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    Jan 17, 2021
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    Framework for the implementation of advanced HIV disease diagnostics in sub-Saharan Africa: programmatic perspectives

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    Authors
    Ndlovu, Z
    Burton, R
    Stewart, R
    Bygrave, H
    Roberts, T
    Fajardo, E
    Mataka, A
    Szumilin, E
    Kerschberger, B
    van Cutsem, G
    Ellman, T
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    Issue Date
    2020-05-27
    Submitted date
    2020-07-09
    
    Metadata
    Show full item record
    Journal
    The Lancet HIV
    Abstract
    Patients with advanced HIV disease have a high risk of mortality, mainly from tuberculosis and cryptococcal meningitis. The advanced HIV disease management package recommended by WHO, which includes diagnostics, therapeutics, and patient psychosocial support, is barely implemented in many different countries. Here, we present a framework for the implementation of advanced HIV disease diagnostics. Laboratory and point-of-care-based reflex testing, coupled with provider-initiated requested testing, for cryptococcal antigen and urinary Mycobacterium tuberculosis lipoarabinomannan antigen, should be done for all patients with CD4+ cell counts of 200 cells per μL or less. Implementation of the advanced HIV disease package should be encouraged within primary health-care facilities and task shifting of testing to lay cadres could facilitate access to rapid results. Implementation of differentiated antiretroviral therapy delivery models can allow clinicians enough time to focus on the management of patients with advanced HIV disease. Efficient up-referral and post-discharge systems, including the development of patient-centric advanced HIV disease literacy, are also crucial. Implementation of the advanced HIV disease package is feasible at all health-care levels, and it should be part of the core of the global response towards ending AIDS as a public health threat.
    Publisher
    Elsevier
    URI
    http://hdl.handle.net/10144/619670
    DOI
    10.1016/S2352-3018(20)30101-6
    PubMed ID
    32473102
    Type
    Article
    Other
    Language
    en
    Description
    We regret that this article is behind a paywall.
    EISSN
    2352-3018
    ae974a485f413a2113503eed53cd6c53
    10.1016/S2352-3018(20)30101-6
    Scopus Count
    Collections
    HIV/AIDS

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