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dc.contributor.authorMbewe, Nyuma
dc.contributor.authorVinikoor, Michael J
dc.contributor.authorFwoloshi, Sombo
dc.contributor.authorMwitumwa, Mundia
dc.contributor.authorLakhi, Shabir
dc.contributor.authorSivile, Suilanji
dc.contributor.authorYavatkar, Mallika
dc.contributor.authorLindsay, Brianna
dc.contributor.authorStafford, Kristen
dc.contributor.authorHachaambwa, Lottie
dc.contributor.authorMulenga, Lloyd
dc.contributor.authorClaassen, Cassidy W
dc.date.accessioned2022-02-25T15:40:28Z
dc.date.available2022-02-25T15:40:28Z
dc.date.issued2022-02-22
dc.identifier.urihttp://hdl.handle.net/10713/18106
dc.description.abstractBackground: 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.en_US
dc.description.urihttps://doi.org/10.1186/s12981-022-00433-8en_US
dc.language.isoenen_US
dc.publisherSpringer Natureen_US
dc.relation.ispartofAIDS Research and Therapyen_US
dc.rights© 2022. The Author(s).en_US
dc.subjectAdvanced HIV diseaseen_US
dc.subjectSub-Saharan Africaen_US
dc.subjectTB diagnosticsen_US
dc.subjectViral load monitoringen_US
dc.titleAdvanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review.en_US
dc.typeArticleen_US
dc.identifier.doi10.1186/s12981-022-00433-8
dc.identifier.pmid35193598
dc.source.journaltitleAIDS research and therapy
dc.source.volume19
dc.source.issue1
dc.source.beginpage10
dc.source.endpage
dc.source.countryEngland


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