Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenanc...Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.展开更多
Retention of the patients in HIV-care is critical for success of Anti Retroviral Treatment (ART) programme to reduce HIV-related morbidity & mortality and prevent emergence of drug resistance. In last decade in De...Retention of the patients in HIV-care is critical for success of Anti Retroviral Treatment (ART) programme to reduce HIV-related morbidity & mortality and prevent emergence of drug resistance. In last decade in Delhi (April 2004 to March 2014), overall 24% HIV-positive patients were lost-to-follow-up (LTFU) at step-1 (testing to enrolment into HIV-care), 7.8% at step-2 (enrolment to ART eligibility), 23.7% at step-3 (eligibility to initiation of ART) and 16.6% at step-4 (initiation to lifelong ART) of retention cascade. About 2/3rd losses at step-4 were within 1st year and 80% within 2 years. The retention of the patients in pre-ART care was 3 times lower than those initiated ART. Only 27.4% patients were in active pre-ART care during 2013. The intensified LTFU tracking (ILT) undertaken during November, 2013 through March, 2014 was not successful in tracking 97% pre-ART LTFU clients due to incomplete addresses/or migration since address proof of patients on enrolment into HIV-care was not mandatory prior to 2009. Amongst patients tracked, 1.5% were alive, 0.24% had disengaged from care while 1.2% had died. After ILT overall “On ART” and “Pre-ART” LTFU rate in the last decade was 15.5% and 45.2%, respectively. The retention cascade of last year from April 2013 to March 2014 showed improvement through strategies adopted in Third Phase of National AIDS Control Programme (NACP-III;2007-2013), and “On ART” and “Pre-ART” LTFU rates declined to 9.4% and 7.4%, respectively. However, desired at least 90% retention at various steps of the cascade could not be achieved. National Policy of delivering ART services through limited number of standalone ART centers in India, despite its significant success, has limitation of leaky treatment cascade and calls for policy makers to decentralize the programme by its appropriate integration with general health services and task shifting to improve continuum of care.展开更多
<strong>Background:</strong> Patients medical records are used to document care processes for communication amongst healthcare workers for continued patient management. Incomplete or inaccurate documentati...<strong>Background:</strong> Patients medical records are used to document care processes for communication amongst healthcare workers for continued patient management. Incomplete or inaccurate documentation can adversely affect the quality of patients’ care, leading to medication and treatment errors, increased morbidity, and mortality. Quality documentation in medical records is therefore an essential component of optimal healthcare and facilitates an individual’s continuity of care. This study aimed to assess the quality of documentation of clinical data through the review of the accuracy and completeness of clinical records among newly diagnosed HIV-positive persons. The study is a sub analysis of a prospective longitudinal study that followed a cohort of 12,413 persons who were newly diagnosed with HIV infection. Severe limitations in retrieving reliable information and data became an obstacle to our research and led the study team to conduct medical records documentation and data audit to verify the accuracy and completeness of the data for newly diagnosed HIV positive persons. <strong>Methods: </strong>A cross-sectional study was conducted using routine data generated from 75 randomly selected newly diagnosed HIV positive persons aged 12-years-old and above between June 1, 2014 and March 31, 2015 in 36 purposively selected primary health care (PHC) clinics in South Africa. The facilities were selected from three high HIV-burden districts of South Africa (Gert Sibande, uThukela and City of Johannesburg). <strong>Results: </strong>Significant differences in the accuracy and completeness of clinical records were observed between data generated through the self-assessment by the facility managers and data primarily collected through review of the patients’ clinical stationery and facility registers. 80% of the newly diagnosed HIV positive persons were not documented as screened for tuberculosis (TB) on the clinical chart and 69% of newly diagnosed clients were not clinically staged (WHO staging). Furthermore, 80% of newly diagnosed HIV positive persons’ follow up visit dates were not documented in the patient’s clinical chart. Completeness of the data elements on the case record forms ranged from as low as 26% to a maximum of 66%. It was noteworthy that all the clients’ information documented in HIV counselling and testing registers, continuum of care registers and clinical charts were only partially completed. <strong>Conclusion:</strong> Each of the health care facilities under study had some significant gaps in medical records documentation of clinical data on newly diagnosed HIV positive persons. Data and information accuracy and completeness were a serious challenge in most facilities during the period under investigation. Of interest was the inconsistency of data recorded in the HCT registers, continuum of care and clinical charts of individual patients. <strong>This is a major impediment to HIV/AIDS comprehensive care.</strong>展开更多
BACKGROUND The human immunodeficiency virus(HIV)continuum of care cascade illustrates the 90-90-90 goals defined by the Joint United Nations Program on HIV/acquired immunodeficiency syndrome(UNAIDS).The care cascade i...BACKGROUND The human immunodeficiency virus(HIV)continuum of care cascade illustrates the 90-90-90 goals defined by the Joint United Nations Program on HIV/acquired immunodeficiency syndrome(UNAIDS).The care cascade includes the following five steps:Diagnosis,linkage to care,retention in care,adherence to antiretroviral therapy(ART),and viral suppression.AIM To elaborate the HIV cascade of patients diagnosed with HIV at the Nossa Senhora da Conceição Hospital(HNSC)and to determine possible local causes for the loss of patients between each step of the cascade.METHODS This retrospective cohort study included patients diagnosed with HIV infection from January 1,2015 to December 31,2016 and followed up until July 31,2019.The data were analyzed by IBM SPSS software version 25,and Poisson regression with simple robust variance was used to analyze variables in relation to each step of the cascade.Variables with P<0.20 were included in multivariable analysis,and P<0.05 was considered significant.Pearson’sχ^(2) test was used to compare the groups of patients followed up at the HNSC and those followed up at other sites.RESULTS The results were lower than those expected by the UNAIDS,with 94%of patients linked,91%retained,81%adhering to ART,and 84%in viral suppression.Age and site of follow-up were the variables with the highest statistical significance.A comparison showed that the cascade of patients from the HNSC had superior results than outpatients,with a significant difference in the last step of the cascade.CONCLUSION The specialized and continued care provided at the HNSC was associated with better results and was closer to the goals set by the UNAIDS.The development of the HIV cascade using local data allowed for the stratification and evaluation of risk factors associated with the losses occurring between each step of the cascade.展开更多
目的通过Meta分析评价医院-社区-家庭延续护理对慢阻肺患者出院后的康复效果。方法系统检索中国知网、万方、维普、中国生物医学文献数据库、Web of Science、The Cochrane Library、PubMed、CINAHI、EMbase共9个数据库公开发表的医院-...目的通过Meta分析评价医院-社区-家庭延续护理对慢阻肺患者出院后的康复效果。方法系统检索中国知网、万方、维普、中国生物医学文献数据库、Web of Science、The Cochrane Library、PubMed、CINAHI、EMbase共9个数据库公开发表的医院-社区-家庭延续护理模式对慢阻肺出院患者肺康复影响的随机对照研究,检索时间为建库至2023年12月31日,采用RevMan5.3软件进行Meta分析。结果纳入23篇文献,Meta分析结果显示:与医院主导的常规延续性护理相比,医院-社区-家庭延续护理模式能较好改善患者肺功能及呼吸困难症状,第1秒用力呼吸量(FEV1)[MD=0.51,95%CI(0.32,0.71),P<0.01]、第1秒用力呼吸量占预计值百分比(FEV1%)[MD=4.52,95%CI(3.13,5.19),P<0.01]、第1秒用力呼吸量与用力肺活量的比值(FEV1/FVC)[MD=8.34,95%CI(5.39,11.30),P<0.01]、改良版呼吸困难量表(mMRC)得分[MD=-0.39,95%CI(-0.52,-0.26),P<0.01];有效提高患者运动耐量[MD=45.23,95%CI(22.33,68.12),P<0.01];显著提高患者生存质量[MD=-4.48,95%CI(-5.46,-3.50),P<0.01]及降低再入院率[MD=0.28,95%CI(0.19,0.43),P<0.01]。结论医院-社区-家庭延续护理模式能有效改善慢阻肺出院患者肺功能和呼吸困难症状,提高患者运动耐量和生存质量,降低再住院率。展开更多
Through the comparative analysis on the theories and practical experience of the development of old-age care (OAC) in both China and other countries,and based on the interview and questionnaire survey in Zhejiang Prov...Through the comparative analysis on the theories and practical experience of the development of old-age care (OAC) in both China and other countries,and based on the interview and questionnaire survey in Zhejiang Province and Hangzhou City,this paper proposes the research and analysis framework for the old-age service system,i.e.,"OAC mode-OAC service system-OAC facility system." The paper argues that,oriented by OAC mode of "taking community-and home-based care as the main body and institution-based care as supplement," China should build an OAC facility system and planning thoughts that take "continuum of care" as concept and long-term care system as core.Taking Zhejiang Province and Hangzhou City as examples,the paper conducts the optimization research on current OAC facilities planning in terms of hierarchical system,scale,and differentiation,so as to formulate more systematic and operable planning standards for OAC facilities.展开更多
文摘Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.
文摘Retention of the patients in HIV-care is critical for success of Anti Retroviral Treatment (ART) programme to reduce HIV-related morbidity & mortality and prevent emergence of drug resistance. In last decade in Delhi (April 2004 to March 2014), overall 24% HIV-positive patients were lost-to-follow-up (LTFU) at step-1 (testing to enrolment into HIV-care), 7.8% at step-2 (enrolment to ART eligibility), 23.7% at step-3 (eligibility to initiation of ART) and 16.6% at step-4 (initiation to lifelong ART) of retention cascade. About 2/3rd losses at step-4 were within 1st year and 80% within 2 years. The retention of the patients in pre-ART care was 3 times lower than those initiated ART. Only 27.4% patients were in active pre-ART care during 2013. The intensified LTFU tracking (ILT) undertaken during November, 2013 through March, 2014 was not successful in tracking 97% pre-ART LTFU clients due to incomplete addresses/or migration since address proof of patients on enrolment into HIV-care was not mandatory prior to 2009. Amongst patients tracked, 1.5% were alive, 0.24% had disengaged from care while 1.2% had died. After ILT overall “On ART” and “Pre-ART” LTFU rate in the last decade was 15.5% and 45.2%, respectively. The retention cascade of last year from April 2013 to March 2014 showed improvement through strategies adopted in Third Phase of National AIDS Control Programme (NACP-III;2007-2013), and “On ART” and “Pre-ART” LTFU rates declined to 9.4% and 7.4%, respectively. However, desired at least 90% retention at various steps of the cascade could not be achieved. National Policy of delivering ART services through limited number of standalone ART centers in India, despite its significant success, has limitation of leaky treatment cascade and calls for policy makers to decentralize the programme by its appropriate integration with general health services and task shifting to improve continuum of care.
文摘<strong>Background:</strong> Patients medical records are used to document care processes for communication amongst healthcare workers for continued patient management. Incomplete or inaccurate documentation can adversely affect the quality of patients’ care, leading to medication and treatment errors, increased morbidity, and mortality. Quality documentation in medical records is therefore an essential component of optimal healthcare and facilitates an individual’s continuity of care. This study aimed to assess the quality of documentation of clinical data through the review of the accuracy and completeness of clinical records among newly diagnosed HIV-positive persons. The study is a sub analysis of a prospective longitudinal study that followed a cohort of 12,413 persons who were newly diagnosed with HIV infection. Severe limitations in retrieving reliable information and data became an obstacle to our research and led the study team to conduct medical records documentation and data audit to verify the accuracy and completeness of the data for newly diagnosed HIV positive persons. <strong>Methods: </strong>A cross-sectional study was conducted using routine data generated from 75 randomly selected newly diagnosed HIV positive persons aged 12-years-old and above between June 1, 2014 and March 31, 2015 in 36 purposively selected primary health care (PHC) clinics in South Africa. The facilities were selected from three high HIV-burden districts of South Africa (Gert Sibande, uThukela and City of Johannesburg). <strong>Results: </strong>Significant differences in the accuracy and completeness of clinical records were observed between data generated through the self-assessment by the facility managers and data primarily collected through review of the patients’ clinical stationery and facility registers. 80% of the newly diagnosed HIV positive persons were not documented as screened for tuberculosis (TB) on the clinical chart and 69% of newly diagnosed clients were not clinically staged (WHO staging). Furthermore, 80% of newly diagnosed HIV positive persons’ follow up visit dates were not documented in the patient’s clinical chart. Completeness of the data elements on the case record forms ranged from as low as 26% to a maximum of 66%. It was noteworthy that all the clients’ information documented in HIV counselling and testing registers, continuum of care registers and clinical charts were only partially completed. <strong>Conclusion:</strong> Each of the health care facilities under study had some significant gaps in medical records documentation of clinical data on newly diagnosed HIV positive persons. Data and information accuracy and completeness were a serious challenge in most facilities during the period under investigation. Of interest was the inconsistency of data recorded in the HCT registers, continuum of care and clinical charts of individual patients. <strong>This is a major impediment to HIV/AIDS comprehensive care.</strong>
文摘BACKGROUND The human immunodeficiency virus(HIV)continuum of care cascade illustrates the 90-90-90 goals defined by the Joint United Nations Program on HIV/acquired immunodeficiency syndrome(UNAIDS).The care cascade includes the following five steps:Diagnosis,linkage to care,retention in care,adherence to antiretroviral therapy(ART),and viral suppression.AIM To elaborate the HIV cascade of patients diagnosed with HIV at the Nossa Senhora da Conceição Hospital(HNSC)and to determine possible local causes for the loss of patients between each step of the cascade.METHODS This retrospective cohort study included patients diagnosed with HIV infection from January 1,2015 to December 31,2016 and followed up until July 31,2019.The data were analyzed by IBM SPSS software version 25,and Poisson regression with simple robust variance was used to analyze variables in relation to each step of the cascade.Variables with P<0.20 were included in multivariable analysis,and P<0.05 was considered significant.Pearson’sχ^(2) test was used to compare the groups of patients followed up at the HNSC and those followed up at other sites.RESULTS The results were lower than those expected by the UNAIDS,with 94%of patients linked,91%retained,81%adhering to ART,and 84%in viral suppression.Age and site of follow-up were the variables with the highest statistical significance.A comparison showed that the cascade of patients from the HNSC had superior results than outpatients,with a significant difference in the last step of the cascade.CONCLUSION The specialized and continued care provided at the HNSC was associated with better results and was closer to the goals set by the UNAIDS.The development of the HIV cascade using local data allowed for the stratification and evaluation of risk factors associated with the losses occurring between each step of the cascade.
文摘目的通过Meta分析评价医院-社区-家庭延续护理对慢阻肺患者出院后的康复效果。方法系统检索中国知网、万方、维普、中国生物医学文献数据库、Web of Science、The Cochrane Library、PubMed、CINAHI、EMbase共9个数据库公开发表的医院-社区-家庭延续护理模式对慢阻肺出院患者肺康复影响的随机对照研究,检索时间为建库至2023年12月31日,采用RevMan5.3软件进行Meta分析。结果纳入23篇文献,Meta分析结果显示:与医院主导的常规延续性护理相比,医院-社区-家庭延续护理模式能较好改善患者肺功能及呼吸困难症状,第1秒用力呼吸量(FEV1)[MD=0.51,95%CI(0.32,0.71),P<0.01]、第1秒用力呼吸量占预计值百分比(FEV1%)[MD=4.52,95%CI(3.13,5.19),P<0.01]、第1秒用力呼吸量与用力肺活量的比值(FEV1/FVC)[MD=8.34,95%CI(5.39,11.30),P<0.01]、改良版呼吸困难量表(mMRC)得分[MD=-0.39,95%CI(-0.52,-0.26),P<0.01];有效提高患者运动耐量[MD=45.23,95%CI(22.33,68.12),P<0.01];显著提高患者生存质量[MD=-4.48,95%CI(-5.46,-3.50),P<0.01]及降低再入院率[MD=0.28,95%CI(0.19,0.43),P<0.01]。结论医院-社区-家庭延续护理模式能有效改善慢阻肺出院患者肺功能和呼吸困难症状,提高患者运动耐量和生存质量,降低再住院率。
文摘Through the comparative analysis on the theories and practical experience of the development of old-age care (OAC) in both China and other countries,and based on the interview and questionnaire survey in Zhejiang Province and Hangzhou City,this paper proposes the research and analysis framework for the old-age service system,i.e.,"OAC mode-OAC service system-OAC facility system." The paper argues that,oriented by OAC mode of "taking community-and home-based care as the main body and institution-based care as supplement," China should build an OAC facility system and planning thoughts that take "continuum of care" as concept and long-term care system as core.Taking Zhejiang Province and Hangzhou City as examples,the paper conducts the optimization research on current OAC facilities planning in terms of hierarchical system,scale,and differentiation,so as to formulate more systematic and operable planning standards for OAC facilities.
