Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study.
Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study.
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DOI：
10.1136/bmjopen-2011-000195
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Wright J
中科院分区：
文献类型：
--
作者：
Burtle D;Welfare W;Elden S;Mamvura C;Vandelanotte J;Petherick E;Walley J;Wright J
在斯威士兰的一家地区医院实施和评估正式的抗逆转录病毒疗法(ART)护理服务。运筹学。南部非洲的地区医院。1171名既往被诊断为艾滋病病毒的患者。基线患者组由使用该服务的前200名患者组成。确定了两个随访组：第一组为2009年4月至6月招募的所有患者，第二组为2010年2月招募的200名患者。引入抗逆转录病毒治疗前护理--一整套干预措施，包括咨询；定期审查；临床分期；及时启动抗逆转录病毒疗法；社会和心理支持；以及预防和管理结核病等机会性感染。接受抗逆转录病毒治疗资格评估的患者比例、开始接受抗逆转录病毒治疗的符合条件的患者比例以及接受明确的循证干预措施(包括预防性复方新诺明和结核病筛查)的比例。在实施ART前服务后，接受明确干预的患者比例增加；接受ART资格评估的患者比例显著增加(基线：59%，组1：%，组2：76%；p=0.001)；符合ART资格的患者开始治疗的比例增加(基线：53%，组1：81%，组：2，81%；p<；0.001)，患者被宣布符合ART资格到开始治疗的中位时间显著减少(基线：61 天，组1：39 天，组2：14 天；p<；0.001)。这一干预措施是护理模式从支离破碎的急性护理模式向更全面的服务转变的一部分。引入结构化的抗逆转录病毒治疗前，与艾滋病毒患者在评估、管理和启动治疗的及时性方面的显著改善有关。抗逆转录病毒治疗前护理对南部非洲地区医院护理质量的影响。在引入抗逆转录病毒治疗前护理服务后，接受抗逆转录病毒治疗的患者比例更高，符合条件的患者开始接受抗逆转录病毒治疗的比例更高，接受关键干预的比例更高。这是一项在常规服务环境中进行的务实评估。这项干预是由现有临床工作人员作为常规卫生服务提供的一部分实施的。常规数据收集系统没有将检测和艾滋病毒护理数据联系起来，从而阻止了从检测到启动的评估。评估的重点是那些已知状态的人，而不是新的测试者、结核病患者或怀孕的人。评估依赖于中期结果，即开始抗逆转录病毒治疗，而不是长期结果，如死亡率。对于那些需要长期随访但不是ART的患者，缺乏信息。
To implement and evaluate a formal pre-antiretroviral therapy (ART) care service at a district hospital in Swaziland. Operational research. District hospital in Southern Africa. 1171 patients with a previous diagnosis of HIV. A baseline patient group consisted of the first 200 patients using the service. Two follow-up groups were defined: group 1 was all patients recruited from April to June 2009 and group 2 was 200 patients recruited in February 2010. Introduction of pre-ART care—a package of interventions, including counselling; regular review; clinical staging; timely initiation of ART; social and psychological support; and prevention and management of opportunistic infections, such as tuberculosis. Proportion of patients assessed for ART eligibility, proportion of eligible patients who were started on ART and proportion receiving defined evidence-based interventions (including prophylactic co-trimoxazole and tuberculosis screening). Following the implementation of the pre-ART service, the proportion of patients receiving defined interventions increased; the proportion of patient being assessed for ART eligibility significantly increased (baseline: 59%, group 1: 64%, group 2: 76%; p=0.001); the proportion of ART-eligible patients starting treatment increased (baseline: 53%, group 1: 81%, group: 2, 81%; p<0.001) and the median time between patients being declared eligible for ART and initiation of treatment significantly decreased (baseline: 61 days, group 1: 39 days, group 2: 14 days; p<0.001). This intervention was part of a shift in the model of care from a fragmented acute care model to a more comprehensive service. The introduction of structured pre-ART was associated with significant improvements in the assessment, management and timeliness of initiation of treatment for patients with HIV. Impact of pre-ART care on the quality of care in a district hospital in Southern Africa. After introduction of a pre-ART care service, a higher proportion of patients were assessed for ART, a higher proportion of those eligible started on ART and a higher proportion received key interventions. This was a pragmatic evaluation in a routine service setting. The intervention was implemented as part of routine health service delivery by existing clinical staff. Routine data collection systems do not link testing and HIV care data, preventing an evaluation from testing to initiation. The evaluation focuses on those with a known status, rather than new testers, those with tuberculosis or those who are pregnant. The evaluation relies on intermediate outcomes, that is, initiation on ART, rather than long-term outcomes, such as mortality. There is a lack of information on those requiring long-term follow-up but not ART.