Reaching the Unreached: Providing Quality Care to HIV-Infected Children through Telemedicine-An Innovative Pilot Initiative from Maharashtra, India.
Reaching the Unreached: Providing Quality Care to HIV-Infected Children through Telemedicine-An Innovative Pilot Initiative from Maharashtra, India.
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DOI：
10.1155/2020/6432476
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发表时间：
2020
影响因子：
2.1
通讯作者：
Setia MS
中科院分区：
文献类型：
--
作者：
Manglani M;Gabhale Y;Lala MM;Balakrishnan S;Bhuyan K;Rewari BB;Setia MS
印度国家艾滋病控制组织设立了区域儿科抗逆转录病毒治疗中心;该中心随后升级为七个儿科英才中心，以加强对感染艾滋病毒/艾滋病儿童的治疗和护理质量。2013年10月，作为马哈拉施特拉邦艾滋病毒护理儿科卓越中心的一个试点项目，建立了儿科艾滋病毒远程医疗倡议，这是一种电子分散（由当地医疗保健提供者提供护理，由中央机构通过远程医疗设施提供支持）的儿科艾滋病毒专家护理和转诊服务模式。我们设计了本研究，以比较管理，遵守ART，并在ART中心的儿童死亡率与那些没有链接到PCoE通过远程医疗与PCoE。 这是一项回顾性横断面研究，对2013年10月至2015年8月在ART中心进行的CLHA的次要数据进行了记录，以记录中期结果，并确定该计划是否改善了在与非关联ART中心关联的ART中心登记的CLHA的护理质量。定期进行远程医疗会议的中心被称为链接定期中心，不定期进行远程医疗会议的中心（少于12个视频会议病例的中位数）被称为链接不定期中心。分析了31个连锁中心（1365个不规则中心和1438个规则中心）的2803名儿童和28个非连锁中心的2608名儿童的数据。ART前组（ART初治）儿童的结局为（1）ART前存活，（2）ART前失访，（3）ART前期间死亡，（4）符合条件但未开始ART，（5）缺失基线和最近的CD 4计数。接受ART的儿童的结局是：（1）接受ART后存活，（2）接受ART后失访，（3）接受ART后死亡，（4）缺失基线和最新CD 4计数。 我们发现，在ART前组中，与非链接中心相比，链接-常规中心（79% vs. 70%，p < 0.001）和链接-非常规中心（76% vs. 70%，p = 0.04）的儿童存活率更高。在该组中，缺失基线CD 4计数和最新CD 4计数的儿童比例在连锁（常规中心）中心显著较低。在ART组中，我们发现，与非正规连锁中心相比，正规连锁中心的儿童存活率更高（77% vs. 69%，p < 0.001）;非连锁中心的存活率没有显著差异（77% vs. 78%，p = 0.56）。在该组中，与非连锁中心相比，连锁-规则中心（3% vs. 13%，p<0.001）和连锁-不规则中心（1% vs. 13%，p < 0.001）的基线CD 4计数缺失比例显著较低。此外，与非关联中心（6% vs. 18%，p < 0.001）和非关联中心（6% vs. 18%，p < 0.001）相比，关联-规则中心中最近一次CD 4计数缺失的儿童比例显著较低。 我们的研究表明，通过远程医疗连接的中心在患者护理和治疗方面表现更好，随访损失更少，CLHA的死亡率更低。总体而言，这一儿科艾滋病毒远程医疗试点项目已被证明是可接受的，可行的，有效地提高了马哈拉施特拉邦感染艾滋病毒儿童的护理质量。
The National AIDS Control Organization (NACO) of India created the Regional Pediatric Antiretroviral Therapy (ART) Center; this was subsequently upgraded to seven Pediatric Centers of Excellence (PCoEs) to strengthen the quality of treatment and care of children living with HIV/AIDS (CLHAs). In October 2013, the pediatric HIV telemedicine initiative, an e-decentralized (care provided by local healthcare providers and support provided by a central agency through telemedicine facilities) model of expert pediatric HIV care and referral services, was established as a pilot project at the Pediatric Center of Excellence for HIV Care in Maharashtra. We designed the present study to compare management, compliance to ART, and mortality in children in the ART centers linked to the PCoE through telemedicine versus those that are not linked to the PCoE. It was a retrospective cross-sectional study of secondary data from CLHAs from October 2013 through August 2015 in the ART centers to document the intermediate outcomes and to determine if the initiative has improved the quality of care for the CLHAs enrolled in the linked ART centers with nonlinked ART centers. The centers in which the telemedicine sessions were conducted regularly were called linked-regular centers and in whom it was conducted irregularly (less than the median of 12 videoconference cases), it was called a linked-irregular center. Data from 2803 children in 31 linked (1365 in irregular and 1438 in regular centers) and 2608 children in 28 nonlinked centers were analyzed. The outcomes in children in the pre-ART group (ART naïve) were (1) alive on pre-ART, (2) lost to follow-up on pre-ART, (3) death during the pre-ART period, (4) eligible but not initiated on ART, and (5) missing baseline and latest CD4 counts. The outcomes of children on ART were (1) alive on ART, (2) lost to follow-up on ART, (3) death on ART, and (4) missing baseline and latest CD4 counts. We found that a higher proportion of children in the linked-regular centers (79% vs. 70%, p < 0.001) and linked-irregular centers (76% vs. 70%, p = 0.04) was alive compared with that in the nonlinked centers in the pre-ART group. In this group, the proportion of children with missing baseline CD4 counts and latest CD4 counts was significantly low in linked (regular centers) centers. In the ART group, we found that a higher proportion of children in the linked-regular centers was alive compared with that in the linked-irregular centers (77% vs. 69%, p < 0.001); the proportion was not significantly different in nonlinked centers (77% vs. 78%, p = 0.56). In this group, the proportion of missing baseline CD4 counts was significantly lower in the linked-regular centers (3% vs 13%, p<0.001) and linked-irregular centers (1% vs. 13%, p < 0.001) compared with that in the nonlinked centers. Furthermore, the latest CD4 counts were missing in a significantly lower proportion of children in the linked-regular centers compared with those in the linked-irregular centers (6% vs. 18%, p < 0.001) and nonlinked centers (6% vs. 18%, p < 0.001). Our study shows that the centers linked through telemedicine performed better in terms of patient care and treatment, with a lesser loss to follow-up and lesser deaths in CLHA. Overall, this pilot project of telemedicine for pediatric HIV has been proven to be acceptable, feasible, and effective in improving the quality of care for children living with HIV across the state of Maharashtra.
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影响因子：
10.9
作者：
Azfar, Rahat S.;Lee, Robert A.;Kovarik, Carrie L.
通讯作者：
Kovarik, Carrie L.
DOI：
10.1016/s0011-5029(99)90009-3
发表时间：
1999-06-01
期刊：
Disease-a-month : DM
影响因子：
--
作者：
Zajtchuk, R;Gilbert, G R
通讯作者：
Gilbert, G R
影响因子：
4.7
作者：
Zaylor, C;Nelson, EL;Cook, DJ
通讯作者：
Cook, DJ
影响因子：
5.2
作者：
Le Doare, Kirsty;Mackie, N. E.;Foster, C.
通讯作者：
Foster, C.
影响因子：
3.7
作者：
Rout, Sarit Kumar;Gabhale, Yashwant R.;Manglani, Mamta, V
通讯作者：
Manglani, Mamta, V