A clinician-nurse model to reduce early mortality and increase clinic retention among high-risk HIV-infected patients initiating combination antiretroviral treatment.

Journal of the International AIDS Society
Paula BraitsteinSylvester Kimaiyo

Abstract

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. 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. 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 mort...Continue Reading

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Citations

Oct 28, 2016·Journal of the International AIDS Society·Gitau MburuSoe Naing
Jun 30, 2016·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Ruby N FayorseyElaine J Abrams
Dec 6, 2012·Current Opinion in HIV and AIDS·Peter H Kilmarx, Tsitsi Mutasa-Apollo
Aug 16, 2017·International Journal of Health Policy and Management·Shahnaz KohanAli Gholami
Jan 1, 2014·Analytical Cellular Pathology (Amsterdam)·Prashanth Panta, Venkat Raghavender Venna
Jun 21, 2017·Journal of the International AIDS Society·Jessica E HabererDavid R Bangsberg
Jun 14, 2013·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Michelle S LiBenjamin H Chi
Mar 8, 2013·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Winstone NyandikoPaula Braitstein
Aug 16, 2016·BMC Pregnancy and Childbirth·Sherri BucherFabian Esamai
Apr 17, 2015·Tropical Medicine & International Health : TM & IH·Peter MacPhersonDavid A Ross
Mar 1, 2016·Scandinavian Journal of Statistics, Theory and Applications·Menggang Yu, Constantin T Yiannoutsos
Feb 5, 2021·PloS One·Sylvia KusemererwaNelson Kawulukusi Sewankambo
Aug 27, 2021·Revista da Escola de Enfermagem da U S P·Priscila Tadei Nakata ZagoCristianne Maria Famer Rocha

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Software Mentioned

STATA
AMPATH

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