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Title: Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study
Authors: Burtle, David
Welfare, William
Elden, Susan
Mamvura, Canaan
Vandelanotte, Joris
Petherick, Emily S.
Walley, John
Wright, John
Issue Date: 2012
Publisher: BMJ Publishing Group
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.
Abstract: 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.
Description: 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/)
Sponsor: 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.
Version: Published
DOI: 10.1136/bmjopen-2011-000195
URI: https://dspace.lboro.ac.uk/2134/20556
Publisher Link: http://dx.doi.org/10.1136/bmjopen-2011-000195
Appears in Collections:Published Articles (Sport, Exercise and Health Sciences)

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