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    Advanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review.

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    Author
    Mbewe, Nyuma
    Vinikoor, Michael J
    Fwoloshi, Sombo
    Mwitumwa, Mundia
    Lakhi, Shabir
    Sivile, Suilanji
    Yavatkar, Mallika
    Lindsay, Brianna
    Stafford, Kristen
    Hachaambwa, Lottie
    Mulenga, Lloyd
    Claassen, Cassidy W
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    Date
    2022-02-22
    Journal
    AIDS Research and Therapy
    Publisher
    Springer Nature
    Type
    Article
    
    Metadata
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    See at
    https://doi.org/10.1186/s12981-022-00433-8
    Abstract
    Background: Zambia recently achieved UNAIDS 90-90-90 treatment targets for HIV epidemic control; however, inpatient facilities continue to face a large burden of patients with advanced HIV disease and HIV-related mortality. Management of advanced HIV disease, following guidelines from outpatient settings, may be more difficult within complex inpatient settings. We evaluated adherence to HIV guidelines during hospitalization, including opportunistic infection (OI) screening, treatment, and prophylaxis. Methods: We reviewed inpatient medical records of people living with HIV (PLHIV) admitted to the University Teaching Hospital in Lusaka, Zambia between December 1, 2018 and April 30, 2019. We collected data on patient demographics, antiretroviral therapy (ART), HIV biomarkers, and OI screening and treatment-including tuberculosis (TB), Cryptococcus, and OI prophylaxis with co-trimoxazole (CTX). Screening and treatment cascades were constructed based on the 2017 WHO Advanced HIV Guidelines. Results: We reviewed files from 200 charts of patients with advanced HIV disease; of these 92% (184/200) had been on ART previously; 58.1% (107/184) for more than 12 months. HIV viral load (VL) testing was uncommon but half of VL results were high. 39% (77/200) of patients had a documented CD4 count result. Of the 172 patients not on anti-TB treatment (ATT) on admission, TB diagnostic tests (either sputum Xpert MTB/RIF MTB/RIF or urine TB-LAM) were requested for 105 (61%) and resulted for 60 of the 105 (57%). Nine of the 14 patients (64%) with a positive lab result for TB died before results were available. Testing for Cryptococcosis was performed predominantly in patients with symptoms of meningitis. Urine TB-LAM testing was rarely performed. Conclusions: At a referral hospital in Zambia, CD4 testing was inconsistent due to laboratory challenges and this reduced recognition of AHD and implementation of AHD guidelines. HIV programs can potentially reduce mortality and identify PLHIV with retention and adherence issues through strengthening inpatient activities, including reflex VL testing, TB-LAM and serum CrAg during hospitalization.
    Rights/Terms
    © 2022. The Author(s).
    Keyword
    Advanced HIV disease
    Sub-Saharan Africa
    TB diagnostics
    Viral load monitoring
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/18106
    ae974a485f413a2113503eed53cd6c53
    10.1186/s12981-022-00433-8
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