b>Qualitative study using in-depth interviews with 12 HIV/MDR-TB co-infected patients followed in a Médecins Sans Frontières (MSF) clinic in Mumbai, India, five lay caregivers and ten health professionals. The data were thematically analysed along three dimensions of patients' experience of being and staying on treatment: physiological, psycho-social and structural.</p><p><b>RESULTS: </b>By the time patients and their families initiate treatment for co-infection, their financial and emotional resources were often depleted. Side effects of the drugs were reported to be severe and debilitating, and patients expressed the burden of care and stigma on the social and financial viability of the household. Family caregivers were crucial to maintaining the mental and physical health of patients, but reported high levels of fatigue and stress. Médecins Sans Frontières providers recognised that the barriers to patient adherence were fundamentally social, rather than medical, yet were limited in their ability to support patients and their families.</p><p><b>CONCLUSIONS: </b>The treatment of MDR-TB among HIV-infected patients on antiretroviral therapy is hugely demanding for patients, caregivers and families. Current treatment regimens and case-holding strategies are resource intensive and require high levels of support from family and lay caregivers to encourage patient adherence and retention in care.</p>  a1365-3156