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Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study..pdf (321.69 kB)

Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study

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posted on 2016-03-11, 14:26 authored by David Burtle, William Welfare, Susan Elden, Canaan Mamvura, Joris Vandelanotte, Emily PetherickEmily Petherick, John Walley, John Wright
Objective: To implement and evaluate a formal pre-antiretroviral therapy (ART) care service at a district hospital in Swaziland. Design: Operational research. Setting: District hospital in Southern Africa. Participants: 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. Intervention: 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. Primary and secondary outcome measures: 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). Results: 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). Conclusions: 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.

Funding

This document is an output from a project funded by UK Aid from the UK Department for International Development (DFID) for the benefit of developing countries.

History

School

  • Sport, Exercise and Health Sciences

Published in

BMJ Open

Volume

2

Issue

2

Citation

BURTLE, D. ... et al, 2012. Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study. BMJ Open, 2, e000195.

Publisher

BMJ Publishing Group

Version

  • VoR (Version of Record)

Publisher statement

This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial 2.0 Unported (CC BY-NC 2.0) licence. Full details of this licence are available at: http://creativecommons.org/licenses/by-nc/2.0/

Publication date

2012

Notes

This is an Open Access article and is available for use under the terms of the Creative Commons Attribution Non-Commercial 2.0 Licence (https://creativecommons.org/licenses/by-nc/2.0/)

eISSN

2044-6055

Language

  • en

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