Linkage to HIV Care and Antiretroviral Therapy by HIV Testing Service Type in Central Mozambique

Gerdts, Sarah E.; Wagenaar, Bradley H.; Micek, Mark A.; Farquhar, Carey; Kariaganis, Marina; Amos, Juvenal; Gimbel, Sarah; Pfeiffer, James; Gloyd, Stephen; Sherr, Kenneth

doi:10.1097/qai.0000000000000081

Cited by 16 publications

(19 citation statements)

References 27 publications

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“…Retention rates in this cohort after 6 and 12 months were similar to some other studies [16], but higher than in the majority of comparable investigations: Peltzer et al, or Fox and Rosen found an all-cause attrition rate double as high in their South African cohorts [18,24]. According to UNAIDS, there is considerable variation in reported retention rates among countries, but data from 18 countries showed that 12-month retention rates averaged 86% [1], similar to the rate found in our Ugandan cohort.…”

Section: Discussionsupporting

confidence: 91%

“…This has also been discussed as an explanation for women enrolling into ART services at earlier disease stages than men, as frequently described in previous studies [10,11,16]. Generally, in low-and middleincome countries, one in four people who initiate ART present at late disease stage with CD4-cell counts below 100 cells/mm³ [1].…”

Section: Discussionmentioning

confidence: 87%

“…Yet, indisputably, reproductive health services focus on girls and women more than on men and offer multiple possibilities of testing women´s HIV status, which their male counterparts might not find so easily. Hence, delayed HIV diagnosis and treatment often results from lack of male access to testing, and there is a pressing need to discuss how testing facilities and opportunities can be made more widely available outside of reproductive health services [16,19]. Sekandi et al showed that door-to-door home-based testing is acceptable and feasible and can increase the reach of HIV testing services in Uganda [20].…”

Section: Discussionmentioning

confidence: 99%

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Antiretroviral Therapy Programme Retention and Outcomes after 12 Months in a Retrospective Patient Cohort in Fort Portal, Uganda: The Ongoing Challenge of Male ART Performance

Mugenyi¹

2015

J AIDS Clin Res

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Background: Antiretroviral therapy (ART) programmes have been extensively scaled-up in countries like Uganda. While success of these programmes largely depends on lasting patient retention, attrition rates are often especially high in the first year after treatment initiation. Our study aimed at analysing recent data of a Ugandan ART patient cohort regarding 12 months ART outcomes and programme retention. Methods: Virika Hospital in Fort Portal, Western Uganda, is offering ART services according to national treatment standards. A routinely collected patient monitoring database was used for retrospective analysis, following-up 369 patients for 12 months after enrolment. Primary outcome indicator was 12 months retention (being alive and active in programme). We assessed clinical ART progress, attrition, mortality and influencing factors, particularly gender differences. Results: From 369 ART patients, two-thirds were female. Overall ART outcomes and adherence in this cohort were satisfying, but in men, improvement of CD4-cell counts and weight gain after 12 months were significantly lower than in female patients. In total, one in eight patients (12.2%) was subject to all-cause attrition after 12 months. We identified low CD4-cell count at ART enrolment as the only independent risk factor for attrition after 12 months (p=0.037), while male patients were at highest risk for this, showing significantly lower CD4-cell counts at ART initiation (p=0.008). Conclusion: We found overall outcomes of this ART programme encouraging, however, attention must be paid particularly to male ART patients. Men were underepresented in our cohort, enrolled in the ART programme at later disease stage, and showed worse ART outcomes after 12 months. Our data suggests that the known challenge of male ART performance is persisting, and that it has not sufficiently been addressed in the past years. Especially the problem of male late-presenters in ART programmes should lead to action in health services planning and implementation, for example by offering more HIV testing opportunities to men. J o ur nal o f A ID S & Cli n ic a l R es earc h

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Antiretroviral Therapy Programme Retention and Outcomes after 12 Months in a Retrospective Patient Cohort in Fort Portal, Uganda: The Ongoing Challenge of Male ART Performance

Mugenyi¹

2015

J AIDS Clin Res

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“…23 In 2013, the Ministry of Health (MOH) began its national rollout of Option B+ services to streamline PMTCT services and increase ART coverage. 24 Maternal and child health (MCH) nurses were trained to manage ART through the postpartum period.…”

Section: Introductionmentioning

confidence: 99%

Option B+ in Mozambique: Formative Research Findings for the Design of a Facility-Level Clustered Randomized Controlled Trial to Improve ART Retention in Antenatal Care

Napua

Pfeiffer

Chale

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction:With the rollout of “Option B+” in Mozambique in 2013, initial data indicated major challenges to early retention in antiretroviral therapy (ART) among HIV-positive pregnant women. We sought to develop and test a pilot intervention in 6 large public clinics in central Mozambique to improve retention of mothers starting ART in antenatal care. The results from the formative research from this study described here were used to design the intervention.Methods:The research was initiated in early 2013 and completed in early 2014 in each of the 6 study clinics and consisted of (1) patient flow mapping and measurement of retention through collection of health systems data from antenatal care registries, pharmacy registries, ART clinic databases, (2) workforce assessment and measurement of patient waiting times, and (3) patient and worker individual interviews and focus groups.Results:Coverage of HIV testing and ART initiation were over 90% at all sites, but retention at 30-, 60-, and 90-day pharmacy refill visits was very low ranging from only 5% at 1 site to 30% returning at 90 days. These data revealed major systemic bottlenecks that contributed to poor adherence and retention in the first month after ART initiation. Long wait times, short consultations, and poor counseling were identified as barriers.Conclusions:Based on these findings, we designed an intervention with these components: (1) workflow modification to redefine nurse tasks, shift tasks to community health workers, and enhance patient tracking and (2) an adherence and retention package to systematize active patient follow-up, ensure home visits by community health workers, use text messaging, and intensify counseling by health staff. This intervention is currently under evaluation using a stepped wedge design.

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“…Poor links with ongoing care is a challenge in many settings [8], especially when the mother is reluctant to accept or disclose her HIV diagnosis [9]. However, it is imperative that systems are put in place to retain HIV-exposed babies in care, to optimize PMTCT efforts and to initiate ART as early as possible in the event that the baby becomes HIV infected [10].…”

Section: Discussionmentioning

confidence: 99%

TB Presenting as Recurrent Pneumonia in a HIV-Infected Infant in Central Viet Nam

Nguyen

et al. 2018

Reports

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Abstract:We report on a six-month-old infant admitted to our intensive care unit (ICU) with recurrent severe pneumonia. The mother was infected with human immunodeficiency virus (HIV)-infected, but initially failed to disclose this to doctors. Neither did she report the grandmother of the child's chronic coughing, likely due to tuberculosis (TB). The infant was diagnosed with X-pert MTB/RIF ® confirmed TB and tested positive for HIV infection. Once a correct diagnosis was established, the child demonstrated good recovery with appropriate TB and antiretroviral treatment (ART). The case demonstrates the importance of including TB in the differential diagnosis for young children not responding to first-line pneumonia treatment, especially in TB endemic areas. Taking a meticulous TB and HIV exposure history, with careful consideration of potential social stigma, is essential. It also demonstrates how the inaccessibility of HIV results and the absence of a continuous patient record may jeopardize patient care.Keywords: tuberculosis; Mycobacterium tuberculosis; infant; HIV; opportunistic infection Case ReportWe admitted a six-month-old girl to the Da Nang Hospital for Women and Children, a provincial referral hospital in central Viet Nam, with a diagnosis of recurrent severe pneumonia. She was discharged from the same hospital two days earlier, but developed a fever with associated heavy breathing at home. On admission, she weighed 5.5 kg and her vital signs were temperature 39 • C, breathing rate 80/min, heart rate 135 beats/min and peripheral oxygen saturation (SpO 2 ) 88% in air; 95% with high flow nasal oxygen.On examination, she was alert, but malnourished with visible chest indrawing. On physical examination she had extensive white plaques in her mouth, suggestive of oral thrush, and hepatosplenomegaly. On auscultation she had symmetric air entry with normal vesicular breathing and no abnormal breath sounds. She was admitted to the intensive care unit (ICU) for intravenous (IV) antibiotics (ceftazidime and gentamycin) and oxygen supplementation. Initial laboratory investigations revealed an abnormal full blood count (hemoglobin: 8.7 g/dL; white blood cells: 10.5 ×

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Linkage to HIV Care and Antiretroviral Therapy by HIV Testing Service Type in Central Mozambique

Cited by 16 publications

References 27 publications

Antiretroviral Therapy Programme Retention and Outcomes after 12 Months in a Retrospective Patient Cohort in Fort Portal, Uganda: The Ongoing Challenge of Male ART Performance

Antiretroviral Therapy Programme Retention and Outcomes after 12 Months in a Retrospective Patient Cohort in Fort Portal, Uganda: The Ongoing Challenge of Male ART Performance

Option B+ in Mozambique: Formative Research Findings for the Design of a Facility-Level Clustered Randomized Controlled Trial to Improve ART Retention in Antenatal Care

TB Presenting as Recurrent Pneumonia in a HIV-Infected Infant in Central Viet Nam

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