Advanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review.
Advanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review.
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DOI：
10.1186/s12981-022-00433-8
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发表时间：
2022-02-22
影响因子：
2.2
通讯作者：
Claassen CW
中科院分区：
文献类型：
--
作者：
Mbewe N;Vinikoor MJ;Fwoloshi S;Mwitumwa M;Lakhi S;Sivile S;Yavatkar M;Lindsay B;Stafford K;Hachaambwa L;Mulenga L;Claassen CW
赞比亚最近实现了艾滋病规划署控制艾滋病毒流行的90-90-90治疗目标；然而，住院设施继续面临艾滋病毒晚期患者和艾滋病毒相关死亡患者的沉重负担。在复杂的住院环境中，遵循门诊设置的指南，对晚期艾滋病毒疾病的管理可能会更加困难。我们评估了住院期间对HIV指南的遵守情况，包括机会性感染(OI)筛查、治疗和预防。我们查阅了2018年12月1日至2019年4月30日期间在赞比亚卢萨卡大学教学医院住院的艾滋病毒携带者(PLHIV)患者的医疗记录。我们收集了关于患者人口统计学、抗逆转录病毒治疗(ART)、HIV生物标志物以及OI筛查和治疗的数据--包括结核病(TB)、隐球菌和使用复方新诺明(CTX)预防OI。筛查和治疗级联是根据2017年世卫组织艾滋病毒高级指南构建的。我们回顾了200例晚期HIV疾病患者的病历；其中92%(184/200)以前接受过抗逆转录病毒治疗；58.1%(107/184)超过12个月。HIV病毒载量(VL)检测并不常见，但VL结果中有一半是高的。39%(77/200)的患者有记录的CD4计数结果。在入院时未接受抗结核治疗(ATT)的172名患者中，105人(61%)要求进行结核诊断试验(痰Xpert MTB/RIF、MTB/RIF或尿TB-LAM)，结果105人中有60人(57%)。在14名结核病实验室结果呈阳性的患者中，有9名(%)在结果出来之前死亡。隐球菌病的检测主要在有脑膜炎症状的患者中进行。很少进行尿液TB-LAM检测。在赞比亚的一家转诊医院，由于实验室的挑战，CD4检测不一致，这降低了对AHD的认识和AHD指南的实施。HIV计划可以通过加强住院活动，包括住院期间的反射VL测试、TB-LAM和血清CRAG，潜在地降低死亡率，并识别存在滞留和依从性问题的PLHIV。
Zambia recently achieved UNAIDS 90-90-90 treatment targets for HIV epidemic control; however, inpatient facilities continue to face a large burden of patients with advanced HIV disease and HIV-related mortality. Management of advanced HIV disease, following guidelines from outpatient settings, may be more difficult within complex inpatient settings. We evaluated adherence to HIV guidelines during hospitalization, including opportunistic infection (OI) screening, treatment, and prophylaxis. We reviewed inpatient medical records of people living with HIV (PLHIV) admitted to the University Teaching Hospital in Lusaka, Zambia between December 1, 2018 and April 30, 2019. We collected data on patient demographics, antiretroviral therapy (ART), HIV biomarkers, and OI screening and treatment—including tuberculosis (TB), Cryptococcus, and OI prophylaxis with co-trimoxazole (CTX). Screening and treatment cascades were constructed based on the 2017 WHO Advanced HIV Guidelines. We reviewed files from 200 charts of patients with advanced HIV disease; of these 92% (184/200) had been on ART previously; 58.1% (107/184) for more than 12 months. HIV viral load (VL) testing was uncommon but half of VL results were high. 39% (77/200) of patients had a documented CD4 count result. Of the 172 patients not on anti-TB treatment (ATT) on admission, TB diagnostic tests (either sputum Xpert MTB/RIF MTB/RIF or urine TB-LAM) were requested for 105 (61%) and resulted for 60 of the 105 (57%). Nine of the 14 patients (64%) with a positive lab result for TB died before results were available. Testing for Cryptococcosis was performed predominantly in patients with symptoms of meningitis. Urine TB-LAM testing was rarely performed. At a referral hospital in Zambia, CD4 testing was inconsistent due to laboratory challenges and this reduced recognition of AHD and implementation of AHD guidelines. HIV programs can potentially reduce mortality and identify PLHIV with retention and adherence issues through strengthening inpatient activities, including reflex VL testing, TB-LAM and serum CrAg during hospitalization.
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影响因子：
3.7
作者：
Dawood H;Hassan-Moosa R;Zuma NY;Naidoo K
通讯作者：
Naidoo K
影响因子：
2.2
作者：
Workie KL;Birhan TY;Angaw DA
通讯作者：
Angaw DA
DOI：
10.1056/nejmoa1600693
发表时间：
2016-09-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Cohen MS;Chen YQ;McCauley M;Gamble T;Hosseinipour MC;Kumarasamy N;Hakim JG;Kumwenda J;Grinsztejn B;Pilotto JH;Godbole SV;Chariyalertsak S;Santos BR;Mayer KH;Hoffman IF;Eshleman SH;Piwowar-Manning E;Cottle L;Zhang XC;Makhema J;Mills LA;Panchia R;Faesen S;Eron J;Gallant J;Havlir D;Swindells S;Elharrar V;Burns D;Taha TE;Nielsen-Saines K;Celentano DD;Essex M;Hudelson SE;Redd AD;Fleming TR;HPTN 052 Study Team
通讯作者：
HPTN 052 Study Team
DOI：
10.1093/cid/cix1139
发表时间：
2018-03-04
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
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
通讯作者：
Guideline Development Group for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy
影响因子：
15.8
作者：
Kerkhoff, Andrew D.;Sikombe, Kombatende;Geng, Elvin H.
通讯作者：
Geng, Elvin H.