What use is a clinical case definition for AIDS in Africa?

Gilks, C.

doi:10.1136/bmj.303.6811.1189

Cited by 25 publications

(5 citation statements)

References 14 publications

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“…The World Health Organization’s Clinical Staging System for HIV/AIDS was revised in 2005 and has a sensitivity of 51–52% and specificity of 68–88% in predicting CD4 count of <200 cells/mm 3 ( Kagaayi et al 2007 ; Jaffar et al 2008 ). However, it was initially designed as a specific and low-cost means of diagnosing patients with AIDS prior to the widespread availability of point of care diagnostic HIV tests ( Gilks 1990 ). Our quantitative and qualitative data show that a simplified clinical staging approach to ART eligibility assessment that can be utilized in primary care may be required to ensure that patients are managed appropriately.…”

Section: Discussionmentioning

confidence: 99%

Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi*

MacPherson

Lalloo

Choko

et al. 2012

Tropical Med Int Health

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ObjectiveTo understand reasons for suboptimal and delayed uptake of antiretroviral therapy (ART) by describing the patterns of HIV testing and counselling (HTC) and outcomes of ART eligibility assessments in primary clinic attendees.MethodsAll clinic attendances and episodes of HTC were recorded at two clinics in Blantyre. A cohort of newly diagnosed HIV-positive adults (>15 years) was recruited and exit interviews undertaken. Logistic regression models were constructed to investigate factors associated with referral to start ART. Qualitative interviews were conducted with providers and patients.ResultsThere were 2398 episodes of HTC during 18 021 clinic attendances (13.3%) between January and April 2011. The proportion of clinic attendees undergoing HTC was lowest in non-pregnant women (6.3%) and men (8.5%), compared with pregnant women (47.2%). Men had more advanced HIV infection than women (79.7% WHO stage 3 or 4 vs. 56.4%). Problems with WHO staging and access to CD4 counts affected ART eligibility assessments; only 48% completed ART eligibility assessment, and 54% of those reporting WHO stage 3/4 illnesses were not referred to start ART promptly. On multivariate analysis, HIV-positive pregnant women were significantly less likely to be referred directly for ART initiation (adjusted OR: 0.29, 95% CI: 0.13–0.63).ConclusionsThese data show that provider-initiated testing and counselling (PITC) has not yet been fully implemented at primary care clinics. Suboptimal ART eligibility assessments and referral (reflecting the difficulties of WHO staging in primary care) mean that simplified eligibility assessment tools are required to reduce unnecessary delay and attrition in the pre-ART period. Simplified initiation criteria for pregnant women, as being introduced in Malawi, should improve linkage to ART.

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Section: Discussionmentioning

confidence: 99%

Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi*

MacPherson

Lalloo

Choko

et al. 2012

Tropical Med Int Health

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“…A clinical diagnosis of AIDS is made if an individual presents with two major symptoms (extreme weight loss, chronic diarrhea, and prolonged fever) and one minor symptom (persistent cough, skin rash, herpes zoster, Candida, herpes simplex, and lymph node disease). Though this definition has its limitations (Colebunders et al, 1987; Gilks, 1991; Wabwire-Mangen et al, 1989; Widi-Wirski et al, 1988), it is still used where HIV testing is unavailable (as in this study).…”

Section: Methodsmentioning

confidence: 99%

Reliability and validity of two HIV/AIDS-specific quality of life instruments adapted for use in HIV-positive Zimbabweans

et al. 2009

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We sought to assess the reliability and construct validity of the HIV/AIDS-Targeted Quality of Life instrument (HAT-QoL) and the Medical Outcomes Study HIV Health Survey (MOS-HIV) adapted for use in Shona-speaking rural Zimbabwe. HAT-QoL and MOS-HIV were translated and culturally adapted into Shona, and administered to a convenience-sample of 400 patients with HIV-related opportunistic infections. HIV disease severity and bereavement history were assessed. Factor analysis of the HAT-QoL items produced seven factors that were nearly identical to the factor structure reported for an American sample that was the basis for the current HAT-QoL scales. Factor analysis of the MOS-HIV scales resulted in a single factor, not the expected two-factor structure (physical and mental). Convergent and discriminant validity assessments confirmed, in general, that similar Shona HAT-QoL and MOS-HIV dimensions were correlated and dissimilar ones not correlated. Construct validity assessments indicated that, on the whole, most Shona HAT-QoL and MOS-HIV dimensions were capturing anticipated subgroup differences. The exceptions were the Shona MOS-HIV dimensions of general health perceptions, cognitive function, and the quality of life (QoL) item. The reliability and validity of most Shona-adapted HAT-QoL and MOS-HIV dimensions suggest that both instruments are likely useful in measuring the QoL of rural, Shona-speaking populations in Zimbabwe, Mozambique, Zambia, and Botswana.

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“…However, especially for young infants, they fail to replace laboratory tests. 9 Treating children according to their "perceived" HIV status may cause mismanagement and neglect of medical problems or may defer interventions to when their biggest potential has already passed ( Fig. 1).…”

Section: Diagnosis Of Hiv/aids In Childrenmentioning

confidence: 98%

Care and Treatment of HIV-Infected Children in Africa

Baets

Bulterys²,

Abrams³

et al. 2007

The Pediatric Infectious Disease Journal

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More than 90% of pediatric HIV infection occurs in sub-Saharan Africa and 75% of these children currently die before their fifth birthday. Most HIV-infected children in Africa rely on district hospitals for HIV treatment, but insufficient attention has been paid to improving HIV/AIDS care at this level. Considerable confusion exists about optimal use of combination antiretroviral treatment, prophylaxis for opportunistic infections and other rational healthcare interventions that can greatly improve the quality of life for these children. A simple and inexpensive infant HIV diagnostic assay and alternative laboratory markers of pediatric HIV disease progression would be highly beneficial. Routine anthropometric and neurodevelopmental assessments could help guide initiation and monitoring of antiretroviral therapy. Even in the absence of antiretroviral therapy, interventions such as immunizations, provision of micronutrients and nutrition counseling, prevention and treatment of opportunistic as well as endemic infections (such as helminths and malaria) can substantially reduce pediatric HIV-related morbidity and mortality. The need for pain relief, palliative care, counseling and emotional support is often underestimated. Surmounting the sense of hopelessness by providing district healthcare workers with training in basic pediatric HIV/AIDS care is an urgent priority.

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What use is a clinical case definition for AIDS in Africa?

Cited by 25 publications

References 14 publications

Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi*

Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi*

Reliability and validity of two HIV/AIDS-specific quality of life instruments adapted for use in HIV-positive Zimbabweans

Care and Treatment of HIV-Infected Children in Africa

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