Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD-HIV model.
Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD-HIV model.
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DOI：
10.1136/bmjopen-2020-036836
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发表时间：
2020-10-21
期刊：
影响因子：
2.9
通讯作者：
Kachimanga C
中科院分区：
文献类型：
--
作者：
Wroe EB;Kalanga N;Dunbar EL;Nazimera L;Price NF;Shah A;Dullie L;Mailosi B;Gonani G;Ndarama EPL;Talama GC;Bukhman G;Kerr L;Connolly E;Kachimanga C
在马拉维，非传染性疾病占残疾调整生命年的三分之一，获得护理的机会非常有限。与艾滋病毒有关的综合服务得到广泛推荐，但全球范围内的例子很少。我们报告了综合慢性病护理诊所（IC3）的描述性结果。这是一项回顾性队列研究。这项研究包括马拉维Neno农村地区14个初级保健设施的艾滋病毒-非传染性疾病诊所。包括2015年1月至2017年12月期间入组的所有新患者，包括6233例HIV-NCD诊断。其中包括3334名艾滋病毒患者（59.7%为女性）和2990名非传染性疾病患者（67.3%为女性），10%的患者年龄在15岁以下。患者在最近的医疗中心就诊，医院团队定期上门加强人员配备。数据收集在纸质表格上，并输入电子病历。对于接受过一次以上访视的患者，在入组后1年报告常规临床测量结果。一年的保留是通过诊断报告的。NCD诊断为1693例高血压，668例哮喘，486例癫痫，149例糖尿病和109例严重精神疾病。截至2018年12月，8.3%的15岁以上非传染性疾病患者也在接受艾滋病毒治疗。艾滋病毒和非传染性疾病的一年保留率分别为85%和72%，分别为8.4%和25.5%，死亡率分别为4.0%和1.4%。临床结果显示，高血压、糖尿病、哮喘和癫痫的改善具有统计学意义。在1807例（80%）有病毒载量结果的HIV患者中，85%的患者病毒载量检测不到。建立在艾滋病毒平台上的IC3模式促进了马拉维农村地区的快速权力下放和获得非传染性疾病服务。临床结果和继续接受护理的情况良好，这表明在初级保健一级整合慢性病护理为解决艾滋病毒和慢性非传染性疾病的巨大双重负担提供了一条前进道路。
Non-communicable diseases (NCDs) account for one-third of disability-adjusted life years in Malawi, and access to care is exceptionally limited. Integrated services with HIV are widely recommended, but few examples exist globally. We report descriptive outcomes from an Integrated Chronic Care Clinic (IC3). This is a retrospective cohort study. The study includes an HIV–NCD clinic across 14 primary care facilities in the rural district of Neno, Malawi. All new patients, including 6233 HIV–NCD diagnoses, enrolled between January 2015 and December 2017 were included. This included 3334 patients with HIV (59.7% women) and 2990 patients with NCD (67.3% women), 10% overall under age 15 years. Patients were seen at their nearest health centre, with a hospital team visiting routinely to reinforce staffing. Data were collected on paper forms and entered into an electronic medical record. Routine clinical measurements are reported at 1-year post-enrolment for patients with more than one visit. One-year retention is reported by diagnosis. NCD diagnoses were 1693 hypertension, 668 asthma, 486 epilepsy, 149 diabetes and 109 severe mental illness. By December 2018, 8.3% of patients with NCD over 15 years were also on HIV treatment. One-year retention was 85% for HIV and 72% for NCDs, with default in 8.4% and 25.5% and deaths in 4.0% and 1.4%, respectively. Clinical outcomes showed statistically significant improvement for hypertension, diabetes, asthma and epilepsy. Of the 1807 (80%) of patients with HIV with viral load results, 85% had undetectable viral load. The IC3 model, built on an HIV platform, facilitated rapid decentralisation and access to NCD services in rural Malawi. Clinical outcomes and retention in care are favourable, suggesting that integration of chronic disease care at the primary care level poses a way forward for the large dual burden of HIV and chronic NCDs.
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影响因子：
2.9
作者：
Kane J;Landes M;Carroll C;Nolen A;Sodhi S
通讯作者：
Sodhi S
DOI：
10.2471/blt.06.036574
发表时间：
2007-11-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Janssens, B;Van Damme, W;Zachariah, R
通讯作者：
Zachariah, R
DOI：
10.1097/qai.0000000000000254
发表时间：
2014-09-01
影响因子：
3.6
作者：
Hyle, Emily P.;Naidoo, Kogieleum;Freedberg, Kenneth A.
通讯作者：
Freedberg, Kenneth A.
影响因子：
13
作者：
Kwan, Gene F.;Bukhman, Alice K.;Bukhman, Gene
通讯作者：
Bukhman, Gene
影响因子：
3.3
作者：
Labhardt, Niklaus D.;Balo, Jean-Richard;Stoll, Beat
通讯作者：
Stoll, Beat