dc.contributor.author |
Paula, Braitstein |
|
dc.contributor.author |
Siika, Abraham |
|
dc.contributor.author |
Hogan, Joseph |
|
dc.contributor.author |
Kosgei, Rose |
|
dc.contributor.author |
Sang, Edwin |
|
dc.contributor.author |
Sidle, John |
|
dc.contributor.author |
Wools-Kaloustian, Kara |
|
dc.contributor.author |
Keter, Alfred |
|
dc.contributor.author |
Mamlin, Joseph |
|
dc.contributor.author |
Kimaiyo, Sylvester |
|
dc.date.accessioned |
2017-10-04T13:17:24Z |
|
dc.date.available |
2017-10-04T13:17:24Z |
|
dc.date.issued |
2012-02 |
|
dc.identifier.uri |
https://www.biomedcentral.com/1758-2652/content/15/1/7 |
|
dc.identifier.uri |
http://ir.mu.ac.ke:8080/xmlui/handle/123456789/154 |
|
dc.description.abstract |
Background: In resource-poor settings, mortality is at its highest during the first 3 months after combination
antiretroviral treatment (cART) initiation. A clear predictor of mortality during this period is having a low CD4 count
at the time of treatment initiation. The objective of this study was to evaluate the effect on survival and clinic
retention of a nurse-based rapid assessment clinic for high-risk individuals initiating cART in a resource-constrained
setting.
Methods: The USAID-AMPATH Partnership has enrolled more than 140,000 patients at 25 clinics throughout
western Kenya. High Risk Express Care (HREC) provides weekly or bi-weekly rapid contacts with nurses for
individuals initiating cART with CD4 counts of ≤100 cells/mm3. All HIV-infected individuals aged 14 years or older
initiating cART with CD4 counts of ≤100 cells/mm3 were eligible for enrolment into HREC and for analysis.
Adjusted hazard ratios (AHRs) control for potential confounding using propensity score methods.
Results: Between March 2007 and March 2009, 4,958 patients initiated cART with CD4 counts of ≤100 cells/mm3.
After adjusting for age, sex, CD4 count, use of cotrimoxazole, treatment for tuberculosis, travel time to clinic and
type of clinic, individuals in HREC had reduced mortality (AHR: 0.59; 95% confidence interval: 0.45-0.77), and
reduced loss to follow up (AHR: 0.62; 95% CI: 0.55-0.70) compared with individuals in routine care. Overall, patients
in HREC were much more likely to be alive and in care after a median of nearly 11 months of follow up (AHR: 0.62;
95% CI: 0.57-0.67).
Conclusions: Frequent monitoring by dedicated nurses in the early months of cART can significantly reduce
mortality and loss to follow up among high-risk patients initiating treatment in resource-constrained settings. |
en_US |
dc.description.sponsorship |
The USAID-AMPATH
Rockefeller Foundation
Kenyan National Leprosy,Tuberculosis, and Lung Disease (NLTLD) Programme |
en_US |
dc.language.iso |
en |
en_US |
dc.publisher |
Journal of the International AIDS Society |
en_US |
dc.subject |
Antiretrovirals |
en_US |
dc.subject |
Mortality |
en_US |
dc.subject |
Losses to follow up |
en_US |
dc.subject |
Adherence |
en_US |
dc.subject |
Models of care |
en_US |
dc.subject |
Africa |
en_US |
dc.title |
A clinician-nurse model to reduce early mortality and increase clinic retention among high-risk HIV-infected patients initiating combination antiretroviral treatment |
en_US |
dc.type |
Article |
en_US |