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dc.contributor.authorMangana, F
dc.contributor.authorMassaquoi, L D
dc.contributor.authorMoudachirou, R
dc.contributor.authorHarrison, R
dc.contributor.authorKaluangila, T
dc.contributor.authorMucinya, G
dc.contributor.authorNtabugi, N
dc.contributor.authorvan Cutsem, G
dc.contributor.authorBurton, R
dc.contributor.authorIsaakidis, P
dc.date.accessioned2020-11-18T20:55:42Z
dc.date.available2020-11-18T20:55:42Z
dc.date.issued2020-10-07
dc.date.submitted2020-11-04
dc.identifier.pmid33028245
dc.identifier.doi10.1186/s12879-020-05470-0
dc.identifier.urihttp://hdl.handle.net/10144/619753
dc.description.abstractBackground: HIV continues to be the main determinant morbidity with high mortality rates in Sub-Saharan Africa, with a high number of patients being late presenters with advanced HIV. Clinical management of advanced HIV patients is thus complex and requires strict adherence to updated, empirical and simplified guidelines. The current study investigated the impact of the implementation of a new clinical guideline on the management of advanced HIV in Kinshasa, Democratic Republic of Congo (DRC). Methods: A retrospective analysis of routine clinical data of advanced HIV patients was conducted for the periods; February 2016 to March 2017, before implementation of new guidelines, and November 2017 to July 2018, after the implementation of new guidelines. Eligible patients were patients with CD4 < 200 cell/μl and presenting with at least 1 of 4 opportunistic infections. Patient files were reviewed by a medical doctor and a committee of 3 other doctors for congruence. Statistical significance was set at 0.05%. Results: Two hundred four and Two hundred thirty-one patients were eligible for inclusion before and after the implementation of new guidelines respectively. Sex and age distributions were similar for both periods, and median CD4 were 36 & 52 cell/μl, before and after the new guidelines implementation, respectively. 40.7% of patients had at least 1 missed/incorrect diagnosis before the new guidelines compared to 30% after new guidelines, p < 0.05. Clinical diagnosis for TB and toxoplasmosis were also much improved after the implementation of new guidelines. In addition, only 63% of patients had CD4 count test results before the new guidelines compared to 99% of patients after new guidelines. Death odds after the implementation of new guidelines were significantly lower than before new guidelines in a multivariate regression model that included patients CD4 count and 10 other covariates, p < 0.05. Conclusions: Simplification and implementation of a new and improved HIV clinical guideline coupled with the installation of laboratory equipment and point of care tests potentially helped reduce incorrect diagnosis and improve clinical outcomes of patients with advanced HIV. Regulating authorities should consider developing simplified versions of guidelines followed by the provision of basic diagnostic equipment to health centers.en_US
dc.language.isoenen_US
dc.publisherBMCen_US
dc.rightsWith thanks to BMC.en_US
dc.subjectAdvanced HIV
dc.subjectHIV clinical guideline
dc.subjectHIV clinical management
dc.subjectHIV infection
dc.subjectSub-Saharan Africa
dc.titleImpact of the implementation of new guidelines on the management of patients with HIV infection at an advanced HIV clinic in Kinshasa, Democratic Republic of Congo (DRC).en_US
dc.typeArticle
dc.identifier.eissn1471-2334
dc.identifier.journalBMC infectious diseasesen_US
dc.source.journaltitleBMC infectious diseases
dc.source.volume20
dc.source.issue1
dc.source.beginpage734
dc.source.endpage
refterms.dateFOA2020-11-18T20:55:47Z
dc.source.countryEngland


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