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Adeyemi, Olukemi, Mary Lyons, Tsi Njim, Joseph Okebe, Josephine Birungi, Kevin Nana, Jean Claude Mbanya, et al. "Integration of non-communicable disease and HIV/AIDS management: a review of healthcare policies and plans in East Africa." BMJ Global Health 6, no. 5 (May 2021): e004669. http://dx.doi.org/10.1136/bmjgh-2020-004669.
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BackgroundLow-income and middle-income countries are struggling to manage growing numbers of patients with chronic non-communicable diseases (NCDs), while services for patients with HIV infection are well established. There have been calls for integration of HIV and NCD services to increase efficiency and improve coverage of NCD care, although evidence of effectiveness remains unclear. In this review, we assess the extent to which National HIV and NCD policies in East Africa reflect the calls for HIV-NCD service integration.MethodsBetween April 2018 and December 2020, we searched for policies, strategies and guidelines associated with HIV and NCDs programmes in Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. Documents were searched manually for plans for integration of HIV and NCD services. Data were analysed qualitatively using document analysis.ResultsThirty-one documents were screened, and 13 contained action plans for HIV and NCDs service integration. Integrated delivery of HIV and NCD care is recommended in high level health policies and treatment guidelines in four countries in the East African region; Kenya, Rwanda, Tanzania and Uganda, mostly relating to integrating NCD care into HIV programmes. The increasing burden of NCDs, as well as a move towards person-centred differentiated delivery of services for people living with HIV, is a factor in the recent adoption of integrated HIV and NCD service delivery plans. Both South Sudan and Burundi report a focus on building their healthcare infrastructure and improving coverage and quality of healthcare provision, with no reported plans for HIV and NCD care integration.ConclusionDespite the limited evidence of effectiveness, some East African countries have already taken steps towards HIV and NCD service integration. Close monitoring and evaluation of the integrated HIV and NCD programmes is necessary to provide insight into the associated benefits and risks, and to inform future service developments.
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Santos, Edwiges, Andre Japiassu, Marcia Lazera, and Fernando Bozza. "Fungal disease in AIDS patients in intensive care." Critical Care 17, Suppl 4 (2013): P41. http://dx.doi.org/10.1186/cc12941.
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Metrikin, Aaron S., Merrick Zwarenstein, Malcolm H. Steinberg, Estelle Van Der Vyver, Gary Maartens, and Robin Wood. "Is HIV/AIDS a primary-care disease? Appropriate levels of outpatient care for patients with HIV/AIDS." AIDS 9, no. 6 (June 1995): 619–24. http://dx.doi.org/10.1097/00002030-199506000-00014.
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Rusingiza, Emmanuel K., Ziad El-Khatib, Bethany Hedt-Gauthier, Gedeon Ngoga, Symaque Dusabeyezu, Neo Tapela, Cadet Mutumbira, et al. "Outcomes for patients with rheumatic heart disease after cardiac surgery followed at rural district hospitals in Rwanda." Heart 104, no. 20 (April 20, 2018): 1707–13. http://dx.doi.org/10.1136/heartjnl-2017-312644.
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BackgroundIn sub-Saharan Africa, continued clinical follow-up, after cardiac surgery, is only available at urban referral centres. We implemented a decentralised, integrated care model to provide longitudinal care for patients with advanced rheumatic heart disease (RHD) at district hospitals in rural Rwanda before and after heart surgery.MethodsWe collected data from charts at non-communicable disease (NCD) clinics at three rural district hospitals in Rwanda to describe the outcomes of 54 patients with RHD who received cardiac valve surgery during 2007–2015.ResultsThe majority of patients were adults (46/54; 85%), and 74% were females. The median age at the time of surgery was 22 years in adults and 11 years in children. Advanced symptoms—New York Heart Association class III or IV—were present in 83% before surgery and only 4% afterwards. The mitral valve was the most common valve requiring surgery. Valvular surgery consisted mostly of a single valve (56%) and double valve (41%). Patients were followed for a median of 3 years (range 0.2–7.9) during which 7.4% of them died; all deaths were patients who had undergone bioprosthetic valve replacement. For patients with mechanical valves, anticoagulation was checked at 96% of visits. There were no known bleeding or thrombotic events requiring hospitalisation.ConclusionOutcomes of postoperative patients with RHD tracked in rural Rwanda health facilities were generally good. With appropriate training and supervision, it is feasible to safely decentralise follow-up of patients with RHD to nurse-led specialised NCD clinics after cardiac surgery.
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Vivithanaporn, P., H. B. Krentz, L. DeBlock, M. J. Gill, and C. Power. "PO09-MO-10 Neurological disease burden among HIV/AIDS patients receiving active care." Journal of the Neurological Sciences 285 (October 2009): S194. http://dx.doi.org/10.1016/s0022-510x(09)70746-4.
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Katz, Irwin, R. Glen Hass, Nina Parisi, Janetta Astone, Denise McEvaddy, and David J. Lucido. "Lay People's and Health Care Personnel's Perceptions of Cancer, Aids, Cardiac, and Diabetic Patients." Psychological Reports 60, no. 2 (April 1987): 615–29. http://dx.doi.org/10.2466/pr0.1987.60.2.615.
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Although some writers assume that negative attitudes toward cancer and other chronic disease patients are prevalent, systematic data have been scarce. Perceptions of patients and their illnesses were assessed for college students, nurses, medical students, and chiropractic students. Subjects rated cancer, AIDS, diabetes, and heart disease patients, as well as the nonill, on 21 bipolar trait items, selected to measure competence, moral worth, dependence, depression, and morbidity. There were also measures of social distance, cancer anxiety, disease beliefs, and ascribed illness responsibility. With minor exceptions, all subsamples perceived cancer victims less favorably than diabetics, heart patients, and the nonill on competence, dependence, depression, and morbidity. Cancer patients were always seen as even more depressed than AIDS sufferers but were rated just as favorably as well people on moral worth. People with AIDS were generally the most negatively evaluated and most rejected group. Cancer was consistently described as the most painful condition and, next to AIDS, the least understood medically and most deadly. Cancer anxiety was moderately predictive of perceptions of cancer victims, and ratings of illness responsibility were moderately predictive of moral worth ratings for the cancer and AIDS groups. Theoretical and practical implications were discussed.
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Mohata, Nehal Nareshkumar, Saud Gafur Deshmukh, Sudhir Sudhakar Pendke, Akshay Rajeshwar Padgilwar, and Sunil Devrao Dokhale. "Ocular manifestation in human immunodeficiency virus patients presenting to tertiary eye care centre in rural area." Indian Journal of Clinical and Experimental Ophthalmology 7, no. 2 (June 15, 2021): 363–65. http://dx.doi.org/10.18231/j.ijceo.2021.071.
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The ocular manifestations of HIV/AIDS may lead to visual impairment or blindness. The need of hour is an understating of ocular sequelae of HIV infection leading to an early diagnosis of AIDS so that we can start early and effective treatment as per conditions.1. To study the prevalence of ocular manifestations in HIV patients; 2. To study relation of CD4 T Cell count with ocular diseases. The study concluded that HIV/AIDS is a significant cause of ocular disease. Almost around 39% patients having HIV/AIDS have eye disease. HIV Retinopathy is most common in posterior segment and lens involvement is most common in anterior segment manifestations. Usually, early presentation of ocular manifestations in HIV/AIDS patients is asymptomatic or with very less symptoms, which leads to delay in diagnosis and treatment.
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Mukakarangwa, Marie Claire, Geldine Chironda, Busisiwe Bhengu, and Godfrey Katende. "Adherence to Hemodialysis and Associated Factors among End Stage Renal Disease Patients at Selected Nephrology Units in Rwanda: A Descriptive Cross-Sectional Study." Nursing Research and Practice 2018 (June 3, 2018): 1–8. http://dx.doi.org/10.1155/2018/4372716.
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Introduction. Worldwide, End Stage Renal Disease (ESRD) has become a public health concern increasing the number of patients maintained on hemodialysis prior to renal transplantation. Nonadherence to hemodialysis continues to impact on the care of ESRD patients, causing high increase in morbidity and mortality. Purpose of the Study. The purpose of this study was to determine the level of adherence to hemodialysis and the associated factors among End Stage Renal Disease (ESRD) patients in selected nephrology units in Rwanda. Methods. This was a descriptive cross-sectional design involving 41 participants. Participants were recruited using a purposive sampling technique. Demographic and adherence to hemodialysis data were collected with the use of structured interview schedules. Descriptive statistics were used to describe the demographic variables and the level of adherence to hemodialysis. Inferential statistics of chi-square was used to establish factors associated with adherence to hemodialysis. Results. Twenty-one (51%) of ESRD participants adhered highly (scores < 80%) to HD. Seventeen (42%) adhered moderately (70–79%) to HD while three (7%) had low level of adherence to HD (below 70%). The factors associated with adherence to hemodialysis were age (mean = 27; 95% CI 26.76–29, 17; p = 038) and religion (95% CI 26.29–60.12, p = 003). Frequencies of education of health care workers about the importance of not missing dialysis (95% CI 26.71–42.56, p = .000), perceived relative importance of hemodialysis (95% CI 20.44–27.76, p = .020), and experiencing difficulties during the procedure (95% CI 20.80–28.36, p = .004) were significantly associated with adherence to hemodialysis. Conclusion. Adherence to hemodialysis is still a public health concern in Rwanda. Health care providers and particularly nurses should continue to advocate for adherence to HD for better health outcomes. Further research is needed to identify the barriers to HD in Rwanda.
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Coker, R. J., and D. M. Mitchell. "The Role of Bronchoscopy in Patients with HIV Disease." International Journal of STD & AIDS 5, no. 3 (May 1994): 172–76. http://dx.doi.org/10.1177/095646249400500303.
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Pulmonary involvement is a frequent feature of patients infected with the human immunodeficiency virus (HIV). Pneumocystis carinii pneumonia (PCP) is still the commonest AIDS defining diagnosis despite the advent of effective prophylaxis and antiretroviral treatment. Other pulmonary manifestations of AIDS, including tuberculosis, may pose a greater problem in the future. The clinical manifestations of HIV-disease are many and varied, and changing as the disease is modified by therapeutic interventions. With specific and increasingly effective treatments the need for definitive diagnosis is obvious. Fibreoptic bronchoscopy is a well established tool for the diagnosis of HIV-related pulmonary complications. This article aims to give an account on the use of bronchoscopy in a unit providing care for many HIV seropositive patients.
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Mukasahaha, D., F. Uwinkindi, L. Grant, J. Downing, J. Turyahikayo, M. Leng, and M. A. Muhimpundu. "Assessment of Palliative Care Needs in Hospital Settings in Rwanda." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 111s. http://dx.doi.org/10.1200/jgo.18.78900.
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Background: Rwanda is among the first African countries with a palliative care (PC) policy and implementation plan. A partnership with the Ministry of Health (MoH) through the Rwanda Biomedical Centre (RBC) and the University of Edinburgh has supported an integrated approach including expanding the evidence base. Aim: To assessing the need for (PC) to inform policy, service delivery and training. Methods: A point prevalence PC needs assessment was conducted in nine public hospitals (referral, provincial and district). A records census identified those with life-limiting illness (LLI) who were then invited to participate by interview. The assessment tool included the APCA African POS, POS S, WHO performance status and demographic information. Results: 608 case notes were reviewed, 152 eligible and 124 completed assessment. 25% of all patients admitted had LLI, of which 99.2% had evidence of unmet need determined by at least one score on the APCA POS ≥ 3. Diagnoses 29% cancer, 29% cardiovascular disease, 16.9% end-stage organ failure and 13.7% HIV. Symptoms with greatest impact; nausea and vomiting (34.7%) and pain (32.3%). 63.7% with WHO performance status 4 or 5. 8.1% seen by existing PC services. Conclusion: Although the MoH and RBC are making bold steps toward developing PC in Rwanda, there remains a significant amount of unmet PC needs. Meeting this need requires recognition of the scope of PC needs beyond cancer, feedback to the hospitals and health care workers, thinking strategically how to further strengthen the health system and further capacity building and training.
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Stewart, Ann, Soo Chan Carusone, Kent To, Nicole Schaefer-McDaniel, Mark Halman, and Richard Grimes. "Causes of Death in HIV Patients and the Evolution of an AIDS Hospice: 1988–2008." AIDS Research and Treatment 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/390406.
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This paper reports on the transformation that has occurred in the care of people living with HIV/AIDS in a Toronto Hospice. Casey House opened in the pre-HAART era to care exclusively for people with HIV/AIDS, an incurable disease. At the time, all patients were admitted for palliative care and all deaths were due to AIDS-defining conditions. AIDS-defining malignancies accounted for 22 percent of deaths, mainly, Kaposi sarcoma and lymphoma. In the post-HAART era, AIDS-defining malignancies dropped dramatically and non-AIDS-defining malignancies became a significant cause of death, including liver cancer, lung cancer and gastric cancers. In the post-HAART era, people living with HIV/AIDS served at Casey House have changed considerably, with increasing numbers of patients facing homelessness and mental health issues, including substance use. Casey House offers a picture of the evolving epidemic and provides insight into changes and improvements made in the care of these patients.
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Schleimer, Lauren E., Jean-Marie Vianney Dusengimana, John Butonzi, Catherine Kigonya, Abirami Natarajan, Aline Umwizerwa, Daniel S. O’Neil, et al. "Barriers to Timely Surgery for Breast Cancer in Rwanda." Journal of Global Oncology 4, Supplement 1 (March 2018): 28s. http://dx.doi.org/10.1200/jgo.18.22000.
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Abstract 81 Purpose Surgery is the mainstay of treatment for nonmetastatic breast cancer. Little is known about the quality of breast surgical care in sub-Saharan Africa. Research at the Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center, has suggested that access to timely surgery is inadequate, but barriers have not been systematically examined. The aim of the current study was to gain an understanding of the barriers to breast cancer surgery among patients who were diagnosed at BCCOE by investigating delays and interruptions in care. Methods We used a standardized chart abstraction instrument to collect demographic, treatment, and outcome data as of November 2017 for all patients who were diagnosed with breast cancer at BCCOE in 2014 and 2015. We recorded all visits and treatments received until surgery, disease progression, or loss to follow-up for all patients with stage I to III breast cancer. Results During 2014 and 2015, 91 patients were diagnosed with stage I to III breast cancer and were treated with curative intent—67 patients (74%) underwent surgery, with 22 undergoing surgery at BCCOE and 45 elsewhere. Of the 24 patients with no surgery, 16 were lost to follow-up and eight experienced disease progression before surgical evaluation. Median time from diagnosis to surgery was 103 days (range, 30 to 826 days) for patients without neoadjuvant chemotherapy (NAC) and 268 days (range, 108 to 794 days) for patients with NAC. We defined surgical delays as > 120 days from diagnosis without NAC or > 365 days from diagnosis if NAC was administered. Of the 67 patients who had surgery, 26 patients (39%) experienced delays. When documented, reasons for delay included patient factors, such as social and/or financial issues (n = 5), seeking alternate treatment (n = 2), refusing referral to Kigali (n = 3), or any surgery (n = 1); system factors, such as surgeon nonavailability (n = 1); and changes in clinical status, such as pregnancy (n = 5), treatment-associated adverse events (n = 4), or the need for a second surgical opinion (n = 2). Unexplained failure to complete the initial surgical referral (n = 5) and missed NAC treatment appointments (n = 6) were frequent contributors. Some patients had multiple reasons for delay. For five patients, there was no documented explanation. Conclusion We observed high rates of loss to follow-up, surgical delays, and lapses in care at the point of surgical referral. Identification of the barriers to completing referrals could guide strategies for improving access to timely surgery. Efforts are needed to address social and financial barriers and explore patients’ refusals to undergo surgery. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
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Choy, Fred N., and William W. McCloskey. "Delivery of Infusion Therapies in the Home for Patients With Acquired Immunodeficiency Syndrome." Journal of Pharmacy Practice 5, no. 3 (June 1992): 151–57. http://dx.doi.org/10.1177/089719009200500308.
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Patients with acquired immunodeficiency syndrome (AIDS) often suffer from a variety of infectious and noninfectious complications as a result of their compromised immune status. Therapies that AIDS patients may require include antimicrobial therapy, parenteral nutrition, pain management, chemotherapy, and agents to regulate hematopoiesis. Although parenteral therapies have been more traditionally administered in a hospital, technological advances, economic advantages, and patient and clinician acceptance have helped establish home infusion therapy as a viable alternative for many patients with a chronic disease such as AIDS. Providing pharmaceutical care in the home care arena to patients with AIDS not only involves patient monitoring and parenteral product preparation, but also a thorough understanding of infection control practices. Working in conjunction with other health care professionals, pharmacists play a major role in helping to assure the safe and effective delivery of the complex therapies required by many patients with AIDS in the comfort of their homes.
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Wibisono, Yusuf, Indropo Agusni, Afif Nurul Hidayati, Rahmadewi Rahmadewi, Maylita Sari, Astindari Astindari, Septiana Septiana, and Dwi Murtiastutik. "Cutaneous Adverse Drug Reactions in Hospitalized HIV/AIDS Patients." Berkala Ilmu Kesehatan Kulit dan Kelamin 33, no. 2 (July 31, 2021): 96. http://dx.doi.org/10.20473/bikk.v33.2.2021.96-102.
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Background: Cutaneous adverse drug reaction (CADR) is the most common manifestation of drug hypersensitivity in humanimmunodeficiency virus (HIV), which presented as maculopapular rash. The incidence of CADR is found to be more commonin untreated HIV patients, and the frequency is higher in severe immunodeficiency status. Early diagnosis and appropriatetreatment give better outcomes. Purpose: To evaluate the incidence and management of CADR in HIV and acquired immunedeficiency syndrome (AIDS) patients. Methods: A retrospective descriptive study of HIV/AIDS patients with CADR whowere hospitalized at Intermediate Care and Infectious Disease Centre Dr. Soetomo General Academic Hospital. Result: Therewere more CADR cases in 2017, accounted 2.35% of the total Intermediate Care and Infectious Disease Centre RSUD Dr.Soetomo General Academic Teaching Hospital ward patients. There were more male patients (62.5%), with the mostcommonly found at the age of 25-44 years (64.3%), and which mostly (89.3%) originated from Surabaya. The most commondiagnosis was morbiliform eruption (60.7%), main complaint was red spots all over the body (45%), all of which are obscureerythematous macules. The most common causes were Duviral + Neviral antiretroviral (46%) and the most common treatmentwas dexamethasone injection. Conclusion: The incidence of CADR increased in 2017. The most frequent manifestation wasmorbilliform eruption due to Duviral+Neviral as the first line ARV treatment. Skin management varies widely in form oftopical, oral, and intravenous injection drugs, mostly using steroid class, dexamethasone intravenous injection in particular.
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Matsumoto, Sandra A., and Mary Frances Seideman. "Considerations in the Treatment of Acquired Immunodeficiency Syndrome Patients at Home." Journal of Pharmacy Practice 3, no. 1 (February 1990): 60–65. http://dx.doi.org/10.1177/089719009000300109.
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The rapidly growing acquired immunodeficiency syndrome (AIDS) population faces frequent, expensive hospitalization due to the debilitating sequelae of the disease. Home care offers these patients an opportunity to receive or complete their therapy in comfortable surroundings, allowing them to realize the psychosocial and financial benefits of outpatient care. A myriad of sophisticated drug therapies has been successfully administered in the home setting. Therapy for frequently occurring opportunistic infections often requires treatment with highly toxic drugs such as amphotericin, pentamidine, and ganciclovir. With thorough patient training and diligent monitoring by the home-care pharmacist and nurse, these agents can be safely administered at home. Conventional and investigational chemotherapy and immunomodulator therapy, such as interferon or erythropoeitin, can also be administered at home. Providing total parenteral nutrition to AIDS patients is a controversial treatment modality, but if indicated, it can also be accomplished at home. Outpatient pain management has allowed many patients with terminal or chronic illnesses to minimize time spent in hospitals or extended care facilities, and it can offer the same advantages to patients with AIDS. The psychosocial ramifications of AIDS and its impact on patients and health care professionals must be understood in order to effectively provide total patient care at home. The challenge to the homecare pharmacist is to acquire and maintain a comprehensive knowledge of the treatment options currently available for the management of AIDS.
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Matsumoto, Sandra A., and Mary Frances Seideman. "Considerations in the Treatment of Patients With Acquired Immunodeficiency Syndrome at Home." Journal of Pharmacy Practice 5, no. 3 (June 1992): 158–63. http://dx.doi.org/10.1177/089719009200500309.
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The rapidly growing acquired immunodeficiency syndrome (AIDS) population faces frequent, expensive hospitalization due to the debilitating sequelae of the disease. Home care offers these patients an opportunity to receive or complete their therapy in comfortable surroundings, allowing them to realize the psychosocial and financial benefits of outpatient care. A myriad of sophisticated drug therapies has been successfully administered in the home setting. Therapy for frequently occurring opportunistic infections often requires treatment with highly toxic drugs such as amphotericin, pentamidine, and ganciclovir. With thorough patient training and diligent monitoring by the home-care pharmacist and nurse, these agents can be safely administered at home. Conventional and investigational chemotherapy and immunomodulator therapy, such as interferon or erythropoietin, can also be administered at home. Providing total parenteral nutrition to AIDS patients is a controversial treatment modality, but if indicated, it can also be accomplished at home. Outpatient pain management has allowed many patients with terminal or chronic illnesses to minimize time spent in hospitals or extended care facilities, and it can offer the same advantages to patients with AIDS. The psychosocial ramifications of AIDS and its impact on patients and health care professionals must be understood in order to effectively provide total patient care at home. The challenge to the home-care pharmacist is to acquire and maintain a comprehensive knowledge of the treatment options currently available for the management of AIDS.
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O'Brien, Tony. "Palliative care and taboos within motor neurone disease." Palliative Medicine 7, no. 4_suppl (October 1993): 69–72. http://dx.doi.org/10.1177/0269216393007004s11.
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Taboos, whether held by professional carers, patients or families have the capacity to influence a whole range of choices that must be made during the course of any illness. In the case of motor neurone disease, decisions regarding if, when and how to break bad news, the place of care (home, hospital or hospice), the introduction of aids and devices, and, ultimately, choices regarding the place of death, will all be influenced by a range of taboos. If professional carers have major unresolved issues concerning their own mortality, it is unlikely that they will be able to truly stand alongside those who are facing their own imminent death. In discussing taboos, essentially what is of concern is attitudes. A basic change in attitudes is required if we are to stop viewing patients with incurable illness as some kind of medical failure.
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Shah, Hardik, Parul Bhatt, Binal Vaghani, and Kushal Patel. "HIV-AIDS patients with respiratory manifestation: study at tertiary care center." International Journal of Advances in Medicine 4, no. 1 (January 23, 2017): 270. http://dx.doi.org/10.18203/2349-3933.ijam20170124.
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Background: HIV affects virtually all organ systems in the body. Pulmonary disease is one of the most frequent complications of HIV infection. It is found in mostly married, young and middle aged, urban poor with male preponderance and heterosexual and blood transfusion being the commonest source of infection. Prompt diagnosis and early management may hasten the clinical recovery and reduce the risk and severity of toxic drug effects. Moreover knowledge regarding the incidence and early manifestations may help in developing strategies regarding prophylactic therapy of various infections of respiratory system. Aim of this study was to find the Incidence, occurrence and pattern of respiratory infections in HIV infected patients, use of various drugs used and response of therapy in respiratory infections and to study impact of HAART in PLHA with respiratory infection. Methods: Fifty HIV infected patients showing clinical evidence of respiratory system involvement and admitted in our hospital from May 2014 to November 2015 were studied in present study. Clinical history was noted and detailed physical examination, laboratory evaluation and specialized tests were carried out in all patients looking especially for presence of associated opportunistic infections in other systems.Results: Cough and dyspnea were the prominent respiratory symptoms and commonest sign was consolidation (42%) and effusion (24%) or no respiratory signs (26%).Tuberculosis (66%) followed by bacterial pneumonia (24%) including recurrent bacterial pneumonia (6%), PCP (8%) and fungal infection (2%), were the commonest respiratory manifestations. Commonest organisms isolated in bacterial pneumonia were Streptococcus Pneumonia, Staph aureus and Klebsiella. Incidence of pulmonary TB was 66%. PCP was found in 8% of cases. HAART combination of lamivudine, stavudine and nevirapine were found efficacious, safe and well tolerated when combined with other antibiotics and/or AKT.Conclusions: Heterosexual exposure (70%) and blood borne infection (18%) were commonest route of infection. Fever and weight loss was commonest presenting constitutional symptoms and all patients either belonged to B or C category.
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Shyirambere, Cyprien, Mary Jue Xu, Shekinah Nefreteri Elmore, Temidayo Fadelu, Leana May, Neo Tapela, Denis Gilbert Umuhizi, et al. "Treating Nephroblastoma in Rwanda: Using International Society of Pediatric Oncology Guidelines in a Novel Oncologic Care Model." Journal of Global Oncology 2, no. 3 (June 2016): 105–13. http://dx.doi.org/10.1200/jgo.2015.000067.
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Purpose Success in treating nephroblastoma in high-income countries has been transferred to some resource-constrained settings; multicenter studies report disease-free survival of greater than 70%. However, few reports present care models with rural-based components, care tasks shifted to internists and pediatricians, and data collection structured for monitoring and evaluation. Here, we report clinical outcomes and protocol compliance for patients with nephroblastoma evaluated at Butaro Cancer Center of Excellence in Rwanda. Patients and Methods This retrospective study reports the care of 53 patients evaluated between July 1, 2012, and June 30, 2014. Patients receiving less than half of their chemotherapy at Butaro Cancer Center of Excellence were excluded. Results Of the 53 patients included, 9.4% had stage I, 13.2% had stage II, 24.5% had stage III, 26.4% had stage IV, and 5.7% had stage V disease; the remaining 20.8% had unknown stage disease from inadequate work-up or unavailable surgical report. The incidence of neutropenia increased with treatment progression, and the greatest proportion of delays occurred during the surgical referral phase. At the end of the study period, 32.1% of patients (n = 17) remained alive after treatment; 24.5% (n = 13) remained alive while continuing treatment, including one patient with recurrent disease; 30.2% (n = 16) died; and 13.2% (n = 7) were lost to follow-up. Conclusion Our findings confirm that nephroblastoma can be effectively treated in resource-constrained settings. Using an approach in which chemotherapy is delivered at a rural-based center by nononcologists and data are used for routine evaluation, care can be delivered in safe, novel ways. Protocol modifications to mitigate chemotherapy toxicities and strong communication between the multidisciplinary team members will likely minimize delays and further improve outcomes in similar settings.
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Elbein, RC. "Nutrition and HIV infection. A continuum of care." Journal of the American Podiatric Medical Association 85, no. 8 (August 1, 1995): 434–38. http://dx.doi.org/10.7547/87507315-85-8-434.
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Nutrition is a fundamental intervention in the early and ongoing treatment of human immunodeficiency virus (HIV) disease. Nutrition therapy, in coordination with other medical interventions, can extend and improve the quality and quantity of life in individuals infected with HIV and living with acquired immune deficiency syndrome (AIDS). The author reviews the current literature and practice for nutrition use in the treatment of patients with HIV and AIDS.
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Mgbere, Osaro, Salma Khuwaja, Tanvir K. Bell, Maria C. Rodriguez-Barradas, Raouf Arafat, Janet M. Blair, and Ekere James Essien. "Managing the Personal Side of Health Care among Patients with HIV/AIDS." Journal of the International Association of Providers of AIDS Care (JIAPAC) 16, no. 2 (July 9, 2016): 149–60. http://dx.doi.org/10.1177/2325957414555229.
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The study describes the HIV care providers’ sociodemographic and medical practice characteristics and the health care services offered to patients during medical care encounters in Houston/Harris County, Texas. We used data from the pilot cycle of the Centers for Disease Control and Prevention Medical Monitoring Project Provider Survey conducted in June to September 2009. The average age and HIV care experience of the providers were 46.7 and 11.7 years, respectively, and they provided care to an average of 113 patients monthly. The average proportion of HIV-infected patients seen per month by race/ethnicity was 43.3% for blacks, 28.5% for whites, 26.6% for Hispanics, 1.3% for Asians, and 0.6% for other races. A total of 67% of providers offered HIV testing to all patients 13 to 64 years of age. Most HIV care providers (73.9%) reported that patients in their practices sought HIV care only after experiencing symptoms. Understanding the HIV care delivery system from providers’ perspectives may help enhance support services, patients’ ongoing care and retention, leading to improved health outcomes.
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Men, C., B. Meessen, M. Van Pelt, W. Van Damme, and H. Lucas. "“I Wish I Had AIDS”: A qualitative study on access to health care services for HIV/AIDS and diabetic patients in Cambodia." Health, Culture and Society 2, no. 1 (March 23, 2012): 22–39. http://dx.doi.org/10.5195/hcs.2012.67.
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Financially stricken Cambodian patients with diabetes and HIV/AIDS typically encounter multiple, serious barriers to effective care. This process may extend over many years and involve numerous rounds of diagnosis and treatment as the disease progresses from initial symptoms to longer term complications. Living with both the impact of the disease and this ongoing struggle for care can severely disrupt the everyday life of both sufferers and their families. Our retrospective study adopted qualitative research methods to collect data from HIV/AIDS and diabetic patients enrolled and not enrolled in treatment programs at varying institutions in urban and rural settings. Using purposive sampling techniques, a total of 25 HIV/AIDS and 45 diabetic patients were recruited. Semi-structured and open-ended interviews were used to collect information on patient experiences of different phases in the on-going process of seeking care and treatment. The findings indicate that both HIV/AIDS and diabetic patients encounter multiple supply- and demand-side barriers to care at different stages of their illness. More strikingly, our research findings suggest that supply-side barriers, for example rationing systems or targeting strategies that limit access to free treatment or social assistance, are substantially higher for diabetic patients. This perceived inequity had a profound impact on diabetic patients to the extent that some “wished they had HIV/AIDS”. These findings suggest that there is an urgent need to widen the focus of health care to address the substantial and increasing burden of disease resulting from diabetes and other serious chronic disorders in Cambodia and many other low/middle income countries.
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Biswas, Sayan. "Hospice Care, Disease Burden Prediction, and the “Unbefriended” Patient." International Journal of Recent Surgical and Medical Sciences 6, no. 02 (September 22, 2020): 77–79. http://dx.doi.org/10.1055/s-0040-1716803.
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AbstractThe COVID-19 pandemic has created a global mayhem. Patient care has been severely affected. Patients with chronic conditions such as dialysis-dependent end stage renal diseases are finding it challenging to seek out continuous treatment. Ground breaking work by Dr. Ravikanth Yalamuri of Methodist TexSan Hospital is paving new pathways for tackling patient volume in hospital settings, especially in hospices. In particular, Dr. Yalamuri has provided succinct insights into empathetic caring for the unbefriended patients. These elderly orphans have major issues with cognition and require high levels of social aids and support, especially when they are admitted to the hospital or when they have a terminal illness. Dr. Yalamuri has highlighted the utility of operations research in these multifaceted disease model prediction.
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Ngoga, G., P. H. Park, R. Borg, G. Bukhman, E. Ali, F. Munyaneza, N. Tapela, E. Rusingiza, J. K. Edwards, and B. Hedt-Gauthier. "Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013–2014." Public Health Action 9, no. 4 (December 21, 2019): 142–47. http://dx.doi.org/10.5588/pha.19.0007.
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Setting: Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda.Objective: To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home.Design: A retrospective descriptive cohort study using routinely collected data involving adult patients aged 18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014.Results: Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs.Conclusion: By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.
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Barnes, Rosemary, Cristina Barrett, Susan Weintraub, Gabrielle Holowacz, Meeley Chan, and Evan Leblanc. "Hospital Response to Psychosocial Needs of AIDS In Patients." Journal of Palliative Care 9, no. 2 (June 1993): 22–28. http://dx.doi.org/10.1177/082585979300900205.
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Compassionate care for HIV-infected persons requires response to psychosocial needs. With no new external funding, Women's College Hospital, a 270-bed urban teaching hospital, provided effective psychosocial services for HIV-infected in patients by developing a comprehensive policy, educating staff, organizing existing services into a psychosocial support team to provide crisis intervention, and developing liaisons with community AIDS organizations. A retrospective chart review of epide-miologic and psychosocial patient data was carried out for 59 HIV in patients (58 men, 1 woman) admitted during 1987–89. Of the cohort, 91% indicated homosexual contact as the only risk factor. A psychosocial support team contacted 90% of these in patients. One third (36%) of the patients designated as next of kin individuals who were not legally or biologically related. Approximately 25%–30% made active arrangements for impending death, e.g. wills and funeral plans. Thirteen patients, 22%, died in hospital, and three, 5%, on first admission. Experience showed that psychosocial interventions that focus on human dignity and quality of life, normally seen as elements of palliative care, are critically important from the earliest stages of HI V disease and should not be reserved only for those who are terminally ill.
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Silva, Luana Maria Jales Dantas, Érika Ramos da Cunha Medeiros, José Nyedson Moura de Gois, and Luanne Eugênia Nunes. "Importance of pharmacist in pharmacotherapeutic adhesion of patients with HIV/AIDS." Research, Society and Development 9, no. 10 (September 20, 2020): e1289108280. http://dx.doi.org/10.33448/rsd-v9i10.8280.
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Acquired Immunodeficiency Syndrome (AIDS) is a disease characterized by progressive stages after the vulnerability of the immune system to the Human Immunodeficiency Virus (HIV) infection, which can affect the worldwide population. The antiretroviral therapy (ART) indicated for infected patients improves the patient's quality of life by preventing disease progression. The health team, including the pharmacist, is essential to assist and ensure the safety and efficacy of pharmacotherapeutic treatment. This work aims to present the importance of pharmaceutical care in pharmacotherapeutic follow-up for HIV/AIDS patients through an integrative literature review. 14 articles were analyzed, which showed a prevalence of the disease in a male patient over 30 years old, with an incidence always greater than 50%. The main causes that hinder adherence to antiretrovirals are disinformation on the risk of non-adherence, lack of understanding about prescription drugs, low education, drug, and alcohol use among male patients. Studies have shown that pharmaceutical care and the multidisciplinary team can positively assist in increasing adherence to antiretrovirals. Therefore, the interventions and guidelines carried out by the pharmaceutical professional together with the health team show promising results that favor adherence to medications by patients with HIV/AIDS. However, greater commitment and collaboration between health professionals is necessary to improve the quality of life of these patients, working mainly in the process of adhering to treatment.
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Spina, Michele, Antonino Carbone, Annunziata Gloghini, Diego Serraino, Massimiliano Berretta, and Umberto Tirelli. "Hodgkin's Disease in Patients with HIV Infection." Advances in Hematology 2011 (2011): 1–7. http://dx.doi.org/10.1155/2011/402682.
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Hodgkin lymphoma (HL) represents one of the most common non-AIDS-defining cancers with an increasing incidence overtime. Clinically, patients present advanced stages of disease with extranodal involvement in the majority of cases. In the last years, significant improvements in the treatment of patients with HL and HIV infection have been achieved. In the lack of randomized trials, several phase II studies have showed that in the era of highly active antiretroviral therapy (HAART) the same regimens employed in HIV-negative patients with HL can be used in HIV setting with similar results. Moreover, in the last years the feasibility of high dose chemotherapy and peripheral stem cell rescue has allowed to save those patients who failed the upfront treatment. Finally, in the near future, a better integration of diagnostic tools (including PET scan), chemotherapy (including new drugs), radiotherapy, HAART, and supportive care will significantly improve the outcome of these patients.
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Álvarez-Moreno, Carlos A., Abel E. González-Vélez, Claudia C. Colmenares-Mejía, Karen L. Rincón-Ramírez, Javier A. García-Buitrago, Paola A. Rengifo-Bobadilla, and Mario A. Isaza-Ruget. "The cost of hospital care for HIV patients in Colombia: an insurer’s perspective." International Journal of STD & AIDS 30, no. 7 (May 2, 2019): 696–702. http://dx.doi.org/10.1177/0956462419835636.
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The aim of this study was to evaluate the cost derived from the hospitalization of people living with HIV (PLHIV) in Colombia between 2011 and 2015. This is an analysis of the direct cost of PLHIV hospitalization from the perspective of an insurer of the Colombian General Social Security System. The costs were calculated in Colombian pesos and corrected for inflation on the basis of the 2017 Consumer Price Index of the Bank of the Republic of Colombia. It was converted to US dollars at the Market Representative Exchange Rate of the same year. We analyzed 1129 hospitalizations in 612 PLHIV, of which 12% started with a diagnosis of HIV during the same hospitalization, with the majority in the AIDS stage (63%). The median overall cost of hospitalizations was US$1509 (25th and 75th percentiles: US$711–US$3254), being even higher in patients with AIDS and as the CD4 T lymphocyte count decreased. The cost derived from the medical care of PLHIV increases as the clinical control of the disease worsens, and it is a key indicator of the impact of the strategies implemented for the timely identification of the infection and subsequent management of the disease.
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Adams, Audrey, and Franklin D. Lowy. "Infection Control and the Hospitalized AIDS Patient." Infection Control 6, no. 5 (May 1985): 200–201. http://dx.doi.org/10.1017/s0195941700061427.
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Acquired immunodeficiency syndrome (AIDS) has created new and difficult challenges for infection control services. Limited information on the pathogenesis and means of transmission coupled with the reported high mortality rates of this disease, have heightened public fears about the potential risks resulting from exposure to AIDS. Hospitalization of these patients, with the attendant responsibilities for their care by hospital personnel, has served to focus and amplify these public concerns in a relatively small and inter-related community. The result, in some hospitals, has been an increase in incidents which interfere with the proper care of AIDS patients. While a great deal has been written about the appropriate precautions recommended for the care of these patients, little attention has been focused on the practical problems encountered within the institution of these policies and within the education of the concerned and relatively uninformed hospital community. The success of such a program is essential to assure the proper care of these patients. The purpose of the present report is to summarize the experience at our institution and to outline the approach adopted by the Infection Control Unit to deal with these problems.
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Valenti, William M. "AIDS Update: HTLV-III Testing, Immune Globulins and Employees with AIDS." Infection Control 7, no. 8 (August 1986): 427–30. http://dx.doi.org/10.1017/s0195941700064675.
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As we have become experienced in dealing with AIDS, we have learned that early concern over employees who refuse to care for patients with AIDS was merely the tip of the iceberg from the infection control standpoint. During the past 5 years, additional questions and concerns have been raised regarding employee health and AIDS. An interesting body of literature has emerged recently that discusses many of these current employee health issues. Some of these questions have been answered in major communications in The New England Journal of Medicine, the Journal of the American Medical Association, and The Lancet. Many other topics have been covered in short communications in letters to the editor in these same journals and in the CDC's Morbidity and Mortality Weekly Report (MMWR). When taken together, this writing presents a very clear picture of what is happening with AIDS in the health care arena. It is obvious that most of the concerns regarding AIDS in health care settings can be answered by taking a close look at the available epidemiologic data. It is important to remember that the decision-making process related to AIDS is easier if we try to separate the emotional issues surrounding the disease from the scientific data available.
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Kutoane, M. N., and J. De Beer. "THE PERCEPTIONS OF CRITICAL CARE NURSES IN RELATION TO THEIR EDUCATIONAL PREPAREDNESS IN CARING FOR PEOPLE LIVING WITH HIV/AIDS." Africa Journal of Nursing and Midwifery 16, no. 1 (September 10, 2016): 130–44. http://dx.doi.org/10.25159/2520-5293/1494.
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Many HIV-infected patients diagnosed with the complex staging of the disease and severe opportunistic events require admission to critical care units, making care complicated. Further to this, antiretroviral therapy and unanswered questions concerning its use in these units add to the already intricate and complicated cases admitted to critical care. Complications are increased by issues including legal statutes concerning HIV/Aids testing and disclosure. As a result, this study was aimed at exploring the perceptions of critical care nurses towards their educational preparedness in managing HIV/AIDS patients admitted to CCUs in KwaZulu-Natal. A quantitative descriptive research design was used and data collection included a structured questionnaire and open-ended questions. The sample size consisted of 100 CCNs (79 from the public setting and 21 from the private sector). Of the critical care nurses, 44.6% (n=25) who had undergone training in HIV/AIDS management, only 25% (n=14) perceived that they were not educationally prepared to provide effective services for patients with HIV/AIDS. Fifty (n=50) (89.3%) critical care nurses reported that HIV/AIDS management should be incorporated into the critical care curriculum. Their universal perception, n=42 (75%), was that this will improve the standards of care. Nurses are still challenged by factors such as the advanced level of the HIV disease, confidentiality, knowledge about treatment regimen and emotional challenges related to caring for these patients. More research with a larger scale sample is required to provide appropriate generalisation of the findings of this study. Alternatively, a qualitative research study exploring the lived experiences of critical care nurses caring for people living with HIV/AIDS is suggested.
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Habimana, Dominique Savio, Jean Claude Semuto Ngabonziza, Patrick Migambi, Yves Mucyo-Habimana, Grace Mutembayire, Francine Byukusenge, Innocent Habiyambere, et al. "Predictors of Rifampicin-Resistant Tuberculosis Mortality among HIV-Coinfected Patients in Rwanda." American Journal of Tropical Medicine and Hygiene 105, no. 1 (July 7, 2021): 47–53. http://dx.doi.org/10.4269/ajtmh.20-1361.
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Abstract.Tuberculosis (TB), including multidrug-resistant (MDR; i.e., resistant to at least rifampicin and isoniazid)/rifampicin-resistant (MDR/RR) TB, is the most important opportunistic infection among people living with HIV (PLHIV). In 2005, Rwanda launched the programmatic management of MDR/RR-TB. The shorter MDR/RR-TB treatment regimen (STR) has been implemented since 2014. We analyzed predictors of MDR/RR-TB mortality, including the effect of using the STR overall and among PLHIV. This retrospective study included data from patients diagnosed with RR-TB in Rwanda between July 2005 and December 2018. Multivariable logistic regression was used to assess predictors of mortality. Of 898 registered MDR/RR-TB patients, 861 (95.9%) were included in this analysis, of whom 360 (41.8%) were HIV coinfected. Overall, 86 (10%) patients died during MDR/RR-TB treatment. Mortality was higher among HIV-coinfected compared with HIV-negative TB patients (13.3% versus 7.6%). Among HIV-coinfected patients, patients aged ≥ 55 years (adjusted odds ratio = 5.89) and those with CD4 count ≤ 100 cells/mm3 (adjusted odds ratio = 3.77) had a higher likelihood of dying. Using either the standardized longer MDR/RR-TB treatment regimen or the STR was not correlated with mortality overall or among PLHIV. The STR was as effective as the long MDR/RR-TB regimen. In conclusion, older age and advanced HIV disease were strong predictors of MDR/RR-TB mortality. Therefore, special care for elderly and HIV-coinfected patients with ≤ 100 CD4 cells/mL might further reduce MDR/RR-TB mortality.
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Sharma, Kamlesh, Vandana Sharma, Aradhana Singh, and Ketki . "Pattern of hepatobiliary involvement in HIV/AIDS patients: study in a tertiary care centre." International Journal of Research in Medical Sciences 7, no. 1 (December 26, 2018): 146. http://dx.doi.org/10.18203/2320-6012.ijrms20185370.
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Background: Diseases of hepatobiliary system is a major problem in patients with HIV infection. It has been estimated that approximately one third of the death of patients with HIV infection are in some way related to liver disease. While this is predominantly a reflection of the problems encountered in the setting of co-infection Hepatitis B or C, it is also a reflection of the hepatic injury in the form of hepatic steatosis, that can be due to antiretroviral therapy. There had been little work done on liver function tests in HIV patients without pre-existing liver disease like viral hepatitis, or alcoholic hepatitis. So, this study was designed to assess the pattern of liver function test derangement in HIV patients. Aims and objective was to study the different pattern of hepatobiliary involvement in HIV positive patients, and to gauge the extent of liver damage.Methods: The study included 50 HIV positive patients coming to SMS hospital and Medical College, Jaipur, in medicine and HIV clinic of skin and VD department. Subjects having HIV test positive by ELISA, are included in this study. Other causes of liver function derangements were excluded from the study.Results: Maximum number of the patients were in the age group of 23-32 years. Out of 50 cases studied, 41 (82 %) cases had abnormal liver function tests, while 9 (18%) had normal liver function tests. Most of the cases had liver function abnormalities, and most common abnormality was raised SGOT/SGPT.Conclusions: Almost all types of liver function tests are found to be deranged in HIV patients. The pattern of hepatobiliary involvement varied from fatty liver, cholestasis to Toxic necrosis and granulomas.
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Lim, Hwa-Jung, and Bo-Yeoul Kim. "Effects of a Standardized Care Protocol for Patients with Degenerative Spine Disease." Open Nursing Journal 13, no. 1 (February 25, 2019): 28–38. http://dx.doi.org/10.2174/1874434601913010028.
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Background:Many patients facing spinal surgery experience fear and anxiety about surgery, anesthesia, risk of postoperative pain or complications, or even death. Spinal surgery patients often experience mobility disorders due to lasting postoperative pain and require aids such as spinal braces, which can induce depression. Alleviating patients’ anxiety and depression during the perioperative period by utilizing consistent and standardized information is required for high-quality care.Objective:We developed and assessed a standardized care protocol for degenerative spinal surgery patients.Methods:The protocol was developed through focus group interviews with spinal surgery patients and the recommendations of an expert panel. Then, a quasi-experimental design was employed to comparatively study patients undergoing spinal surgery. Ninety-eight Patients were assigned to either a treatment group (n= 49) or a control group (n= 49). The treatment group received an intervention based on the newly developed standardized care protocol, while the control group received traditional care. After treatment, participants’ anxiety, depression, uncertainty, and care satisfaction were compared between groups.Results:Patients who had received the care protocol-based intervention showed lower anxiety, depression, and uncertainty, and higher satisfaction than did those who received traditional care.Conclusion:The developed care protocol may be useful for reducing anxiety and depression and for improving the healthcare provided to spinal surgery patients, as it involves the proactive dissemination of accurate information throughout the hospitalization process. The protocol also positively affected patients’ uncertainty and satisfaction with their medical care.
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Memish, Ziad A., Jaffar A. Al-Tawfiq, Sanaa M. Filemban, Syed Qutb, Abdullah Fodail, Batol Ali, and May Darweeish. "Antiretroviral therapy, CD4, viral load, and disease stage in HIV patients in Saudi Arabia: a 2001–2013 cross-sectional study." Journal of Infection in Developing Countries 9, no. 07 (July 30, 2015): 765–69. http://dx.doi.org/10.3855/jidc.6588.
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Introduction: The incidence of HIV/AIDS is increasing worldwide and in the Middle East. In this study, we analyzed the use of antiretroviral therapy (ART), the patterns of CD4 and viral load (VL), and stage of presentation. Methodology: Laboratory variables, ART use, and CD4 count were obtained and analyzed retrospectively. Results: A total of 997 cases from eight HIV/AIDS care providers were included. Of the total cases, 274 (28.3%) had a CD4 count of < 200 cells/mm3, and 413 (42.3%) had a viral load of > 5 log10. Of the total cases, 50% were on highly active antiretroviral therapy (HAART), and the majority of cases were asymptomatic (70%). Of those patients on ART, 247 (39.5%) took tenofovir/emtricitabine combined with either efavirenz (147; 14.7%) or lopinavir/ritonavir (100; 10%), and 158 (15.8%) were on lamivudine and zidovudine with either efavirenz (32; 3.2%) or lopinavir/ritonavir (126; 12.6%). Other combinations were used in 70 (7%) patients. The mean (± standard deviation) of baseline CD4 and viral load were 401 cells/mm3 (322 cells/mm3) and 4.6 log1010 (1.3 log10), respectively. At diagnosis, 72% of patients were asymptomatic; 50% had AIDS and 20% had CD4 count < 350. Conclusions: ART use was in line with international guidelines, but the number of patients receiving ART was lower than expected. Large proportions of cases presented late with AIDS at diagnosis or had CD4 < 350. Further data is needed to evaluate the medical care of patients with HIV/AIDS in the Kingdom of Saudi Arabia.
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Brettle, R. P., L. Willcocks, F. M. Cowan, and A. M. Richardson. "Inpatient Health Care Utilization for Patients With HIV and AIDS in the Edinburgh City Hospital." International Journal of STD & AIDS 5, no. 3 (May 1994): 194–201. http://dx.doi.org/10.1177/095646249400500308.
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A retrospective analysis of HIV-positive patients admitted to the City Hospital, Edinburgh by 31st December 1992, 7 years after the inception of the HIV clinic, revealed that 373 patients, 72% of them injection drug users (IDUs), had required 2069 admissions (5.5/admitted patient, 3.3/clinic patient or 0.5/clinic patient/year) and had utilized 21934 bed days (59 bed days/admitted patient, 35 days/clinic patient or 5 bed days/clinic patient/year). The average length of stay (ALOS) was significantly longer for AIDS than HIV (non-AIDS) admissions (14.0 vs 9.5, P < 0.0001) as it was for admissions with a CD200 diagnosis (a CD4 count below 200 cells per mm3 on two consecutive occasions) compared to those without (12.1 vs 10.0 days, P = 0.004). There was no gender effect on ALOS but there was a significant effect of risk activity; homo/bisexuals had a significantly longer ALOS than drug users ( P < 0.0001). Homo/bisexual patients with AIDS or a CD200 diagnosis had longer ALOS than drug users (15.7 vs 13 days and 15.8 vs 10.8). By 1992 each member of the clinic was on average utilizing one admission per year and 11.6 bed days per year. The number of admissions in that year for patients without a CD200 or AIDS diagnosis was however low (0.5 and 0.75 admissions/patient/year) compared to patients with an AIDS or CD200 diagnosis (2.6 and 1.6 admissions/patient/year). The annual number of occupied bed days/living patient was greatest for those with AIDS (60 vs 5 days) or with a CD200 diagnosis (23.5 vs 4.1 days). Females with AIDS used more annual bed days than males (64.2 vs 52.7 days) but not if analysed by CD200 diagnosis (22.0 vs 24.1). As far as risk activity was concerned drug users used more bed days per year than homo/bisexuals with AIDS (60 vs 52 days) or without AIDS (5.4 vs 4.4 days). However homo/bisexuals used more bed days than drug users with a CD200 diagnosis (39.8 vs 20.4 days) or without (7.0 vs 4.2 days) a CD200 diagnosis. Thus in Edinburgh, both clinical and immunological staging, were predictive of resource utilization. Gender, however, was not predictive and the effect of risk activity was complex possibly because of differing socio-economic status. The extra hospital resources for drug use related HIV appears to be in the form of more frequent admissions at all stages of HIV disease rather than in an increased ALOS per admission.
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Chin, Curtis D., Yuk Kee Cheung, Tassaneewan Laksanasopin, Mario M. Modena, Sau Yin Chin, Archana A. Sridhara, David Steinmiller, et al. "Mobile Device for Disease Diagnosis and Data Tracking in Resource-Limited Settings." Clinical Chemistry 59, no. 4 (April 1, 2013): 629–40. http://dx.doi.org/10.1373/clinchem.2012.199596.
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BACKGROUND Collection of epidemiological data and care of patients are hampered by lack of access to laboratory diagnostic equipment and patients' health records in resource-limited settings. We engineered a low-cost mobile device that combines cell-phone and satellite communication technologies with fluid miniaturization techniques for performing all essential ELISA functions. METHODS We assessed the device's ability to perform HIV serodiagnostic testing in Rwanda and synchronize results in real time with electronic health records. We tested serum, plasma, and whole blood samples collected in Rwanda and on a commercially available sample panel made of mixed antibody titers. RESULTS HIV testing on 167 Rwandan patients evaluated for HIV, viral hepatitis, and sexually transmitted infections yielded diagnostic sensitivity and specificity of 100% and 99%, respectively. Testing on 40 Rwandan whole-blood samples—using 1 μL of sample per patient—resulted in diagnostic sensitivity and specificity of 100% and 100%. The mobile device also successfully transmitted all whole-blood test results from a Rwandan clinic to a medical records database stored on the cloud. For all samples in the commercial panel, the device produced results in agreement with a leading ELISA test, including detection of weakly positive samples that were missed by existing rapid tests. The device operated autonomously with minimal user input, produced each result 10 times faster than benchtop ELISA, and consumed as little power as a mobile phone. CONCLUSIONS A low-cost mobile device can perform a blood-based HIV serodiagnostic test with laboratory-level accuracy and real-time synchronization of patient health record data.
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Turtle, L., R. Vyakernam, A. Menon-Johansson, M. R. Nelson, and N. Soni. "Intensive Care Usage by HIV-Positive Patients in the HAART Era." Interdisciplinary Perspectives on Infectious Diseases 2011 (2011): 1–5. http://dx.doi.org/10.1155/2011/847835.
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In the 1980s the outlook for patients with the acquired immunodeficiency syndrome (AIDS) and critical illness was poor. Since then several studies of outcome of HIV+ patients on ICU have shown improving prognosis, with anti-retroviral therapy playing a large part. We retrospectively examined intensive care (ICU) admissions in a large HIV unit in London. Between April 2001 and April 2006 43 patients were admitted to the ICU. The mean age of patients was 44 years and 74% were male. Fifty-six percent of admissions were receiving anti-retroviral therapy and 44% had an AIDS defining diagnosis. The median CD4 count was 128 cells/mL and the median APACHE II score was 21. The commonest diagnostic ICU admission category was respiratory disease. This group experienced higher mortality despite slightly lower APACHE II scores, though this did not achieve statistical significance. The follow up period was one year or until April 2007, when data were censored. ICU mortality was 33%, in hospital mortality was 51% and overall mortality at the end of the study period was 67%. Median survival was 1008 days. The CD4 count did not predict long-term survival, although the sample size was too small for this to be conclusive.
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Dhakad, Megh S., Ravinder Kaur, Ritu Goyal, Preena Bhalla, and Richa Dewan. "Epidemiological profile of candidiasis in HIV/AIDS patients in a tertiary care hospital." International Journal Of Community Medicine And Public Health 7, no. 12 (November 25, 2020): 4858. http://dx.doi.org/10.18203/2394-6040.ijcmph20205153.
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Background: Clinical research in fungal infections is largely a neglected area in health care settings in India. Candida species cause diseases ranging from mucosal infections to systemic mycoses depending on host’s immune status. Aim of this study was to evaluate the clinico-epidemiological profile of candidiasis, and their correlation with an immunological profile in HIV/AIDS patients.Methods: Clinical details and investigations of 200 symptomatic, confirmed HIV-positive patients, suspected of having candidiasis were recorded and analyzed. Relevant clinical samples depending on the organ system involved were collected and subjected to direct microscopy, culture isolation and serology. Identification and speciation of the isolates was done by biochemical methods as per standard recommended procedures. CD4-count was determined by flow cytometry using Fluorescent Activated Cell Sorter Count system.Results: Patients ranged from 17-65 years with a mean age of 33.83±9.07 years. Most common clinical presentations were seen to be white oral patches (82%), weight loss (79%), fever (67%), loss of appetite (53%), headache (51.5%), cough (38.5%) and diarrhea (30%). Gastrointestinal system (35%) was the most commonly involved system. The CD4-counts ranged from 16-1033 cells/μl. 93 (46.5%) patients had CD4-counts <200 cells/μl, while CD4-count <100 cells/μl was seen in 40 (20%) and CD4-count <50 cells/μl in 20 (10%). Candidiasis was detected in 60% of the patients. Yeasts isolated were C. albicans (82.51%), C. tropicalis (6.29%), C. krusei (4.89%), C. parapsilosis (3.49%), and C. glabrata (2.79%).Conclusions: C. albicans was predominant species and presence of oral candidiasis is a matter of concern. Early and accurate diagnosis of candidiasis is one of the keys helps for the success of effective HIV/AIDS disease management.
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van Olmen, Josefien, François Schellevis, Wim Van Damme, Guy Kegels, and Freya Rasschaert. "Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care." Journal of Tropical Medicine 2012 (2012): 1–10. http://dx.doi.org/10.1155/2012/349312.
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There is growing attention for chronic diseases in sub-Saharan Africa (SSA) and for bridges between the management of HIV/AIDS and other (noncommunicable) chronic diseases. This becomes more urgent with increasing numbers of people living with both HIV/AIDS and other chronic conditions. This paper discusses the commonalities between chronic diseases by reviewing models of care, focusing on the two most dominant ones, diabetes mellitus type 2 (DM2) and HIV/AIDS. We argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care. We developed a “chronic dimension framework,” which analyses the “disease dimension,” the “health provider dimension,” the patient or “person dimension,” and the “environment dimension” of chronic diseases. Applying this framework to HIV/AIDS and DM2 shows that it is useful to think about management of both in tandem, comparing care delivery platforms and self-management strategies. A literature review on care delivery models for diabetes and HIV/AIDS in SSA revealed potential elements for cross-fertilisation: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support, and self-management strategies; and strengthening health services.
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Cevallos, Leonardo Cano, Edison Cano Cevallos, Andrea Vélez Vera, Nathalie Suárez, Maryuri Delgado, and Xavier Delgado Ollague. "HIV in Ecuador: A Current Perspective of the Epidemics from a Major HIV Care Center." Open Forum Infectious Diseases 4, suppl_1 (2017): S437. http://dx.doi.org/10.1093/ofid/ofx163.1105.
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Abstract Background Human Immunodeficiency Virus (HIV) infection is estimated to affect 36.7 million people (persons living with HIV [PLWH]). In Latin America and Caribbean exist around 2 million of PLWH. Ecuador estimates are close to 35.000 PLWH with prevalence of 3 cases per 1000 population, being 31.4% woman. Since the first case of HIV reported in the country in 1983 the efforts have been made to improve prevention and treatment of the disease being epidemiology paramount in planning. Herein we present a current panorama of HIV in Ecuador from a major center serving approximately 2 million people in the coastal zone. Methods Patients with diagnosis of HIV/AIDS (ICD-10 B24) from January to December 2015 were included from a database comprising 346.386 visits to outpatient clinics. The variables we consider were demographics, newly vs. previously diagnosed, type of antiretroviral regimen, AIDS-defining conditions, CD4 count and viral load. The statistical analysis was made on Microsoft Excel. Results A total of 3776 HIV positive patients were found during the study period. Median age was 37 ± 15, 37 ± 15 for males and 38 ± 15 for females (P > 0.05). Male to female ratio was 4.72:1. More than half patients (2588, 68.5%) were receiving antiretroviral therapy. The most common therapy used was tenofovir + emtricitabine + efavirenz, followed zidovudine + lamivudine + efavirenz for 472 (18.2%). Most patients (91.97%) with HIV infection were not in AIDS stage. Newly diagnosed HIV was seen in 824 patients (21.82%), of which 59 (7%) were on AIDS stage at time of diagnosis. There was only 45 cases in this group (5.46%) with CD4 <200 cells/mm3 possibly suggesting rapid progression or advanced disease. Conclusion HIV infection is a public health concern in Ecuador affecting mostly young males. More than half patients are on antiretroviral therapy and most patients are not in AIDS stage. This study comprises a current view of the epidemiological situation of HIV/AIDS in the coast of Ecuador and allows for planning and further research. Disclosures All authors: No reported disclosures.
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Ayim-Aboagye, Desmond. "HIV/AIDS in different cultures." Scandinavian Journal of Pain 3, no. 3 (July 1, 2012): 198. http://dx.doi.org/10.1016/j.sjpain.2012.05.066.
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Abstract Background/aims HIV/AIDS is a disease that is taking many lives in Ghana and other countries in Africa. It is a disease that has infected people in Sweden, though not as many as Africa has reported. The present investigation concerns how HIV/AIDS patients in Ghana, a cultural tropic climate, and patients in Sweden, the Nordic region, experience their pain. Methods With empirical data from both countries, the research will unveil how these patients cope or adapt to their illness with all the attention they receive from the environments and their native resources. Apart from the theoretical considerations where literature/secondary sources on the subject will be analysed, the investigation will administer Coping Experience Questionnaires (CEQ) and The Medical Outcomes Study Short Form 36 (SF36) to reach a deeper analysis on how they adapt to their illness and wellbeing. The study will also utilise both the Structured Interviewed (SI) and In-depth Interview (IDI) to muster relevant data about their experience with hospital environments, native resources, and human relations. Results and conclusion It is estimated that the results of the investigation will firstly, help doctoral students to comprehend coping strategies and differences in conditions with HIV/AID patients in diverse cultures, and secondly, help to understand psychiatry care of patients from different cultural climates.
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Mercer, Mary Beth, Susannah L. Rose, Cassandra Talerico, Brian J. Wells, Mahesh Manne, Nirav Vakharia, Stacey Jolly, Alex Milinovich, Janine Bauman, and Michael W. Kattan. "Use of Visual Decision Aids in Physician–Patient Communication." Journal of Patient Experience 5, no. 3 (December 14, 2017): 167–76. http://dx.doi.org/10.1177/2374373517746177.
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Introduction: A risk calculator paired with a personalized decision aid (RC&DA) may foster shared decision-making in primary care. We assessed the feasibility of using an RC&DA with patients in a primary care outpatient clinic and patients’ experiences regarding communication and decision-making. Methods: This pilot study was conducted with 15 patients of 3 primary care physicians at a clinic within a tertiary medical center. An atherosclerotic cardiovascular disease (ASCVD) risk calculator was used to generate a personalized RC&DA that displayed absolute 10-year risk information as an icon array graphic. Patient perceptions of utility of the RC&DA, preferences for decision-making, and uncertainty with risk reduction decisions were measured with a semi-structured interview. Results: Patients reported that the RC&DA was easy to understand and knowledge gained was useful to modify their ASCVD risk. Patients used the RC&DA to make decisions and reported low uncertainty with those decisions. Conclusions: Our findings demonstrate the feasibility of, and positive patient experiences related to using, an RC&DA to facilitate shared decision-making between physicians and patients in an outpatient primary care setting.
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Kabeza, Claudine B., Lorenz Harst, Peter E. H. Schwarz, and Patrick Timpel. "Assessment of Rwandan diabetic patients’ needs and expectations to develop their first diabetes self-management smartphone application (Kir’App)." Therapeutic Advances in Endocrinology and Metabolism 10 (January 2019): 204201881984531. http://dx.doi.org/10.1177/2042018819845318.
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Background: Knowledge of and coping with diabetes is still poor in some communities in Rwanda. While smartphone applications (or apps) have demonstrated improving diabetes self-care, there is no current study on the use of smartphones in the self-management of diabetes in Rwanda. Methods: The main objective of this study was to assess the needs and expectations of Rwandan diabetic patients for mobile-health-supported diabetes self-management in order to develop a patient-centred smartphone application (Kir’App). Results: Convenience sampling was used to recruit study participants at the Rwanda Diabetes Association. Twenty-one patients participated in semi-structured, in-depth, face-to-face interviews. Thematic analysis was performed using Mayring’s method of qualitative content analysis. Conclusions: The study included 21 participants with either type 1 (female = 5, male = 6) or type 2 (female = 6, male = 4) diabetes. Participants’ age ranged from 18 to 69 years with a mean age of 35 and 29 years, respectively. Eight main themes were identified. These were (a) diabetes education and desired information provision; (b) lack of diabetes knowledge and awareness; (c) need for information in crisis situations; (d) required monitoring and reminder functions; (e) information on nutrition and alcohol consumption; (f) information on physical activity; (g) coping with burden of disease, through social support and network; (h) app features. This study provides recommendations that will be used to design the features of the first Rwandan diabetes self-management smartphone application (Kir’App). The future impact of the application on the Rwandan diabetic patients’ self-management capacity and quality of life will be evaluated afterwards.
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Nzayisenga, Ignace, Roanne Segal, Natalie Pritchett, Mary J. Xu, Paul H. Park, Edgie V. Mpanumusingo, Denis G. Umuhizi, et al. "Gestational Trophoblastic Neoplasia Treatment at the Butaro Cancer Center of Excellence in Rwanda." Journal of Global Oncology 2, no. 6 (December 2016): 365–74. http://dx.doi.org/10.1200/jgo.2015.002568.
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Purpose Gestational trophoblastic neoplasia (GTN) is a highly treatable disease, most often affecting young women of childbearing age. This study reviewed patients managed for GTN at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda to determine initial program outcomes. Patients and Methods A retrospective medical record review was performed for 35 patients with GTN assessed or treated between May 1, 2012, and November 30, 2014. Stage, risk score, and low or high GTN risk category were based on International Federation of Gynecology and Obstetrics staging and the WHO scoring system and determined by beta human chorionic gonadotropin level, chest x-ray, and ultrasound per protocol guidelines for resource-limited settings. Pathology reports and computed tomography scans were assessed when possible. Treatment was based on a predetermined protocol stratified by risk status. Results Of the 35 patients (mean age, 32 years), 26 (74%) had high-risk and nine (26%) had low-risk disease. Nineteen patients (54%) had undergone dilation and curettage and 11 (31%) had undergone hysterectomy before evaluation at BCCOE. Pathology reports were available in 48% of the molar pregnancy surgical cases. Systemic chemotherapy was initiated in 30 of the initial 35 patients: 13 (43%) received single-agent oral methotrexate, 15 (50%) received EMACO (etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine), and two (7%) received alternate regimens. Of the 13 patients initiating methotrexate, three had their treatment intensified to EMACO. Four patients experienced treatment delays because of medication stockouts. At a median follow-up of 7.8 months, the survival probability for low-risk patients was 1.00; for high-risk patients, it was 0.63. Conclusion This experience demonstrates the feasibility of GTN treatment in rural, resource-limited settings. GTN is a curable disease and can be treated following the BCCOE model of cancer care.
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Santos, B., E. J. Beck, and M. F. Peixoto. "Survival and Medical Intervention in Southern Brazilian AIDS Patients." International Journal of STD & AIDS 5, no. 4 (July 1994): 279–83. http://dx.doi.org/10.1177/095646249400500410.
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The aim of the study was to describe survival patterns of Southern Brazilian AIDS patients: 224 predominantly working class AIDS patients were treated in an AIDS referral centre in Porto Alegre between October 1986 and September 1991. The caseload increased progressively, as did the number of female AIDS cases treated at the Hospital during the study period. Self-referred patients were more likely to present with an AIDS defining condition ( P < 0.03) and they ( n = 106) had significantly worse survival patterns compared with patients referred by other health care professionals ( n = 112; P < 0.04). Median survival from the time of AIDS diagnosis was 5 months which did not change significantly during the study period ( P = 0.38). Patients ( n = 42) presenting with opportunistic infections other than mycobacterial disease ( n = 42), Pneumocystis carinii pneumonia ( n = 37) or candidiasis ( n = 18), had significantly worse survival patterns ( P = 0.001). Patients treated with zidovudine ( n = 33) survived significantly longer from time of AIDS diagnosis than those not on zidovudine ( n = 185; P = 0.0002). No significant survival differences were observed from time of AIDS diagnosis between those who commenced on zidovudine before developing AIDS ( n = 17) and those who were treated with zidovudine since diagnosed with AIDS ( n = 16; P = 0.80). During the study period zidovudine was only available through private prescriptions. Survival of Southern Brazilian AIDS patients has not improved: earlier access to HIV-related services and the provision of effective and affordable therapeutic interventions are two measures which could improve future survival patterns.
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Diesel, Holly, Patrick Ercole, and Donna Taliaferro. "Knowledge and Perceptions of HIV/AIDS among Cameroonian Nursing Students." International Journal of Nursing Education Scholarship 10, no. 1 (September 18, 2013): 209–18. http://dx.doi.org/10.1515/ijnes-2012-0036.
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AbstractThe HIV/AIDS pandemic impacts people throughout the world and is complicated by fear, prejudice, and stigma. Nurses play a major role in the health care delivery systems, yet in many parts of the world with high HIV sero-prevalence rates, nurses lack sufficient training and education to provide care to patients with HIV/AIDS. In an effort to build capacity and improve knowledge, attitudes and beliefs regarding care of patients with HIV/AIDS, a 4-day workshop was provided by American nursing students for Cameroonian nursing students. The training program included HIV epidemiology, disease management, and natural course of the disease, testing, legal and ethical issues, and infection control practices. Pre- and post-test scores were calculated using a series of surveys that measured HIV-related knowledge, attitudes, and beliefs. Results indicated that these measures of HIV-related perceptions improved due to the train-the-trainer workshop.
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Zekeri, Andrew A., Tsegaye Habtemariam, Berhanu Tameru, David Ngawa, and Vinaida Robnett. "Conspiracy Beliefs about HIV/AIDS among HIV-Positive African-American Patients in Rural Alabama." Psychological Reports 104, no. 2 (April 2009): 388–94. http://dx.doi.org/10.2466/pr0.104.2.388-394.
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This is apparently the first survey examining endorsement of HIV/AIDS conspiracy beliefs and their relations to educational attainment among 205 HIV-positive African-American patients receiving care at an AIDS Outreach Organization in Alabama. 31% somewhat or strongly believed that, “AIDS is a form of genocide against African Americans,” 29% strongly agreed that “AIDS was created by the government to control the black population,” 56.1% agreed that the government is withholding a cure for AIDS, and 69.8% agreed that the government is withholding information about the disease from the public. 52% agreed that “HIV is a manmade virus,” and 43.1% that “AIDS was produced in the government's laboratory.” Respondents with high school or college education were less likely to endorse conspiracy beliefs. Being open and sensitive to questions about conspiracy beliefs plus understanding the historical roots and social context from which such questions arise in African-American communities is needed to counter such beliefs.
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O’Neil, Daniel S., Nancy L. Keating, Jean Marie V. Dusengimana, Vedaste Hategekimana, Aline Umwizera, Tharcisse Mpunga, Lawrence N. Shulman, and Lydia E. Pace. "Quality of Breast Cancer Treatment at a Rural Cancer Center in Rwanda." Journal of Global Oncology, no. 4 (December 2018): 1–11. http://dx.doi.org/10.1200/jgo.2016.008672.
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Purpose As breast cancer incidence and mortality rise in sub-Saharan Africa, it is critical to identify strategies for delivery of high-quality breast cancer care in settings with limited resources and few oncology specialists. We investigated the quality of treatments received by a cohort of patients with breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center. Patients and Methods We reviewed medical records of all female patients diagnosed with invasive breast cancer at BCCOE between July 2012 and December 2013. We evaluated the provision of chemotherapy, endocrine therapy, surgery, and chemotherapy dose densities. We also applied modified international quality metrics and estimated overall survival using interval-censored analysis. Results Among 150 patients, 28 presented with early-stage, 64 with locally advanced, and 53 with metastatic disease. Among potentially curable patients (ie, those with early-stage or locally advanced disease), 74% received at least four cycles of chemotherapy and 63% received surgery. Among hormone receptor–positive patients, 83% received endocrine therapy within 1 year of diagnosis. Fifty-seven percent of potentially curable patients completed surgery and chemotherapy and initiated endocrine therapy if indicated within 1 year of biopsy. Radiotherapy was not available. At the end of follow-up, 62% of potentially curable patients were alive, 24% were dead, and 14% were lost to follow-up. Conclusion Appropriate delivery of chemotherapy and endocrine therapy for breast cancer is possible in rural sub-Saharan African even without oncologists based on site. Performing timely surgery and ensuring treatment completion were key challenges after the opening of BCCOE. Further investigation should examine persistent quality gaps and the relationship between treatment quality and survival.
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Barnardt, Pieter. "Managing AIDS-related Kaposi’s sarcoma and pregnancy." Southern African Journal of HIV Medicine 14, no. 2 (June 4, 2013): 87–88. http://dx.doi.org/10.4102/sajhivmed.v14i2.83.
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An estimated 30 - 40% of HIV-infected patients are likely to develop cancer during the progression of their disease. The occurrence of malignancy among these patients represents a difficult challenge in their care. Kaposi’s sarcoma (KS) – currently the most common tumour observed with an estimated incidence of 15 - 20% – represents the first manifestation of AIDS in 30 - 40% of patients. Any organ may be involved, but the gastrointestinal tract and lung remain the most frequently involved locations. The case described here presented a clinical and ethical dilemma where visceral KS, pregnancy and medical complications required multi-disciplinary management.