Can cash help eliminate mother-to-child HIV transmission?
Can cash help eliminate mother-to-child HIV transmission?
复制标题
现金可以帮助消除艾滋病毒母婴传播吗？
DOI：
10.1016/s2352-3018(16)00003-5
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Bekker,Linda-Gail
中科院分区：
文献类型：
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作者：
Pettifor,Audrey;Rosenberg,Nora;Bekker,Linda-Gail
load outcomes. Therefore, a relevant question is how many patients with virological failure remained unidentified, and, of equal importance, how many patients who were classified as immunological failure in fact had suppressed viral load (estimated at 17% in a recent meta-analysis6). Consequently, the recommended actions might be redundant in many patients, which would increase work load in an already resource-constrained setting. Second, the study did not assess whether the actions taken resulted in improved health outcomes, in terms of resolving immunological failure, viral suppression or resuppression, or survival. Third, the intervention led to appropriate action in only 55% of cases of immunological failure. The reported reasons for clinicians not acting on alerts included action taken but not recorded, error in the data, CD4 cell analyser out of order or reagent stock-outs, or time constraint during a busy clinic. These findings provide useful guidance about how to optimise further implementation of CDSS.To meet the UNAIDS 90-90-90 treatment goals, WHO recommends viral load monitoring of ART-treated patients as the preferred strategy. 7 Indeed, the Kenyan national ART programme has adopted viral load monitoring as of 2014, gradually replacing CD4 cell counts. 8 I would therefore strongly encourage that the researchers adapt their CDSS towards a viral load-driven system, thus maximising its potential benefits in triggering adherence support, repeat viral load testing, and justified regimen switches. Such a system could ultimately contribute to taking maximum advantage of the few available ART options by averting redundant actions (eg, CD4 cell testing), premature switching, and accumulation of drug resistance. The study findings also call for national ART programmes in sub-Saharan Africa to further strengthen
