Lessons learned: Retrospective assessment of outcomes and management of patients with advanced HIV disease in a semi-urban polyclinic in Epworth, Zimbabwe.
MetadataShow full item record
AbstractHIV continues to be one of the leading causes of infectious death worldwide and presentation with advanced HIV disease is associated with increased morbidity and mortality. Recommendations for the management of advanced HIV disease include prompt screening and treatment of opportunistic infections, rapid initiation of ART and intensified adherence support. We present treatment outcomes of a cohort of patients presenting with advanced HIV disease in a semi-urban Zimbabwean polyclinic. Retrospective cohort analysis of adult patients enrolled for care at Epworth polyclinic, Zimbabwe between 2007 and end June 2016. Treatment outcomes at 6 and 12 months were recorded. Multivariate logistical regression analysis was undertaken to identify risk factors for presentation with advanced HIV Disease (CD4 count less than 200 cells/mm3 or WHO stage 3 or 4) and risks for attrition at 12 months. 16,007 anti-retroviral therapy naive adult patients were included in the final analysis, 47.4% of whom presented with advanced HIV disease. Patients presenting with advanced HIV disease had a higher mortality rate at 12 months following enrollment compared to early stage patients (5.11% vs 0.45%). Introduction of a package of differentiated care for patients with a CD4 count of less than 100 cells/mm3 resulted in diagnosis of cryptococcal antigenaemia in 7% of patients and a significant increase in the diagnosis of TB, although there was no significant difference in attrition at 6 or 12 months for these patients compared to those enrolled prior to the introduction of the differentiated care. The burden of advanced HIV disease remained high over the study period in this semi-urban polyclinic in Zimbabwe. Introduction of a package of differentiated care for those with advanced HIV disease increased the diagnosis of opportunistic infections and represents a model of care which can be replicated in other polyclinics in the resource constrained Zimbabwean context.
PublisherPublic Library of Science
- Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa.
- Authors: Benzekri NA, Sambou JF, Ndong S, Tamba IT, Faye D, Diallo MB, Diatta JP, Faye K, Sall I, Sall F, Manga NM, Malomar JJ, Ndour CT, Hawes SE, Seydi M, Gottlieb GS
- Issue date: 2019 Mar 15
- Characteristics and outcomes of adult Ethiopian patients enrolled in HIV care and treatment: a multi-clinic observational study.
- Authors: Melaku Z, Lamb MR, Wang C, Lulseged S, Gadisa T, Ahmed S, Habtamu Z, Alemu H, Assefa T, Abrams EJ
- Issue date: 2015 May 3
- Managing Advanced HIV Disease in a Public Health Approach.
- Authors: Ford N, Meintjes G, Calmy A, Bygrave H, Migone C, Vitoria M, Penazzato M, Vojnov L, Doherty M, Guideline Development Group for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy .
- Issue date: 2018 Mar 4
- Raltegravir-intensified initial antiretroviral therapy in advanced HIV disease in Africa: A randomised controlled trial.
- Authors: Kityo C, Szubert AJ, Siika A, Heyderman R, Bwakura-Dangarembizi M, Lugemwa A, Mwaringa S, Griffiths A, Nkanya I, Kabahenda S, Wachira S, Musoro G, Rajapakse C, Etyang T, Abach J, Spyer MJ, Wavamunno P, Nyondo-Mipando L, Chidziva E, Nathoo K, Klein N, Hakim J, Gibb DM, Walker AS, Pett SL, REALITY trial team.
- Issue date: 2018 Dec
- Late presentation to HIV/AIDS care at the Douala general hospital, Cameroon: its associated factors, and consequences.
- Authors: Luma HN, Jua P, Donfack OT, Kamdem F, Ngouadjeu E, Mbatchou HB, Doualla MS, Mapoure YN
- Issue date: 2018 Jul 3