Operational assessment of access to ART in rural Africa: the example of Kisantu in Democratic Republic of the Congo

Rompaey, Sara Van; Kimfuta, Jacques; Kimbondo, Pierre; Monn, Cecilia; Buvé, Anne

doi:10.1080/09540121.2010.532538

Cited by 10 publications

(5 citation statements)

References 6 publications

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“…This proportion is too low and indicates delays. Other studies from SSA [5], [13], [14], [18] reported that between 67% [14] and 86% [18] of eligible patients started ART within 3 to 6 months. If we restrict our analysis to those who are eligible based on the criterion used in most other studies (<200 cells/mm 3 ), [5], [13], [19] only 22% of patients would have been eligible; 68% of these started ART <90 days after diagnosis, which is more in line with other studies done in sub-Saharan Africa.…”

Section: Discussionmentioning

confidence: 97%

Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers

Kayigamba¹,

Bakker

Fikse

et al. 2012

PLoS ONE

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IntroductionAccess to antiretroviral therapy (ART) has increased greatly in sub-Saharan Africa. However many patients do not enrol timely into HIV care and treatment after HIV diagnosis. We studied enrolment into care and treatment and determinants of non-enrolment in Rwanda.MethodsData were obtained from routine clinic registers from eight health facilities in Rwanda on patients who were diagnosed with HIV at the antenatal care, voluntary counselling-and-testing, outpatient or tuberculosis departments between March and May 2009. The proportion of patients enrolled into HIV care and treatment was calculated as the number of HIV infected patients registered in ART clinics for follow-up care and treatment within 90 days of HIV diagnosis divided by the total number of persons diagnosed with HIV in the study period.ResultsOut of 482 patients diagnosed with HIV in the study period, 339 (70%) were females, and the median age was 29 years (interquartile range [IQR] 24–37). 201 (42%) enrolled into care and treatment within 90 days of HIV diagnosis. The median time between testing and enrolment was six days (IQR 2–14). Enrolment in care and treatment was not significantly associated with age, sex, or department of testing, but was associated with study site. None of those enrolled were in WHO stage 4. The median CD4 cell count among adult patients was 387 cells/mm3 (IQR: 242–533 cells/mm3); 81 of 170 adult patients (48%) were eligible to start ART (CD4 count<350 cells/mm3 or WHO stage 4). Among those eligible, 45 (56%) started treatment within 90 days of HIV diagnosis.ConclusionLess than 50% of diagnosed HIV patients from eight Rwandan health facilities had enrolled into care and treatment within 90 days of diagnosis. Improving linkage to care and treatment after HIV diagnosis is needed to harness the full potential of ART.

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Section: Discussionmentioning

confidence: 97%

Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers

Kayigamba¹,

Bakker

Fikse

et al. 2012

PLoS ONE

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“…In the neighboring country of Côte d'Ivoire, we had a similar problem of low coverage rate of EID, favored by the civil war, with only 24% of the HIV exposed children early diagnosed in 2010 [24]. In comparison, a study carried out in 2008, showed that DNA polymerase chain reaction testing in routine was 35.2% for children hospitalized in Malawi, but their age was not specified [25].…”

Section: Discussionmentioning

confidence: 99%

Missed Opportunities for Early Access to Care of HIV-Infected Infants in Burkina Faso

et al. 2014

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ObjectiveThe World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso.MethodsWe conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW).ResultsIn 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%–1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW.ConclusionsThe PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou.

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“…Human immunodeficiency virus (HIV) is growing in rural areas, including in sub-Saharan Africa (SSA) [1][2][3][4]. In Ethiopia where 83% of the population is rural, over 37% of the estimated 1.2 million people living with HIV (PLWH) are in rural areas [5].…”

Section: Background: Hiv In Rural Africamentioning

confidence: 99%

Use of Community Health Support Workers for Persons Living With Human Immunodeficiency Virus in Rural Ethiopia: Lessons Learned

Lifson¹,

Workneh

Hailemichael

et al. 2014

J AIDS Clin Res

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Background: Health facilities in rural, resource limited settings face multiple challenges responding to a growing demand for HIV treatment, including lack of adequate numbers of trained health workers. Many programs have used community health support workers (CHSWs) to provide specific services related to HIV care, and to complement facility-based treatment. Methods: In rural southern Ethiopia, 13 HIV-positive CHSWs were assigned to 142 newly diagnosed HIV patients from the same community to provide: education on HIV treatment and health promoting behaviors; counseling and social support; and linkage to the HIV Clinic. Results: Lessons learned in planning and implementing CHSW programs for PLWH include the benefits of: involving local health bureaus, clinicians, and the community; careful recruitment processes and selection criteria for CHSWs; use of local PLWH as CHSWs to facilitate relationships with HIV-positive clients; initial and ongoing training of CHSWs with didactic information and counseling skills; clearly defined responsibilities and regular, supportive supervision with constructive feedback; emphasizing importance of client confidentiality; and financial compensation for CHSWs. Conclusion: Use of CHSWs can be an effective strategy to support the HIV health care system, and offers a strong complement to facility-based care in rural and other resource-limited settings. However, such programs may be most successful if they attend to the multiple issues described above in planning and implementation.

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Operational assessment of access to ART in rural Africa: the example of Kisantu in Democratic Republic of the Congo

Cited by 10 publications

References 6 publications

Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers

Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers

Missed Opportunities for Early Access to Care of HIV-Infected Infants in Burkina Faso

Use of Community Health Support Workers for Persons Living With Human Immunodeficiency Virus in Rural Ethiopia: Lessons Learned

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