This study examined predictors of loss to follow up (LTFU) in patients receiving antiretroviral therapy (ART) in Ethiopia. The study included 2133 HIV patients who initiated ART between 2005-2013 at a hospital in Ethiopia. 26.7% of patients were lost to follow up, defined as not returning for a refill for at least 3 months. Patients who had regimen substitutions, were adolescents, lacked isoniazid prophylaxis, or had low baseline CD4 counts (<200 cells/mm3) were at higher risk of LTFU. Patients with more advanced clinical stages at initiation were less likely to be lost to follow up. The cumulative incidence of LTFU was 8.
SPATIAL CLUSTERING AND ANALYSIS ON HEPATITIS C VIRUS INFECTIONS IN EGYPT IJDKP
Lots of studies worldwide have been carried out to check out the prevalence of Hepatitis C Virus (HCV) in human populations. Spatial data analysis and clustering detection is a vital process in HCV monitoring to discover the area of high risk and to help involved decision makers to draw hypotheses about the cause of disease. Egypt is declared as one of the countries having the highest prevalence rate of HCV worldwide. The anomaly of the HCV infection’s distribution in Egypt allowed several researches to identify the reasons that contributed to such widespread of HCV in this country. One way that can help in identification of areas with highest diseases is to give a detailed knowledge about the geographical distribution of HCV in Egypt. To achieve that goal, Data mining analytical tools integrated with GIS can help to visualize the distribution. Thus, the main propose of this paper is to present a spatial distribution of HCV in Egypt using case data obtained from the Egyptian health institute National Hepatology Tropical Medicine Research Institute (NHTMR). The visualization of the spatial analysis distribution by means of GIS allows us to investigate statistical results that are easily interpreted by non-experts.
This document analyzes the costs and benefits of screening and treatment programs for non-communicable diseases in Rajasthan, India. It finds that screening 50-70% of people aged 30-69 for cardiovascular disease, diabetes, cervical cancer and breast cancer could avert many deaths from these diseases in a cost-effective manner. The interventions would have benefit-cost ratios ranging from 11.9 to 28.8 depending on the disease and discount rate. While start-up costs are substantial, early detection and treatment of non-communicable diseases reduces long-term health costs. Increased funding for primary care screening and management of non-communicable diseases is needed.
Observational research can impact clinical decision making for cancer treatment by providing real-world evidence to complement randomized controlled trials, which have limitations. Observational studies capture long-term outcomes of various treatments in everyday practice. However, their findings are more susceptible to bias. To strengthen observational research, standards are needed for electronic health data collection and reporting, while prioritizing patient privacy and rigorous methodologies. With these improvements, observational data can better inform estimates of cancer progression and treatment effects.
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...Jacob Amofa
This study examined the prevalence and risk factors of wound infections at a tertiary hospital in Northern Ghana. The researchers reviewed medical records from 1096 patients admitted to the surgical ward in 2012. They found that 32.3% of patients had wound infections, with 60.2% acquired in the community and 39.8% acquired in the hospital. Males had a higher prevalence of infections than females. Significant risk factors for wound infection included female gender, living in a rural area, and having diabetes. The study concluded that wound infections were relatively common, with nearly 40% contracted in the hospital setting, and identified several demographic and clinical factors that influenced the risk of infection.
Clinical Features and Patterns of CD4+ T Lymphocyte Counts Among HIV/AIDS Pat...IjcmsdrJournal
Background:The use of CD4+ T Lymphocyte count as a vital component to ascertain the stage of HIV/AIDS disease as well as monitor the progress of the disease continues to take centre stage in the management of HIV/AIDS in Africa and beyond. Most health centres in Sub-saharan Africa rely on cut off reference values from different races and distant parts of the world.
Aim:This study was designed to establish the range of CD4+ T Lymphocyte counts among the HIV-negative individuals and also HIV-positive patients at initial booking in the anti-retroviral clinic of our hospital where clinical diagnosis was established.
Methods:Patients were recruited into the study as they report to the hospital on daily basis; structured questionnaires were administered where socio-demograhic and relevant clinical information were obtained. Blood samples (3-5mls) were collected using aseptic techniqueand processed where HIV screening was conducted, and CD4+ T Lymphocyte cell count was carried out using Cyflow (Partec, Germany). Results were fed into Microsoft excel 2007 version and analysed using SPSS 14.
Results:A total of 386 HIV-positive and 145 HIV-negative individuals were recruited into the study. The average CD4+ T Lymphocytes count among the HIV negative individuals was 850 cells /μL and ranged from 200 to 1950 cells/μL with CD4+ T Lymphocyte counts of less than 300 cells/μL being 5 (3.4%). The CD4+ T Lymphocyte counts of less than 500 cells/μL among the HIV-negative individuals was 19(13.1%). However, the CD4+ T Lymphocyte counts among HIV-infected individuals ranged from 50 to 1450 cells/μL, 0.8% (n=3) while 45.9% (n=177) presented with CD4+ T Lymhocyte counts of 50 or less and less than 250 cells/μL respectively. The fact that 75.9% (n=293) of the patients had a CD4+ T Lymphocyte counts of less than 500 cells/μL shows the general late presentation of patients with HIV infection at our health settings, and as much as 50% of these were aware of their HIV status the very first time.
The document summarizes the results of a survey conducted in India to assess public knowledge and perceptions of clinical research. Some key findings include:
- Over half of respondents had not heard of clinical research, though nearly 60% expressed willingness to participate.
- Most recognized the benefits of research to society, but many were unaware of aspects like compensation and confidentiality.
- Respondents exhibited some distrust in how clinical trials are conducted and regulated in India.
- The survey aims to inform educational programs to increase awareness and address misconceptions among the public.
SPATIAL CLUSTERING AND ANALYSIS ON HEPATITIS C VIRUS INFECTIONS IN EGYPT IJDKP
Lots of studies worldwide have been carried out to check out the prevalence of Hepatitis C Virus (HCV) in human populations. Spatial data analysis and clustering detection is a vital process in HCV monitoring to discover the area of high risk and to help involved decision makers to draw hypotheses about the cause of disease. Egypt is declared as one of the countries having the highest prevalence rate of HCV worldwide. The anomaly of the HCV infection’s distribution in Egypt allowed several researches to identify the reasons that contributed to such widespread of HCV in this country. One way that can help in identification of areas with highest diseases is to give a detailed knowledge about the geographical distribution of HCV in Egypt. To achieve that goal, Data mining analytical tools integrated with GIS can help to visualize the distribution. Thus, the main propose of this paper is to present a spatial distribution of HCV in Egypt using case data obtained from the Egyptian health institute National Hepatology Tropical Medicine Research Institute (NHTMR). The visualization of the spatial analysis distribution by means of GIS allows us to investigate statistical results that are easily interpreted by non-experts.
This document analyzes the costs and benefits of screening and treatment programs for non-communicable diseases in Rajasthan, India. It finds that screening 50-70% of people aged 30-69 for cardiovascular disease, diabetes, cervical cancer and breast cancer could avert many deaths from these diseases in a cost-effective manner. The interventions would have benefit-cost ratios ranging from 11.9 to 28.8 depending on the disease and discount rate. While start-up costs are substantial, early detection and treatment of non-communicable diseases reduces long-term health costs. Increased funding for primary care screening and management of non-communicable diseases is needed.
Observational research can impact clinical decision making for cancer treatment by providing real-world evidence to complement randomized controlled trials, which have limitations. Observational studies capture long-term outcomes of various treatments in everyday practice. However, their findings are more susceptible to bias. To strengthen observational research, standards are needed for electronic health data collection and reporting, while prioritizing patient privacy and rigorous methodologies. With these improvements, observational data can better inform estimates of cancer progression and treatment effects.
Epidemiology of wound_infection_in_a_surgical_ward_of_a_tertiary_care_hospita...Jacob Amofa
This study examined the prevalence and risk factors of wound infections at a tertiary hospital in Northern Ghana. The researchers reviewed medical records from 1096 patients admitted to the surgical ward in 2012. They found that 32.3% of patients had wound infections, with 60.2% acquired in the community and 39.8% acquired in the hospital. Males had a higher prevalence of infections than females. Significant risk factors for wound infection included female gender, living in a rural area, and having diabetes. The study concluded that wound infections were relatively common, with nearly 40% contracted in the hospital setting, and identified several demographic and clinical factors that influenced the risk of infection.
Clinical Features and Patterns of CD4+ T Lymphocyte Counts Among HIV/AIDS Pat...IjcmsdrJournal
Background:The use of CD4+ T Lymphocyte count as a vital component to ascertain the stage of HIV/AIDS disease as well as monitor the progress of the disease continues to take centre stage in the management of HIV/AIDS in Africa and beyond. Most health centres in Sub-saharan Africa rely on cut off reference values from different races and distant parts of the world.
Aim:This study was designed to establish the range of CD4+ T Lymphocyte counts among the HIV-negative individuals and also HIV-positive patients at initial booking in the anti-retroviral clinic of our hospital where clinical diagnosis was established.
Methods:Patients were recruited into the study as they report to the hospital on daily basis; structured questionnaires were administered where socio-demograhic and relevant clinical information were obtained. Blood samples (3-5mls) were collected using aseptic techniqueand processed where HIV screening was conducted, and CD4+ T Lymphocyte cell count was carried out using Cyflow (Partec, Germany). Results were fed into Microsoft excel 2007 version and analysed using SPSS 14.
Results:A total of 386 HIV-positive and 145 HIV-negative individuals were recruited into the study. The average CD4+ T Lymphocytes count among the HIV negative individuals was 850 cells /μL and ranged from 200 to 1950 cells/μL with CD4+ T Lymphocyte counts of less than 300 cells/μL being 5 (3.4%). The CD4+ T Lymphocyte counts of less than 500 cells/μL among the HIV-negative individuals was 19(13.1%). However, the CD4+ T Lymphocyte counts among HIV-infected individuals ranged from 50 to 1450 cells/μL, 0.8% (n=3) while 45.9% (n=177) presented with CD4+ T Lymhocyte counts of 50 or less and less than 250 cells/μL respectively. The fact that 75.9% (n=293) of the patients had a CD4+ T Lymphocyte counts of less than 500 cells/μL shows the general late presentation of patients with HIV infection at our health settings, and as much as 50% of these were aware of their HIV status the very first time.
The document summarizes the results of a survey conducted in India to assess public knowledge and perceptions of clinical research. Some key findings include:
- Over half of respondents had not heard of clinical research, though nearly 60% expressed willingness to participate.
- Most recognized the benefits of research to society, but many were unaware of aspects like compensation and confidentiality.
- Respondents exhibited some distrust in how clinical trials are conducted and regulated in India.
- The survey aims to inform educational programs to increase awareness and address misconceptions among the public.
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
This survey of 948 oncologists from 82 countries investigated which cancer medicines they deemed most essential for public health in their countries. The most commonly selected medicines were doxorubicin, cisplatin, paclitaxel, pembrolizumab, trastuzumab, carboplatin, and 5-fluorouracil - 19 of the top 20 medicines are currently on the WHO Essential Medicines List. Availability of these medicines was lowest in low-income countries, ranging from 9-54% availability, compared to 68-94% availability in high-income countries. Risk of catastrophic health expenditures for cancer treatment was also higher in low-income countries. The findings challenge the feasibility of adding more expensive
ONLINE FUZZY-LOGIC KNOWLEDGE WAREHOUSING AND MINING MODEL FOR THE DIAGNOSIS A...ijcsity
This document presents a model for an online fuzzy-logic knowledge warehousing and mining system for diagnosing and treating HIV/AIDS. The system would store patient data and medical knowledge about HIV/AIDS. It uses fuzzy logic and data mining to predict HIV/AIDS status, monitor patient health over time, and determine recommended treatment plans. The system was tested on real patient data from a hospital in Nigeria. It aims to provide an efficient way to diagnose, treat, and monitor people living with HIV/AIDS.
Anxiety, uncertainty, and resilience of medical students worldwide during the...Ahmad Ozair
The COVID-19 pandemic significantly impacted medical education worldwide. While healthcare professionals labored to ensure proper care for COVID-19 patients, medical students suffered from high rates of anxiety, uncertainty, burnout, and depressive symptoms. Whilst students in the pre-clinical phase of education faced disruption of didactic lectures and laboratory training, senior medical students faced uncertainty regarding their clinical rotations and internships, which are vital for practical exposure to healthcare. Several studies across the world demonstrated that clinical learning was significantly affected, with students in many countries completely cut off from in-person rotations. The disruption of the clinical curriculum coupled with a sense of failure to contribute at a time of significant need often led to despair. Reforms proposed and/or implemented by governments, medical advisory boards, medical schools, and other administrative bodies were felt to be insufficient by the medical student fraternity at large. Consequently, these students continue to face high rates of anxiety, depression, and a general sense of cynicism. In this student-authored perspective, we highlight the challenges faced by and the psychological impact on medical students directly or indirectly from the pandemic.
Modeling Time to Death of HIV Infected Patients on Antiretroviral Therapy in ...Premier Publishers
The main aim of this study was modeling the factors that affect survival time of HIV infected patients by using Cox ph and parametric survival regression models. The analytical methodologies were used the Kaplan-Meier and Log Rank Test to estimate Descriptive analysis, Cox’s regression model was employed to identify the covariates that have a statistical significant effect on the survival time of HIV infected patients and exponential, weibull, log logistic and log-normal survival regression models were applied to compare efficiency of the models. The overall mean estimated survival time of patients was 51.5 months. The Cox Proportional Hazards Regression Model result revealed that baseline weight, ART adherence, baseline CD4 count, WHO clinical stage, level of education, substance use and TB co-infection of patients are the major factors that affect significantly survival time of HIV infected patients. Among the parametric regression models, based on model Comparison methods, the Weibull regression model is better fit. The Weibull regression model results revealed that baseline weight<50 kg, low CD4 count at baseline, no education, WHO stages III and IV, poor ART adherence, co-infection with TB and substance abuse are the categories that reduce the survival probability of HIV infected patients.
The document summarizes the use of electronic health records (EHRs) for syndromic surveillance, using the example of Zika virus. It discusses how EHRs can help improve reporting of outbreaks by recording patient information. While EHRs provide advantages like improved reporting efficiency and criterion validity of data, they also have limitations like the need for diagnostic and demographic accuracy. The document reviews literature on different surveillance systems and their use in various healthcare settings. It concludes by discussing opportunities for further research, such as including new diseases in surveillance systems and improving collaboration between public and private health sectors.
A study was conducted on HIV counseling and testing clients at an integrated counseling and testing center in a tertiary hospital in Odisha, India between 2009-2012. Of the 22,897 clients tested, 1732 (7.5%) tested positive for HIV. Most of the HIV-positive clients were males between 15-49 years old. Client-initiated testing identified more HIV-positive clients than provider-initiated testing. The majority of HIV transmission was found to be through heterosexual contact. There was a need found to increase HIV counseling and testing activities to diagnose more cases of HIV infection.
This study examined whether systemic inflammatory response syndrome (SIRS) scores can predict length of stay in the intensive care unit (ICU) for patients with acute life-threatening injuries. The researchers conducted a retrospective chart review of 246 patients admitted to the ICU of a Level 1 trauma center between 1998-2007. They found that higher SIRS scores on admission and white race were predictive of longer ICU stays. Injury severity scores were also predictive of length of stay. SIRS scores measure the body's inflammatory response and can be assessed at the bedside, providing critical care nurses with an easy tool to help estimate ICU length of stay and prioritize care.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
ASSESSING DEMOGRAPHIC DISPARITIES IN UTILIZATION OF INHALED CORTICOSTEROIDS A...gpartha85
This study analyzed demographic disparities in the utilization of inhaled corticosteroids (ICS) among patients with persistent asthma using data from the National Asthma Survey. The results showed that over half of patients did not use ICS. African Americans and uninsured patients had significantly lower odds of using ICS compared to whites and insured patients respectively. Multivariate analysis controlling for demographic factors found that African Americans had lower odds than whites of using ICS, potentially due to lack of access to care and inconsistencies in treatment guidelines. Insurance status was also a significant predictor of ICS use, with insured patients having higher odds of use.
Syndromic surveillance utilizes clinical and non-clinical data sources to monitor disease outbreaks. This document discusses two studies that investigated using ambulatory electronic health record (EHR) data for electronic syndromic surveillance (ESS). The first study examined EHR data from outpatient clinics in New York City during the 2009 H1N1 influenza outbreak and found that ambulatory data provided useful information to public health officials for assessing the outbreak in real-time. The second study looked at ambulatory clinic data associated with Kaiser Permanente in California during a 2009 gastrointestinal disease outbreak and found that officials were able to preemptively detect a potential outbreak based on a high number of stool tests ordered at outpatient facilities. Both studies illustrated the value
Assessment of the level of awareness on AIDS/HIV in Johor, MalaysiaSriramNagarajan17
This document summarizes a study that assessed awareness of HIV/AIDS among 396 respondents in Johor, Malaysia. The study found that respondents had moderately high overall knowledge of HIV/AIDS, though some misconceptions remained. Most respondents knew that high-risk behaviors like needle sharing and unprotected sex can transmit HIV, but fewer were aware of risks from activities like tattooing or sharing personal items. While most knew there is no cure for HIV/AIDS, over half believed incorrectly that washing after sex prevents transmission. The study provides insight into awareness levels and information gaps regarding HIV/AIDS in Johor.
IRJET- Sepsis Severity Prediction using Machine LearningIRJET Journal
This document discusses using machine learning models to predict sepsis severity and detect positive blood cultures. Specifically, it evaluates temporal models like bidirectional Long Short-Term Memory networks on open and proprietary ICU databases. These temporal models aim to better capture the sequential nature of medical data compared to traditional models. The study assesses different approaches for sepsis risk estimation and detection of positive blood cultures. Preliminary results found temporal models provided complementary functionality to other approaches with their ability to detect sepsis early based on vital sign patterns over time.
Precision Medicine: Opportunities and Challenges for Clinical TrialsMedpace
The momentum and muscle behind "finding the right drug for the right patient at the right dose" has further escalated with President Barack Obama’s announcement of a $215 million dollar Precision Medicine Initiative earlier this year. In this webinar, Dr. Frank Smith will explore advances in precision medicine and how it is affecting clinical research. As a pediatric hematologist/oncologist, he will use his extensive clinical and research background as a backdrop for the discussion.
Topics will include:
The evolution of "personalized medicine" to "precision medicine"
How state-of-the-art molecular biology is creating new diagnostic and prognostic strategies
How these new strategies are helping inform the design of clinical trials
Case study: How precision medicine is improving clinical trials in hematology and oncology
Basics of Information support of the hospitalEneutron
Telemedicine involves using technology to provide medical services from a distance. It includes teleconsultations, teleeducation, mobile medical services, remote patient monitoring, and telesurgery. Screening in various medical fields helps detect diseases early through simple and standardized tests. This allows for preventive measures that can improve health outcomes. Information systems also support doctors by providing medical information and decision support. They help increase the quality of diagnosis and treatment.
Knowledge and attitudes towards complementary and alternative medicine among ...home
The document summarizes a study that examined medical students' knowledge and attitudes toward complementary and alternative medicine (CAM) in Turkey. The study found that the majority of the 943 medical students surveyed were familiar with common CAM methods like herbal treatment, acupuncture, and massage. Most students had positive attitudes toward CAM and expressed willingness to receive training in it. Attitudes declined as students progressed in their medical education. Overall, there was support for integrating CAM into the medical curriculum in Turkey.
This study compared same day sputum microscopy (two sputum samples collected one hour apart) to conventional sputum microscopy (spot sample and early morning sample collected over two days) for tuberculosis diagnosis in Chhattisgarh, India. The study found that same day microscopy missed 17% of smear-positive tuberculosis cases compared to 1% missed by conventional microscopy. Additionally, same day microscopy had a lower proportion of presumptive tuberculosis patients providing both required samples and had a lower proportion of samples with good quality. These findings suggest that same day microscopy may not be as effective as conventional microscopy for tuberculosis diagnosis in this setting.
This document summarizes a case-control study examining occupational risk factors for bladder cancer. The study included 152 bladder cancer patients and compared them to a control group matched for age, sex, and location. It found significantly higher rates of cigarette smoking and opium use in the cancer patients. When controlling for smoking, opium use on its own was still a risk factor. Working in metal industries like welding or with tin carried the highest risk, with an odds ratio of 10.629 for bladder cancer. Other occupations did not show significant associations. The study suggests cigarette smoking, opium use, and occupations involving metal work are risk factors for developing bladder cancer.
This document summarizes a presentation on new sources of big data for precision medicine. It discusses how new data sources like genomics, the human microbiome, epigenomics, and the exposome are generating large amounts of data. It then covers the evolution of precision medicine from concepts like personalized medicine and how strategic initiatives in the UK and US are supporting precision medicine research through funding programs and projects like the Cancer Genome Atlas, eMERGE, and exposome studies. The presentation raises the question of whether we are ready for precision medicine given these new data sources and research efforts.
Effectiveness of the nursing educational program upon nurse's knowledge and p...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Adherence to Antiretroviral Therapy among HIVPositive Patients in Central Hos...Efe Clement Abel
Abstract: Adherence is the quantified level to which an individual follows a prescribed treatment and a low level of adherence to antiretroviral therapy(ART) adversely affects a patient’s treatment outcome and results in a rebound of plasma viraemia, development of resistant strains of HIV, more rapid immune deterioration, development of AIDS and death. This study is aimed at assessing the level of adherence to ART among HIV-positive patients assessing care in Central Hospital, Warri, Delta State, Nigeria. A descriptive cross-sectional study. Data were obtained using a semi-structured, interviewer-administered questionnaire and analysed using SPSS version 23. A total of 303 persons were recruited for the study. The mean age of respondents was 36.2±10.8years. Less than half of the subjects (45.5%) were adherent to their ART. Among the non-adherent subjects, the common reasons reported for missing doses of ART were forgetfulness (50.9%), too busy with other things (43.6%) and away from home (35.8%). This study showed that adherence to ART among the study population was poor. Forgetfulness, too busy with other things and being away from home were the most common reason for non-adherence. It is, therefore, recommended that; regular health education should be organised for HIV patients on ART on the importance of being adherent to their ART, regular assessment of adherence to ART should be carried out and a method of reminding patients who are non-adherent to ART on the need to take their ART as at when due should be considered as part of the routine services provided by ART centres.
This document summarizes a longitudinal study examining the effects of antiretroviral therapy (ART) on CD4 count and body weight in HIV/AIDS patients in Ethiopia. The study analyzed data from 536 patients over 4 years who were receiving ART. Descriptive statistics showed that mean CD4 count increased over time on ART until peaking at time point 6, while mean body weight fluctuated with a maximum at time point 6 as well. The study concluded that ART had positive effects on both CD4 count and body weight outcomes over time for HIV/AIDS patients.
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
This survey of 948 oncologists from 82 countries investigated which cancer medicines they deemed most essential for public health in their countries. The most commonly selected medicines were doxorubicin, cisplatin, paclitaxel, pembrolizumab, trastuzumab, carboplatin, and 5-fluorouracil - 19 of the top 20 medicines are currently on the WHO Essential Medicines List. Availability of these medicines was lowest in low-income countries, ranging from 9-54% availability, compared to 68-94% availability in high-income countries. Risk of catastrophic health expenditures for cancer treatment was also higher in low-income countries. The findings challenge the feasibility of adding more expensive
ONLINE FUZZY-LOGIC KNOWLEDGE WAREHOUSING AND MINING MODEL FOR THE DIAGNOSIS A...ijcsity
This document presents a model for an online fuzzy-logic knowledge warehousing and mining system for diagnosing and treating HIV/AIDS. The system would store patient data and medical knowledge about HIV/AIDS. It uses fuzzy logic and data mining to predict HIV/AIDS status, monitor patient health over time, and determine recommended treatment plans. The system was tested on real patient data from a hospital in Nigeria. It aims to provide an efficient way to diagnose, treat, and monitor people living with HIV/AIDS.
Anxiety, uncertainty, and resilience of medical students worldwide during the...Ahmad Ozair
The COVID-19 pandemic significantly impacted medical education worldwide. While healthcare professionals labored to ensure proper care for COVID-19 patients, medical students suffered from high rates of anxiety, uncertainty, burnout, and depressive symptoms. Whilst students in the pre-clinical phase of education faced disruption of didactic lectures and laboratory training, senior medical students faced uncertainty regarding their clinical rotations and internships, which are vital for practical exposure to healthcare. Several studies across the world demonstrated that clinical learning was significantly affected, with students in many countries completely cut off from in-person rotations. The disruption of the clinical curriculum coupled with a sense of failure to contribute at a time of significant need often led to despair. Reforms proposed and/or implemented by governments, medical advisory boards, medical schools, and other administrative bodies were felt to be insufficient by the medical student fraternity at large. Consequently, these students continue to face high rates of anxiety, depression, and a general sense of cynicism. In this student-authored perspective, we highlight the challenges faced by and the psychological impact on medical students directly or indirectly from the pandemic.
Modeling Time to Death of HIV Infected Patients on Antiretroviral Therapy in ...Premier Publishers
The main aim of this study was modeling the factors that affect survival time of HIV infected patients by using Cox ph and parametric survival regression models. The analytical methodologies were used the Kaplan-Meier and Log Rank Test to estimate Descriptive analysis, Cox’s regression model was employed to identify the covariates that have a statistical significant effect on the survival time of HIV infected patients and exponential, weibull, log logistic and log-normal survival regression models were applied to compare efficiency of the models. The overall mean estimated survival time of patients was 51.5 months. The Cox Proportional Hazards Regression Model result revealed that baseline weight, ART adherence, baseline CD4 count, WHO clinical stage, level of education, substance use and TB co-infection of patients are the major factors that affect significantly survival time of HIV infected patients. Among the parametric regression models, based on model Comparison methods, the Weibull regression model is better fit. The Weibull regression model results revealed that baseline weight<50 kg, low CD4 count at baseline, no education, WHO stages III and IV, poor ART adherence, co-infection with TB and substance abuse are the categories that reduce the survival probability of HIV infected patients.
The document summarizes the use of electronic health records (EHRs) for syndromic surveillance, using the example of Zika virus. It discusses how EHRs can help improve reporting of outbreaks by recording patient information. While EHRs provide advantages like improved reporting efficiency and criterion validity of data, they also have limitations like the need for diagnostic and demographic accuracy. The document reviews literature on different surveillance systems and their use in various healthcare settings. It concludes by discussing opportunities for further research, such as including new diseases in surveillance systems and improving collaboration between public and private health sectors.
A study was conducted on HIV counseling and testing clients at an integrated counseling and testing center in a tertiary hospital in Odisha, India between 2009-2012. Of the 22,897 clients tested, 1732 (7.5%) tested positive for HIV. Most of the HIV-positive clients were males between 15-49 years old. Client-initiated testing identified more HIV-positive clients than provider-initiated testing. The majority of HIV transmission was found to be through heterosexual contact. There was a need found to increase HIV counseling and testing activities to diagnose more cases of HIV infection.
This study examined whether systemic inflammatory response syndrome (SIRS) scores can predict length of stay in the intensive care unit (ICU) for patients with acute life-threatening injuries. The researchers conducted a retrospective chart review of 246 patients admitted to the ICU of a Level 1 trauma center between 1998-2007. They found that higher SIRS scores on admission and white race were predictive of longer ICU stays. Injury severity scores were also predictive of length of stay. SIRS scores measure the body's inflammatory response and can be assessed at the bedside, providing critical care nurses with an easy tool to help estimate ICU length of stay and prioritize care.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
ASSESSING DEMOGRAPHIC DISPARITIES IN UTILIZATION OF INHALED CORTICOSTEROIDS A...gpartha85
This study analyzed demographic disparities in the utilization of inhaled corticosteroids (ICS) among patients with persistent asthma using data from the National Asthma Survey. The results showed that over half of patients did not use ICS. African Americans and uninsured patients had significantly lower odds of using ICS compared to whites and insured patients respectively. Multivariate analysis controlling for demographic factors found that African Americans had lower odds than whites of using ICS, potentially due to lack of access to care and inconsistencies in treatment guidelines. Insurance status was also a significant predictor of ICS use, with insured patients having higher odds of use.
Syndromic surveillance utilizes clinical and non-clinical data sources to monitor disease outbreaks. This document discusses two studies that investigated using ambulatory electronic health record (EHR) data for electronic syndromic surveillance (ESS). The first study examined EHR data from outpatient clinics in New York City during the 2009 H1N1 influenza outbreak and found that ambulatory data provided useful information to public health officials for assessing the outbreak in real-time. The second study looked at ambulatory clinic data associated with Kaiser Permanente in California during a 2009 gastrointestinal disease outbreak and found that officials were able to preemptively detect a potential outbreak based on a high number of stool tests ordered at outpatient facilities. Both studies illustrated the value
Assessment of the level of awareness on AIDS/HIV in Johor, MalaysiaSriramNagarajan17
This document summarizes a study that assessed awareness of HIV/AIDS among 396 respondents in Johor, Malaysia. The study found that respondents had moderately high overall knowledge of HIV/AIDS, though some misconceptions remained. Most respondents knew that high-risk behaviors like needle sharing and unprotected sex can transmit HIV, but fewer were aware of risks from activities like tattooing or sharing personal items. While most knew there is no cure for HIV/AIDS, over half believed incorrectly that washing after sex prevents transmission. The study provides insight into awareness levels and information gaps regarding HIV/AIDS in Johor.
IRJET- Sepsis Severity Prediction using Machine LearningIRJET Journal
This document discusses using machine learning models to predict sepsis severity and detect positive blood cultures. Specifically, it evaluates temporal models like bidirectional Long Short-Term Memory networks on open and proprietary ICU databases. These temporal models aim to better capture the sequential nature of medical data compared to traditional models. The study assesses different approaches for sepsis risk estimation and detection of positive blood cultures. Preliminary results found temporal models provided complementary functionality to other approaches with their ability to detect sepsis early based on vital sign patterns over time.
Precision Medicine: Opportunities and Challenges for Clinical TrialsMedpace
The momentum and muscle behind "finding the right drug for the right patient at the right dose" has further escalated with President Barack Obama’s announcement of a $215 million dollar Precision Medicine Initiative earlier this year. In this webinar, Dr. Frank Smith will explore advances in precision medicine and how it is affecting clinical research. As a pediatric hematologist/oncologist, he will use his extensive clinical and research background as a backdrop for the discussion.
Topics will include:
The evolution of "personalized medicine" to "precision medicine"
How state-of-the-art molecular biology is creating new diagnostic and prognostic strategies
How these new strategies are helping inform the design of clinical trials
Case study: How precision medicine is improving clinical trials in hematology and oncology
Basics of Information support of the hospitalEneutron
Telemedicine involves using technology to provide medical services from a distance. It includes teleconsultations, teleeducation, mobile medical services, remote patient monitoring, and telesurgery. Screening in various medical fields helps detect diseases early through simple and standardized tests. This allows for preventive measures that can improve health outcomes. Information systems also support doctors by providing medical information and decision support. They help increase the quality of diagnosis and treatment.
Knowledge and attitudes towards complementary and alternative medicine among ...home
The document summarizes a study that examined medical students' knowledge and attitudes toward complementary and alternative medicine (CAM) in Turkey. The study found that the majority of the 943 medical students surveyed were familiar with common CAM methods like herbal treatment, acupuncture, and massage. Most students had positive attitudes toward CAM and expressed willingness to receive training in it. Attitudes declined as students progressed in their medical education. Overall, there was support for integrating CAM into the medical curriculum in Turkey.
This study compared same day sputum microscopy (two sputum samples collected one hour apart) to conventional sputum microscopy (spot sample and early morning sample collected over two days) for tuberculosis diagnosis in Chhattisgarh, India. The study found that same day microscopy missed 17% of smear-positive tuberculosis cases compared to 1% missed by conventional microscopy. Additionally, same day microscopy had a lower proportion of presumptive tuberculosis patients providing both required samples and had a lower proportion of samples with good quality. These findings suggest that same day microscopy may not be as effective as conventional microscopy for tuberculosis diagnosis in this setting.
This document summarizes a case-control study examining occupational risk factors for bladder cancer. The study included 152 bladder cancer patients and compared them to a control group matched for age, sex, and location. It found significantly higher rates of cigarette smoking and opium use in the cancer patients. When controlling for smoking, opium use on its own was still a risk factor. Working in metal industries like welding or with tin carried the highest risk, with an odds ratio of 10.629 for bladder cancer. Other occupations did not show significant associations. The study suggests cigarette smoking, opium use, and occupations involving metal work are risk factors for developing bladder cancer.
This document summarizes a presentation on new sources of big data for precision medicine. It discusses how new data sources like genomics, the human microbiome, epigenomics, and the exposome are generating large amounts of data. It then covers the evolution of precision medicine from concepts like personalized medicine and how strategic initiatives in the UK and US are supporting precision medicine research through funding programs and projects like the Cancer Genome Atlas, eMERGE, and exposome studies. The presentation raises the question of whether we are ready for precision medicine given these new data sources and research efforts.
Effectiveness of the nursing educational program upon nurse's knowledge and p...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Adherence to Antiretroviral Therapy among HIVPositive Patients in Central Hos...Efe Clement Abel
Abstract: Adherence is the quantified level to which an individual follows a prescribed treatment and a low level of adherence to antiretroviral therapy(ART) adversely affects a patient’s treatment outcome and results in a rebound of plasma viraemia, development of resistant strains of HIV, more rapid immune deterioration, development of AIDS and death. This study is aimed at assessing the level of adherence to ART among HIV-positive patients assessing care in Central Hospital, Warri, Delta State, Nigeria. A descriptive cross-sectional study. Data were obtained using a semi-structured, interviewer-administered questionnaire and analysed using SPSS version 23. A total of 303 persons were recruited for the study. The mean age of respondents was 36.2±10.8years. Less than half of the subjects (45.5%) were adherent to their ART. Among the non-adherent subjects, the common reasons reported for missing doses of ART were forgetfulness (50.9%), too busy with other things (43.6%) and away from home (35.8%). This study showed that adherence to ART among the study population was poor. Forgetfulness, too busy with other things and being away from home were the most common reason for non-adherence. It is, therefore, recommended that; regular health education should be organised for HIV patients on ART on the importance of being adherent to their ART, regular assessment of adherence to ART should be carried out and a method of reminding patients who are non-adherent to ART on the need to take their ART as at when due should be considered as part of the routine services provided by ART centres.
This document summarizes a longitudinal study examining the effects of antiretroviral therapy (ART) on CD4 count and body weight in HIV/AIDS patients in Ethiopia. The study analyzed data from 536 patients over 4 years who were receiving ART. Descriptive statistics showed that mean CD4 count increased over time on ART until peaking at time point 6, while mean body weight fluctuated with a maximum at time point 6 as well. The study concluded that ART had positive effects on both CD4 count and body weight outcomes over time for HIV/AIDS patients.
This document summarizes a study on factors influencing adherence to antiretroviral therapy (ART) among people living with HIV in Tanzania. The study analyzed data from 943 HIV-positive patients attending care and treatment centers in urban Dar es Salaam and rural Iringa regions of Tanzania. Adherence based on appointment keeping was 65% and based on patient self-reports of doses taken in the past month was 70-83%. Factors associated with better adherence included satisfaction with healthcare services, social support, knowledge of ART use, early presentation to care, and being on ART for over one year. Being in an urban area, using traditional medicine, experiencing side effects, and alcohol use were linked to poorer adherence
Patients from the urban Dar es Salaam region were less likely to be married, have social support, earn less than $150 USD per month, have lower education levels, receive pre-ART counseling, be on first-line ART, experience side effects, and be satisfied with clinic services compared to patients from the rural Iringa region. Patients from Dar es Salaam were more likely to pay less than $0.50 for transport to the clinic, delay registering at the clinic, and take additional medications for opportunistic infections. Adherence based on appointment keeping was higher in Dar es Salaam while adherence based on self-report was higher in Iringa.
Patients from the urban Dar es Salaam region were less likely to be married, have social support for medication reminders, earn less than $150 USD per month, have lower education levels, and consume alcohol compared to the rural Iringa region. Urban patients were also more likely to experience delays in registering for care, pay less for transportation to clinics, and take additional medications for opportunistic infections. Adherence based on appointment keeping was higher in the urban region, while adherence based on self-reported dosage in the past month was higher in the rural region. Factors associated with adherence differed between the urban and rural settings in Tanzania.
This study assessed antiretroviral treatment failure and associated risk factors among HIV patients in Sekota, northeast Ethiopia. The researchers conducted a cross-sectional study of 295 patients on first-line antiretroviral treatment. They found that 16.6% experienced virological failure and 6.1% experienced immunological failure. Poor adherence, CD4 count below 500 cells/μL, and duration of ART between 6-24 months were associated with virological failure. Poor adherence and drug interruption were associated with immunological failure. The study highlights the need for more efforts to address risk factors and maximize viral load testing to monitor treatment failures.
This document discusses a study on the correlation between CD4+ cell count and orofacial and systemic manifestations in newly diagnosed HIV positive patients in India. The study involved 100 patients who were grouped based on their CD4+ cell count. Results showed a significant correlation between lower CD4+ cell count and increased prevalence of both systemic manifestations like tuberculosis and orofacial manifestations like oral candidiasis. A literature review found that oral candidiasis was one of the most common oral manifestations reported in various Asian studies on HIV/AIDS patients. The findings suggest that CD4+ cell count can be used as a diagnostic and prognostic marker for immune suppression in HIV positive individuals.
53.Vohra P, Nimonkar S, Belkhode V, Potdar S, Bhanot R, Izna, Tiwari RVC. CD4 cells count as a prognostic marker in HIV patients with comparative analysis of various studies in Asia Pacific region. J Family Med Prim Care. 2020 May;9(5):2431-2436. doi: 10.4103/jfmpc.jfmpc_137_20. eCollection 2020 May. PubMed PMID: 32754515; PubMed Central PMCID: PMC7380754.
This document describes a study that evaluated the correlation between CD4+ T-cell count and orofacial and systemic manifestations in 100 newly diagnosed HIV-positive patients in India. The patients were grouped based on their CD4+ count, and oral exams and medical histories were recorded. Results showed a significant correlation between lower CD4+ counts and more prevalent systemic manifestations like tuberculosis. Lower CD4+ counts also significantly correlated with more common oral manifestations like oral candidiasis. The study aims to evaluate CD4+ count as a prognostic marker for immune suppression in HIV patients.
People Living with Human Immunodeficiency Virus in Hadhramout: Clinical Prese...asclepiuspdfs
The objective of the study was to determine the clinical features and outcome of patients living with human immunodeficiency virus (HIV) in Hadhramout and nearby governorates. Materials and Methods: This descriptive study was conducted in the antiretroviral therapy (ART) site at Ibn-Sina General Hospital, Mukalla, Hadhramout governorate. All 145 patients were enrolled in HIV treatment and care program from December 2008 to the end of December 2016 with confirmed HIV test. Data included all personal data, clinical staging, drugs taken, and outcomes. Patients were grouped according to the decades to five groups, ≤15 years, 16–30 years, 31–50 years, 51–70 years, and >70 years. Cases classify according to the antiretroviral drugs to ART group and Pre-ART group. The relevant data parameters were analyzed using SPSS statistical software version 21 and Excel 10. Results: A total of 145 cases, most adults (97.9%), males and females were104 (71.7%) and 41 (28.3%), respectively. Mean age was 36.46 years and 30–50 years the most affected age group (55.2%). Clinical Stages 3 and 4 were the common presentation in 73.8%, and most cases were from Mukalla city. Of the total cases, 74.5% were on ART 53.1 of them improved, pulmonary tuberculosis was found in 4 cases, and death cases were (18.5%), mostly due to late presentation and non-adherence, and mostly occurred in early 6 months of starting the ART. 37 patients were in a pre-treatment group (21.6%), where the mortality rate is 35.1%, mainly due to loss of follow-up. Conclusions: Most cases were adult males, young age and have had late presentation, where mortality is higher in the pre-treatment group due to loss of follow-up and in early 6 months of treatment.
33.Vohra P, Jamatia K, Subhada B, Tiwari RVC, Althaf MN, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care. 2019 Oct;8(10):3247-3252. doi: 10.4103/jfmpc.jfmpc_767_19. eCollection 2019 Oct. PubMed PMID: 31742150; PubMed Central PMCID: PMC6857402.
This document summarizes a study that correlated CD4 counts with oral and systemic manifestations in 100 HIV-positive patients in India. The study found that lower CD4 counts were associated with a wider range of oral and systemic manifestations, which can serve as a prognostic marker for immune suppression. Specifically, the study found that tuberculosis was the most common systemic manifestation. Candidiasis and chronic generalized periodontitis were the most prevalent oral manifestations in males, while candidiasis and recurrent aphthous ulcers were most common in females. Nearly all patients with CD4 counts below 200 showed oral manifestations, demonstrating a significant correlation between oral manifestations and lower CD4 counts.
Vohra P, Jamatia K, Subhada B, Tiwari RV, Althaf MS, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care 2019;8:3247-52.
المركز الرابع لمشاريع تحدي الامراض المزمنة
في مبادرة التحول الرقمي fekra_tech
وهو عبارة عن توضيف مكائن الفحص الذاتي للكشف عن المرضي المعرضين للاصابة بالسكري
fekratech.gov.sa
@NDU_KSA
Adverse Events among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral...Dr.Samsuddin Khan
Abstract
Background
Significant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings.
Methods
Médecins Sans Frontières (MSF) is supporting a community-based treatment program for drug-resistant tuberculosis in HIV-infected patients in a slum setting in Mumbai, India since 2007. Patients are being treated for both diseases and the management of AE is done on an outpatient basis whenever possible. Prospective data were analysed to determine the occurrence and nature of AE.
Results
Between May 2007 and September 2011, 67 HIV/MDR-TB co-infected patients were being treated with anti-TB treatment and ART; 43.3% were female, median age was 35.5 years (Interquartile Range: 30.5–42) and the median duration of anti-TB treatment was 10 months (range 0.5–30). Overall, AE were common in this cohort: 71%, 63% and 40% of patients experienced one or more mild, moderate or severe AE, respectively. However, they were rarely life-threatening or debilitating. AE occurring most frequently included gastrointestinal symptoms (45% of patients), peripheral neuropathy (38%), hypothyroidism (32%), psychiatric symptoms (29%) and hypokalaemia (23%). Eleven patients were hospitalized for AE and one or more suspect drugs had to be permanently discontinued in 27 (40%). No AE led to indefinite suspension of an entire MDR-TB or ART regimen.
Conclusions
AE occurred frequently in this Mumbai HIV/MDR-TB cohort but not more frequently than in non-HIV patients on similar anti-TB treatment. Most AE can be successfully managed on an outpatient basis through a community-based treatment program, even in a resource-limited setting. Concerns about severe AE in the management of co-infected patients are justified, however, they should not cause delays in the urgently needed rapid scale-up of antiretroviral therapy and second-line anti-TB treatment
NUR 440 Evidence TableStudy CitationDesignMethodSample.docxvannagoforth
NUR 440 Evidence Table
Study Citation
Design
Method
Sample
Data Collection
Data Analysis
Validity
Reliability
Magill, S. S., O’Leary, E., Janelle, S. J., Thompson, D. L., Dumyati, G., Nadle, J., & Ray, S. M. (2018). Changes in prevalence of health care–associated infections in US Hospitals. New England Journal of Medicine, 379(18), 1732-1744.
Longitudinal and multivariable log-binomial regression modeling
At Emerging Infections Program sites in 10 states, we recruited up to 25 hospitals in each site area, prioritizing hospitals that had participated in the 2011 survey.
Random samples of patients in acute care locations were selected from hospitals’ morning censuses on the survey date with the use of the method that had been used in the 2011 survey
Trained staff of the Emerging Infections Program sites reviewed medical records on the survey date or retrospectively to collect basic demographic and clinical data.
In 2015, a total of 12,299 patients in 199 hospitals were surveyed, as compared with 11,282 patients in 183 hospitals in 2011. Pneumonia, gastrointestinal infections and surgical-site infections were the most common health care–associated infections.
The CDC determined the survey to be a non-research activity.
Point-prevalence surveys of health care–associated infections in health care settings complement location- or infection-specific National Healthcare Safety Network data.
Zuarez-Easton, S., Zafran, N., Garmi, G., & Salim, R. (2017). Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International journal of women's health, 9, 81.
Randomized trials, cohort, case–control, review, and meta-analysis were eligible.
Several electronic databases were searched from inception through June 2016: MEDLINE, PubMed, Ovid, and the Cochrane Library.
100,000 maternities compared to the period between 2003 and 2005
Data was collected through maternal comorbidities, appropriate antibiotic prophylaxis, and evidence-based surgical techniques practices.
Cesarean delivery is one of the most frequent surgical interventions performed worldwide and accounts for up to 60% of deliveries in a number of countries
Two authors (SZE and RS) selected articles first through focused review of abstracts. Eligible studies underwent full-text review.
The research Reviewed maternal death in the UK over a period of 3 years (2006–2008).
Chu, K., Maine, R., & Trelles, M. (2015). Cesarean section surgical site infections in sub-Saharan Africa: a multi-country study from Medecins Sans Frontieres. World journal of surgery, 39(2), 350-355.
Logistic regression was used to model determinants of SSI.
This study included data from four emergency obstetric programs supported by Medecins sans Frontieres, from Burundi, the Democratic Republic of Congo (DRC), and Sierra Leone.
1,276 women underwent CS.
Data were prospectively collected using a standardized paper form and then entered into an electronic database.
Baseline characteristics w ...
1) This study examined hematologic abnormalities in 64 HIV-infected children on highly active antiretroviral therapy (HAART) in Ethiopia.
2) The prevalence of anemia, thrombocytopenia and neutropenia decreased after starting HAART, from 53.1%, 18.8%, and 7.8% to 21.9%, 7.8%, and 4.7% respectively.
3) Mean hemoglobin levels, CD4 count, platelet count, and total leukocyte count increased significantly after HAART initiation.
This research article examines the time to antiretroviral treatment (ART) initiation among HIV-infected patients treated for rifampicin-resistant tuberculosis (RR-TB) in Khayelitsha, South Africa. The study found that of 303 RR-TB and HIV co-infected patients not on ART at RR-TB treatment initiation, 257 (85%) started ART during RR-TB treatment, with varying times to initiation. Treatment success and mortality did not differ based on time to ART initiation. However, 15% of patients never started ART, and those who never received ART had a significantly higher risk of death. The study concludes that all RR-TB/HIV patients should initiate ART regardless of CD4 count
A Mobile-Phone Tele-Medicine System That Promotes Self-Management of Blood Pr...IJERA Editor
The current practice adopted by hypertensive patients in managing hypertension is making frequent visits to a health center as recommended by medical specialists. However, very few patients adhere to this practice as it is time consuming and tiresome especially if they have to travel for long distances to have their BP checked. This practice is also not practical for critically-ill patients. Consequently, most patients neglect BP check-ups and therefore focus on medication alone. This puts the patients’ at risk as uncontrolled BP can lead to fatal complications. The overall objective of this research was to design, develop and pilot-test a mobile telemedicine system that helps patients’ to self-manage their BP condition from the comfort of their homes. Participatory action research design was used in this study. Testing for performance, usability and utilityof the tele-medicine system was conducted.
Evaluation factors contributing to the treatment default by tuberculosis pati...PUBLISHERJOURNAL
Tuberculosis (TB) is one of the biggest public health problem and now ranks alongside Human Immunodeficiency Virus (HIV) as the world’s leading infectious cause of death. Globally, patient compliance with anti-TB therapy estimated as low as 40% in developing countries, remains the principle cause of treatment failure. The aim of this study was to establish the factors contributing to treatment default by Tuberculosis patients at ART clinic in Ishaka Adventist Hospital, Bushenyi District. A cross-sectional and descriptive study which employed both qualitative and quantitative approach of data collection were used. The study was conducted in ART clinic at Ishaka Adventist Hospital, Bushenyi District and it took a period of four weeks. A purposive sampling technique was used to select the study participants. Results showed that out of 38 study participants, majority 26 (68%) were of age 30 years and above. A large proportion 24 (63%) of the participants were unemployed compared to the least 14 (37%) who were employed. Majority 21 (55%) travel at a distance of 10km and above to get TB treatment. Out of 38 participants, majority 26 (68%) did not informed the family or friends when they were on TB treatment. Of 26 participants 16 (61.5%) had fear of being isolated and 2 (7.7%) were other reason of no support. A large proportion of participants rated the attitude of staff who attended to them at the health facility to be unfriendly with 21 (55%) while very few 6 (16%) were rude. The ministry should ensure availability of and access to resources for strengthening systems for delivery of quality tuberculosis treatment, prevention and control.
Keywords: treatment, default, tuberculosis, ART, Uganda
Evaluation factors contributing to the treatment default by tuberculosis pati...
Predictors of Loss to follow-up
1. North American Journal of Medical Sciences | Sep 2014 | Volume 6 | Issue 9 | 453
Introduction
The widespread use of antiretroviral therapy (ART) has
transformed national AIDS responses and has had a huge
positive impact on health.[1]
ART has been shown to
reduce transmission of HIV and HIV-related morbidity
and mortality.[2]
In 2012, 9.7 million people received ART
in low- and middle-income countries (LMICs)[1]
and, as of
2013, ART prevented an estimated 4.2 million deaths in
LMICs in 2002-2012.[1]
However, while increased access
to ART has continued throughout the world, disparities
in ART access still exist.
Despite improved and highly successful programmatic
coverage with ART, significant numbers of adults and
children drop out of care at various points along the
treatment pathway and treatment gains fail to reach
sufficient numbers of children and adolescents.[1]
It is
essential to understand how and why people drop out of
treatment programs, since retention of people on ART and
ensuring adherence to treatment are critical determinants
of successful long-term outcomes. Studies in sub-Saharan
Africa have shown that about half of people who test
HIV-positive are lost between testing and being assessed
Predictors of Loss to follow-up in Patients
Living with HIV/AIDS after Initiation
of Antiretroviral Therapy
Tezera Moshago Berheto, Demissew Berihun Haile1
, Salahuddin Mohammed1
Department of Public Health, Aman College of Health Sciences, Mizan-Teferi, 1
Department of Pharmacy, College of Health
Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
Abstract
Background: Long-term regular follow up of ART is an important component of HIV care. Patients who are lost to follow-up (LTFU)
while on treatment compromise their own health and the long-term success of ART programs. Aim: This study was aimed at determining
the incidence and risk factors for LTFU in HIV patients on ART at ART clinic of Mizan-Aman General Hospital, Ethiopia. Materials
and Methods: A retrospective cohort study of 2133 people living with HIV/AIDS and attending an ART clinic between 2005 and 2013
was undertaken. LTFU was defined as not taking an ART refill for a period of 3 months or longer from the last attendance for refill and
not yet classified as ‘dead’ or ‘transferred-out’. The log-rank test was used to measure differences in time to LTFU between groups and
Cox proportional hazards modeling was used to measure predictors of LTFU. Results: Of 2133 patients, 53.9% were female. The mean
(SD) age of the cohort was 31.5 (8.0), 16 (2.2), and 3.8 (3.0) years for adults, adolescents, and children, respectively. Around 574 (26.7%)
patients were defined as LTFU. The cumulative incidence of LTFU was 8.8 (95% CIs 8.1-9.6) per 1000 person months. Patients with regimen
substitution (HR 5.2; 95% CIs 3.6-7.3), non-isoniazid (INH) prophylaxis (HR 3.7; 95% CIs 2.3-6.2), adolescent (HR 2.1; 95% CIs 1.3-3.4),
and had a baseline CD4
count < 200 cells/mm3
(HR 1.7, 95% CIs 1.3-2.2) were at higher risk of LTFU. WHO clinical stage III (HR 0.6;
95% CIs 0.4-0.9) and IV (HR 0.8; 95% CIs 0.6-1.0) patients at entry were less likely to be LTFU than clinical stage I patients. There was no
significant difference in risk of LTFU in males and females. Conclusion: Overall, these data suggested that LTFU in this study was high.
Patients phase of life, drug related factors, and clinical stages were associated with LTFU in this study. Effective control measures in the
at-risk population need to be implemented to improve retention.
Keywords: Anti-retroviral therapy, AIDS, CD4, Cohort, Ethiopia, HIV, Lost to follow up, Mizan-Teferi, Predictors
Address for correspondence: Mr. Salahuddin Mohammed, Department of Pharmacy, College of Health Sciences, Mizan-Tepi University, Mizan-
Teferi, P.O BOX: 260, Ethiopia. E-mail: salahuddin_pharma48@yahoo.com
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2. Berheto, et al.: Predictors of LTFU in patients on ART
North American Journal of Medical Sciences | Sep 2014 | Volume 6 | Issue 9 |454
for eligibility for therapy, and 32% of people considered
eligibleforARTarethenlostbetweeneligibilityassessment
andinitiationofART.[3]
Datafrom23countriesindicatethat
average retention for people on ART decreases over time,
fromabout86%at12monthsto72%at60months.[1]
Lossto
follow-up(LTFU)negativelyimpactsontheimmunological
benefit of ART and increases AIDS-related morbidity,
mortality, and hospitalizations.[4]
LTFU in patients
receiving ART can result in serious consequences, such
as discontinuation of treatment, drug toxicity, treatment
failure due to poor adherence, and drug resistance;[5-7]
this
results in an increased risk of death[8-13]
of up to 40% in
studies of patients LTFU in sub-Saharan Africa.[14,15]
Poor
nutritional status, lower CD4 count, Tuberculosis (TB) co-
infection, advanced clinical staging, younger age, adverse
drugreactions,gapsinservices,andaccessibilitytoservices
are some of the predictors reported to be associated with
LTFU.[3,14,16-19]
Most studies from sub-Saharan countries have estimated
that 20-40% of patients on ART are lost to follow-up
due to underlying causative factors.[20,21]
Ethiopia has a
national HIV prevalence of 1.9%[22]
but the magnitude
and predictors of LTFU after initiation of ART are not
well-investigated. There are ongoing efforts to develop
comprehensive strategies and recommendations to
improve monitoring and optimize retention in care.
This study aimed to determine the prevalence of, and
identify potential risk factors for, LTFU in an ART clinic
in southwest Ethiopia.
Materials and Methods
Ethical approval
Ethical approval was obtained from the Institutional
Review Board of the Mizan-Tepi University. Written
informedconsentwasnotfeasiblebecausethiswasanalysis
of secondary data retrieved from an electronic database
of the Hospital. Data were anonymized and handled
confidentially during all phases of research activities.
Design and study setting
A retrospective cohort study was conducted in all
patients who initiated ART at the governmental
Mizan-Aman General Hospital in the Southern Nations
Nationalities People Regional state of Ethiopia, 574 km
southwest from Addis Ababa. This ART service was
initiated in 2003 and patients who had received ART
since 2005 were identified from the program database
and selected for study.
Description of loss to follow up
LTFU was defined as not taking an ART refill for a period
of 3 months or longer from the last attendance for refill
and not yet classified as ‘dead’ or ‘transferred-out’.[3]
The time to LTFU was calculated in months according
to the time interval between the dates of ART initiation
to drop out, as recorded by the ART registration health
information data manager. The cohort was stratified into
three age-groups: Children (age ≤10 years), adolescents
(age 11-19 years), and adults (age ≥20 years) as used by
previous studies.[23,24]
Data source and collection
The data for this research was secondary data collected
routinely in the hospital for clinical monitoring and
evaluation purposes and entered in an ART electronic
database during the follow-up time. Further details
are fully described elsewhere.[23]
The primary outcome
variable was LTFU from ART follow-up care after
initiation of treatment, confirmed by reviewing medical
registration at the hospital, noted by ART adherence
supporters. Data recording started from the date
that patients started regular HIV care in the clinic
to confirmation of a final event. Socio-demographic
characteristics such as age and sex, ART drugs received,
CD4 counts, clinical staging (I-IV), TB co-morbidity,
functional status (working, ambulatory, or bed-ridden),
and outcomes were all included for this study.
All data relating to patients with an HIV-positive
diagnosis (CD4 count ≤200 cells/mm3
or who met
clinical staging (WHO Stage III or IV) according to
national ART guidelines effective up to 2012) and who
initiated ART prior to 2012 were included. Patients with
a CD4 count less than 350 cells/mm3
were eligible to
take ART medication, based on 2010 WHO guidelines.
Patients of any age who commenced ART at the due
date were considered eligible for study. A total of
2655 patients had enrolled to receive ART services and
all data from those living with HIV were retrieved for
analysis. A proportion of HIV patients (522; 19.7%)
were transfer-out who continued their ART medication
elsewhere and were therefore excluded from the
analysis.
Statistical analysis
The database was recorded in Microsoft Excel, checked
for consistencies and completeness, and then cleaned
and edited prior to performing analysis in SPSS 20.0 and
STATA 11. The patient characteristics were described in
terms of mean/median or percentage, as appropriate.
The Kaplan-Meier technique was used to estimate time
to LTFU after initiation of ART, with the log-rank test
being used to test the significance of observed differences
between groups. The Cox proportional hazards
regression model was used to determine predictors of
LTFU, expressed as estimated hazard ratios (HRs) with
95% confidence intervals (CIs).
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3. Berheto, et al.: Predictors of LTFU in patients on ART
North American Journal of Medical Sciences | Sep 2014 | Volume 6 | Issue 9 | 455
Results
A total of 2133 patients on ART between 2005 and 2013
and followed for 65,022 person-months were included in
the statistical analysis. The number of clients who started
ART each year is shown in Figure 1. The median (IQR)
follow-up was 25 (8-47) months. Of 2133 patients, 128
(6%) were children, 74 (3.5%) were adolescents, and 1931
(90.5%) were adults. The mean (standard deviation) age
of the cohort was 31.5 (8.0), 16 (2.2), and 3.8 (3.0) years
for adults, adolescents, and children, respectively. 1149
(53.9%) patients were female and there was a higher
proportion of females in the adolescent (63, 85.1%)
and adult (1036, 53.7%) groups, whereas there were
more males in the children group (78, 60.9%), [Table 1].
Only 78%, 50%, and 38% of child, adolescent, and adult
participants, respectively, were started on ART with CD4
counts ≥200 cells/mm3
. However, there was a trend to a
higher baseline CD4 count in adults and adolescents over
time with cohort enrolment; those who were enrolled
earlier had lower baseline CD4 counts than those who
started later. TB co-infection was present in 19.5%
of children, 23% of adolescents, and 21.5% of adults
throughout the follow-up period.
Regimen substitutions were made in 18% (n = 354) of
adults, 14% (n = 18) of children, and 23% (n = 17) of
adolescents. Drug toxicities were responsible for 50%
of regimen substitutions in adults, 47% in adolescents,
and 27% in children. Reasons for regimen substitution
included pregnancy 41 (11.6%), new TB infection 24
(6.2%), planning to fall pregnancy 7 (2%), advent of
new drug of choice 4 (1%), drug stock-out 2 (0.5%) and
others 22 (5.7%). There were no regimen substitutions
due to treatment failure in the cohort. The median (IQR)
duration of follow-up for patients who were LTFU was
9 months (5-18). At the end of the follow-up period,
65.5% (n = 1398) were actively being followed up and
on ART, 7.5% (n = 159) had died and two individuals
had reported discontinuing their medications. A total
of 26.7% (n = 574) patients were defined as LTFU. The
overall proportion of attrition due to both death and
LTFU during the study period was 733 (34.4%) and
the cumulative incidence (95% CIs) of attrition due to
LTFU and death was 11.1 (10.4-11.9) per 1000 person-
months. The cumulative incidence of LTFU (95% CIs)
was 8.8 (8.1-9.6) per 1000 person-months. After people
start ART, the retention rates are initially high and then
gradually decline. The probability of retention (95% CIs)
on ART at the 6th
, 12th
, and 24th
months after initiation of
treatment was 92.0% (90.6-93.0), 82.3% (81.1-84.0) and
75.0% (73.2-77.01), respectively.
Table1:Age-sexdistributionandclinicalcharacteristics
ofARTpatientsbyagecategoryatMizan-AmanGeneral
Hospital,Jan07,2005toMay08,2013
Characteristics Age category n (%)
Children Adolescents Adults
Sex (n=2133)
Male 78 (60.9) 11 (14.9) 895 (46.3)
Female 50 (39.1) 63 (85.1) 1036 (53.7)
Age [n=2133, Mean (SD)] 3.8 (3) 16.9 (2.2) 31.5 (8)
Base line CD4 (n=2050,
median (IQR)=166 (89,256)
369
(240, 826)
196
(100, 278)
160
(86, 246)
CD4 category
0-49 2 (2.7) 6 (8.6) 210 (11.6)
50-199 14 (19.2) 29 (41.4) 913 (50.3)
≥200 57 (78.1) 35 (50) 692 (38.1)
WHO stage at entry
(n=2133)
Stage I and II 20 (15.7) 16 (21.7) 549 (.285)
Stage III 88 (68.8) 49 (66.2) 1129 (58.5)
Stage IV 20 (15.7) 9 (12.2) 23 (13.1)
Functional status at entry
(n=2133)
Bedridden 29 (17.3) 2 (2.3) 145 (6)
Ambulatory 113 (67.3) 27 (31) 570 (23.8)
Working 26 (15.5) 58 (66.7) 1685 (70.2)
TB co-infection (n=2133)
Yes (+ve) 2 (19.5) 17 (23) 415 (21.5)
No (–ve) 103 (80.5) 57 (77) 1516 (78.5)
INH (n=2133)
Yes 5 (3.9) 10 (13.5) 189 (9.8)
No 123 (96.1) 64 (86.5) 1742 (90.2)
Regimen containing NVP
(n=2133)
Yes 104 (81.1) 37 (50) 764 (39.6)
No 24 (18.8) 37 (50) 1167 (60.4)
Cotrimoxazole prophylaxis
(n=2133)
Yes 112 (87.5) 64 (86.5) 2131 (88.8)
No 16 (12.5) 10 (13.5) 269 (11.2)
Regimen Substitution
(n=2133)
Yes 18 (14.1) 17 (23) 354 (18.3)
No 110 (85.9) 57 (77) 1577 (81.7)
INH = Isoniazid
Figure 1: Number of Clients startedARTby each year at Mizan-Aman
General Hospital, Jan 07, 2005 to May 08, 2013.jpg
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4. Berheto, et al.: Predictors of LTFU in patients on ART
North American Journal of Medical Sciences | Sep 2014 | Volume 6 | Issue 9 |456
Risk factors associated with LTFU after ART
initiation
In a multivariate Cox regression model [Table 2], age
category, regimen substitution, WHO clinical staging,
CD4 cell count, non-isoniazid (INH) prophylaxis, and
functional status were independent risk factors for
LTFU [Figure 2]. Adolescent aged 11-19 years (HR 2.1;
95% CIs 1.3-3.4) and adults aged >20 yrs were at higher
risk of LTFU (HR 1.4; 95% CIs 1.0-2.0) when compared
to children aged ≤10 yrs. Men and women were at equal
risk of LTFU [Figure 3]. The risk of LTFU in patients with
WHO clinical stage III (HR 0.6; 95% CIs 0.44-0.9) and
clinical stage IV (HR 0.8; 95% CIs 0.6-1.0) at entry were
lower compared to clinical stage I.
The risk of LTFU was higher in patients with baseline
CD4 cell counts <200 cells/mm3
(HR 1.7; 95% CIs 1.3-2.2)
compared to baseline CD4 counts ≥200 cells/mm3
. The
riskofLTFUinpatientswhodidnottakeINHprophylaxis
was higher than those who did (HR 3.7; 95% CIs 2.3-6.1).
Patients who made regimen substitutions during the
follow-up period had a higher risk of LTFU (HR 5.2; 95%
CIs3.6-7.3).TBco-infectionwasnotassociatedwithLTFU.
Discussion
Several studies have shown that LTFU poses challenges
to the successful implementation of ART programs in
LMICs.[1,3]
In this study, the incidence rate was estimated
to be 8.8 per 1000 person-months. Other studies have
shown that patients who discontinued ART developed
a rapid increase in viral load and depletion of CD4
T lymphocytes, putting them at risk of opportunistic
infections and early death.[25]
Therefore, understanding
the risk factors for LTFU is necessary to maintain
adherence and intervene in groups of patients. In
this analysis, it was estimated that the prevalence of
LTFU from ART was 26.7%, higher than that reported
in other African countries and the Oromia region of
Ethiopia.[15,26-28]
However, ART clinics in the United
Kingdom have reported a LTFU of 38.8%; of these, after
intensive investigational activities for true outcomes,
Figure 2: Cumulative incidence of loss to follow up by functional
status Figure 3: Cumulative incidence of loss to follow up by gender
Table 2: Cox regression analysis of factors associated
with LTFU HIV infected patients on ART therapy
at Mizan-Aman General Hospital, January 2005 to
May 2013
Variables N (%) Adjusted HR
(95% CI)
P-value
Age category 2133
Child ≤10 yrs. 128 (6) R
Adolescent (11-19 yrs). 74 (3.5) 2.1 (1.3, 3.4) 0.002
Adult ≥20 yrs. 1931 (90.5) 1.4 (1.0, 2.0) 0.010
Gender 2133
Male 984 (46.1) 0.9 (1.1 ,0.8) 0.482
Female 1149 (53.9) R
WHO clinical stage 2133
Stage I 225 (10.5) R
Stage II 360 (16.9) 0.7 (0.5, 1.0) 0.117
Stage III 1266 (59.4) 0.6 (0.4, 0.8) 0.007
Stage IV 282 (13.2) 0.7 (0.6, 1.0) 0.037
Functional status at entry 2133
Working 1441 (67.6) R
Ambulatory 549 (25.7) 0.4 (0.3,0.6) 0.001
Bedridden 143 (6.7) 0.7 (0.5, 0.9) 0.005
Ever INH 2133
Yes 240 (9.6) R
No 1929 (90.4) 3.7 (2.2, 6.1) 0.001
CD4 category at entry 1958(100)
≤50 218 (11.1) 1.04 (0.853, 1.267) 0.698
50-199 956 (48.8) 1.663 (1.268, 2.181) 0.000
≥200 784 (40.0) R
TB status 2133
Yes (+ve) 457 (21.4) 1.06 (0.712, 1.572) 0.078
No (–ve) 1676 (78.6) R
Regimen substitution 2133
Yes 389 (18.2) 5.1 (3.6, 7.3) 0.001
No 1744 (81.8) R
INH = Isoniazid, TB = Tuberculosis
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5. Berheto, et al.: Predictors of LTFU in patients on ART
North American Journal of Medical Sciences | Sep 2014 | Volume 6 | Issue 9 | 457
51.7% were actually found to be LTFU, either those who
were alive but had stopped their ARV or untraceable.[29]
LTFU is not only an LMIC problem.
Consistent with our data, report from the British HIV
Association 2008[30]
has shown that the risk of LTFU
increases with decreasing CD4 counts at the entry point
of ART, whereas in Switzerland there was an opposite
trend in the risk of LTFU; patients with higher CD4 cell
counts were more likely to be lost to follow-up.[26]
The
main reasons in rising incidence of LTFU have been
ascribed to poor patient tracing in the low-income setting
and due to lack of reporting the risk of death events
that can be considered as LTFU.[1]
Our study found that
adolescents were twice, and adults 1.4 times, more likely
to become lost to follow-up than children. A study from
Uganda showed that the incidence of mortality was
lower in children[31]
; this may suggest that the competing
risk of death impacts on this age-group. Children may
also be less exposed to stigma and discrimination (two
common risks for LTFU) and the caretakers or parents are
more likely to look after children that, reducing LTFU.
During adolescence, a number of challenges have been
identified that may compromise positive outcomes from
HIV care. Adolescents may be particularly defiant, may
not have caregivers (in contrast to younger children),
may show immaturity in analytical thinking, and there
may be particular challenges associated with puberty
and high LTFU. Previous studies have also shown that
adherence is lower in adolescents than adults.[13,32,33]
We detected no gender difference in LTFU, in contrast
to several other studies that have shown that men
are more likely to become lost to follow-up due to
variation in mobility and a high risk of drug abuse in
men, that may interfere with adherence.[17]
Most men
with drug addiction may experience higher toxicity
due to interaction with ARV drugs that leads to
discontinuation.[34]
The detection of a difference in gender
was compromised in this study due to cultural influences
such as habit of chewing, alcohol consumption, religion,
stigmas and lower mobility of the male population for
inter-regional trade purpose in this particular study
area. Patients with advanced clinical stage (III and IV)
at entry were less likely to be lost to follow-up. This is in
contrast to other African studies, which have shown the
opposite.[35,36]
Our study suggested that clinical stage III
and IV patients have increased health-seeking behavior,
or it may be ascribed to improvements in awareness of
community. Outside Africa, a Swiss study showed a
statistically non-significant trend,[26]
but a French study,
similar to ours showed that a history of an AIDS-defining
illness was associated with reduced LTFU.[37]
Patients who did not take INH prophylaxis were more
likely to be lost to follow-up. Patients generally believe
that if they are in the advanced stages of HIV/AIDS or
considered immunocompromised, they should strictly
maintain follow-up so that they can start prophylaxis
and not be deemed unhealthy. Increase in reinforced
counseling to patients taking INH prophylaxis might
have contributed to better follow-up. TB is a leading
cause of morbidity and mortality in people living with
HIV, including those on ART. However, we saw no
significant association between LTFU status and TB
co-infection. Patients who had substitutions in their
regimen during the follow-up period were at higher
risk of LTFU, similar to an Indian study that reported
that substitution of drugs can be risk factor for ART
default.[17]
The majority of regimen substitution cases in
this study were due to adverse drug reactions, so these
patients may have become concerned about side effects
and the effectiveness of new medication, causing them
to seek other treatment options. Skin hypersensitivity
reactions are common in patients taking nevirapine
(NVP) containing ART regimens. Most patients report
that they experience zidovudine (AZT)-induced anemia
and stavudine (D4T) induced peripheral neuropathy.
All these adverse effects commonly managed through
efavirenz (EFZ) in NVP induced rash and tenofovir
(TDF) or stavudine for zidovudine-induced anemia.[38]
The fear of side-effects is known to be a major cause
of default.[25]
This subgroup of patients who lose faith
in the medication program, irrespective of the reason
for substitution, require special attention and frequent
counseling in order to preserve retention in the ART
program.
The probability of attrition from care was directly
associated with the length of engagement with ART care.
A higher proportion of LTFU was recorded in the first
6 months after ART initiation. Generally, the likelihood
of dropping out from care gradually increases with
longer retention period. The high risk factors for LTFU
after initiation of ART were thought to be due to gaps
in counseling services while refilling, assessment of
ART outcomes by physicians, and tracing service by cell
phones only. The main drawback of this service in this
particular community assumed to be limited coverage
of network and higher rate of cell phone non-users. This
finding is consistent with many other studies, which
reported that a large proportion of patients dropped-out
from care within the first year of ART, the peak period
being the first 6 months of ART. This has been suggested
to be due to less awareness at these early time-points
about treatment outcomes, whether adverse or beneficial.
Our study had some limitations that resulted from poor
tracing of patients in the ART program’s monitoring
and evaluation system, patients who were LTFU may
have died or self-referred to other facilities. Thus,
the findings addressed crudely LTFU who might be
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6. Berheto, et al.: Predictors of LTFU in patients on ART
North American Journal of Medical Sciences | Sep 2014 | Volume 6 | Issue 9 |458
dead, untraceable, self-transfer outs, and defaulters.
The concerted influences of these factors may affect
the accurate record keeping procedures in this clinic.
Decreasing LTFU of patients through provision of
tracking system is crucial for minimizing early mortality,
complications of HIV, reducing viral transmission, and
ensuring success of ART programs.
Conclusion
We report a comparatively high rate of LTFU from an
Ethiopian ART clinic. Low CD4 counts, adolescence,
being in good health, regimen substitution, and
advanced clinical stage were found to be risk factors for
LTFU. Improving comprehensive counseling services,
follow-up for adverse reactions and introducing an ART
outcome evaluation program may help reduce LTFU
to an acceptable level. Our results highlight the need
to better understand the health-seeking behaviors of
patients with ART and to implement strategies in HIV
clinics for better tracking services and minimizing LTFU
from HIV care. Change in way of tracing services like
community education, scaling up of health extension
services community wide, and increasing awareness
by media may reduce LTFU. The lost to follow-up is of
particular importance to ART programs because they
potentially endanger not only their own life, but also
contribute to increased HIV drug resistance due to ART
default.[11,12]
Further studies that address the profiles of
LTFU patients and the contributing factors are required
for clarity.
Abbreviations
AIDS: acquired immunodeficiency syndrome;
ART: Antiretroviral therapy; CIs: confidence intervals;
HIV: human immunodeficiency virus; HR: hazard ratios;
INH: Isoniazid; IQR: interquartile range; LMICs: Low-
and middle-income countries; LTFU: loss to follow up;
SD: standard deviations; TB: Tuberculosis; WHO: World
Health Organization
Acknowledgment
We acknowledge the kind assistance given by all the staff in the
ART clinics. The authors also gratefully acknowledge editorial
assistance from the Nextgenediting Global Initiative.
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How to cite this article: Berheto TM, Haile DB, Mohammed S. Predictors
of loss to follow-up in patients living with HIV/AIDS after initiation of
antiretroviral therapy. North Am J Med Sci 2014;6:453-9.
Source of Support: Nil. Conflict of Interest: None declared.
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