Initiating antiretroviral treatment in a resource-constrained setting: does clinical staging effectively identify patients in need?
Identifieur interne : 000B13 ( Main/Exploration ); précédent : 000B12; suivant : 000B14Initiating antiretroviral treatment in a resource-constrained setting: does clinical staging effectively identify patients in need?
Auteurs : K. Torpey [Zambie] ; M. Lartey [Ghana] ; R. Amenyah [Ghana] ; N. A. Addo [Ghana] ; J. Obeng-Baah [Ghana] ; Y. Rahman [Ghana] ; C. Suzuki [États-Unis] ; Y. D. Mukadi [États-Unis] ; R. Colebunders [Belgique]Source :
- International journal of STD & AIDS [ 0956-4624 ] ; 2009.
Descripteurs français
- KwdFr :
- Adulte, Agents antiVIH (administration et posologie), Agents antiVIH (usage thérapeutique), Détermination de l'admissibilité (), Femelle, Ghana (épidémiologie), Humains, Infections à VIH (immunologie), Infections à VIH (physiopathologie), Infections à VIH (traitement médicamenteux), Mâle, Numération des lymphocytes CD4, Pays en voie de développement, Population rurale, Population urbaine, Sensibilité et spécificité, Valeur prédictive des tests, Évaluation des besoins.
- MESH :
- administration et posologie : Agents antiVIH.
- immunologie : Infections à VIH.
- physiopathologie : Infections à VIH.
- traitement médicamenteux : Infections à VIH.
- usage thérapeutique : Agents antiVIH.
- épidémiologie : Ghana.
- Pascal (Inist)
- Adulte, Détermination de l'admissibilité, Femelle, Humains, Mâle, Numération des lymphocytes CD4, Pays en voie de développement, Population rurale, Population urbaine, SIDA, Maladie sexuellement transmissible, Antiviral, Antirétroviral, Sensibilité et spécificité, Traitement, Médecine, Homme, Valeur prédictive des tests, Évaluation des besoins.
- Wicri :
- geographic : Ghana.
- topic : Maladie sexuellement transmissible, Médecine, Homme.
English descriptors
- KwdEn :
- AIDS, Adult, Anti-HIV Agents (administration & dosage), Anti-HIV Agents (therapeutic use), Antiretroviral agent, Antiviral, CD4 Lymphocyte Count, Developing Countries, Eligibility Determination (methods), Female, Ghana (epidemiology), HIV Infections (drug therapy), HIV Infections (immunology), HIV Infections (physiopathology), Human, Humans, Male, Medicine, Needs Assessment, Predictive Value of Tests, Rural Population, Sensitivity and Specificity, Sexually transmitted disease, Treatment, Urban Population.
- MESH :
- chemical , administration & dosage : Anti-HIV Agents.
- chemical , therapeutic use : Anti-HIV Agents.
- geographic , epidemiology : Ghana.
- drug therapy : HIV Infections.
- immunology : HIV Infections.
- methods : Eligibility Determination.
- physiopathology : HIV Infections.
- Adult, CD4 Lymphocyte Count, Developing Countries, Female, Humans, Male, Needs Assessment, Predictive Value of Tests, Rural Population, Sensitivity and Specificity, Urban Population.
Abstract
In industrialized countries, the initiation of antiretroviral therapy (ART) is based on virological, immunological and clinical markers. The objective of this study was to identify treatment gaps when ART initiation is based on clinical staging alone. The method employed was a retrospective study of 5784 patients enrolled in an HIV treatment programme in two urban and two rural sites in Ghana. Of the patients, 29.5% were in clinical Stages I and II and had a CD4+ T-lymphocyte count less than 200 cells/mm3. Significantly more patients in clinical Stage I from urban sites (37.0%) had a CD4+ T-lymphocyte count less than 200 cells/mm3 as compared with patients from rural sites (23.8%) (P value <0.05). In addition, more men (39.9%) in clinical Stage I had a CD4+ T-lymphocyte count less than 200 cells/mm3 when compared with women (27.4%) (P value <0.05). In conclusion, clinical staging cannot identify a relatively large number of patients who need ART. A wider availability of CD4+ T-lymphocyte count testing will optimize the identification of patients eligible for ART.
Affiliations:
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Torpey</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Family Health International, P.O. Box 320303</s1><s2>Lusaka</s2><s3>ZMB</s3><sZ>1 aut.</sZ></inist:fA14><country>Zambie</country><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Lartey, M" sort="Lartey, M" uniqKey="Lartey M" first="M." last="Lartey">M. Lartey</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, KorleBu Teaching Hospital/University of Ghana Medical School</s1><s3>GHA</s3><sZ>2 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Department of Medicine, KorleBu Teaching Hospital/University of Ghana Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Amenyah, R" sort="Amenyah, R" uniqKey="Amenyah R" first="R." last="Amenyah">R. Amenyah</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Ghana AIDS Commission</s1><s3>GHA</s3><sZ>3 aut.</sZ></inist:fA14><country>Ghana</country><wicri:noRegion>Ghana AIDS Commission</wicri:noRegion></affiliation></author><author><name sortKey="Addo, N A" sort="Addo, N A" uniqKey="Addo N" first="N. A." last="Addo">N. A. Addo</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>National AIDS Control Program/Ministry of Health</s1><s2>Accra</s2><s3>GHA</s3><sZ>4 aut.</sZ></inist:fA14><country>Ghana</country><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Obeng Baah, J" sort="Obeng Baah, J" uniqKey="Obeng Baah J" first="J." last="Obeng-Baah">J. 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Suzuki</name><affiliation wicri:level="2"><inist:fA14 i1="07"><s1>Family Health International, 4401 Wilson Boulevard</s1><s2>Arlington, VA 22203</s2><s3>USA</s3><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Virginie</region></placeName></affiliation></author><author><name sortKey="Mukadi, Y D" sort="Mukadi, Y D" uniqKey="Mukadi Y" first="Y. D." last="Mukadi">Y. D. Mukadi</name><affiliation wicri:level="2"><inist:fA14 i1="07"><s1>Family Health International, 4401 Wilson Boulevard</s1><s2>Arlington, VA 22203</s2><s3>USA</s3><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Virginie</region></placeName></affiliation></author><author><name sortKey="Colebunders, R" sort="Colebunders, R" uniqKey="Colebunders R" first="R." last="Colebunders">R. Colebunders</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Institute of Tropical Medicine, Nationalestraat 155</s1><s2>Antwerp 2000</s2><s3>BEL</s3><sZ>9 aut.</sZ></inist:fA14><country>Belgique</country><wicri:noRegion>Antwerp 2000</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">International journal of STD & AIDS</title><title level="j" type="abbreviated">Int. j. STD AIDS</title><idno type="ISSN">0956-4624</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">International journal of STD & AIDS</title><title level="j" type="abbreviated">Int. j. STD AIDS</title><idno type="ISSN">0956-4624</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Adult</term><term>Anti-HIV Agents (administration & dosage)</term><term>Anti-HIV Agents (therapeutic use)</term><term>Antiretroviral agent</term><term>Antiviral</term><term>CD4 Lymphocyte Count</term><term>Developing Countries</term><term>Eligibility Determination (methods)</term><term>Female</term><term>Ghana (epidemiology)</term><term>HIV Infections (drug therapy)</term><term>HIV Infections (immunology)</term><term>HIV Infections (physiopathology)</term><term>Human</term><term>Humans</term><term>Male</term><term>Medicine</term><term>Needs Assessment</term><term>Predictive Value of Tests</term><term>Rural Population</term><term>Sensitivity and Specificity</term><term>Sexually transmitted disease</term><term>Treatment</term><term>Urban Population</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Agents antiVIH (administration et posologie)</term><term>Agents antiVIH (usage thérapeutique)</term><term>Détermination de l'admissibilité ()</term><term>Femelle</term><term>Ghana (épidémiologie)</term><term>Humains</term><term>Infections à VIH (immunologie)</term><term>Infections à VIH (physiopathologie)</term><term>Infections à VIH (traitement médicamenteux)</term><term>Mâle</term><term>Numération des lymphocytes CD4</term><term>Pays en voie de développement</term><term>Population rurale</term><term>Population urbaine</term><term>Sensibilité et spécificité</term><term>Valeur prédictive des tests</term><term>Évaluation des besoins</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Anti-HIV Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-HIV Agents</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Ghana</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Agents antiVIH</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Eligibility Determination</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Agents antiVIH</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Ghana</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>CD4 Lymphocyte Count</term><term>Developing Countries</term><term>Female</term><term>Humans</term><term>Male</term><term>Needs Assessment</term><term>Predictive Value of Tests</term><term>Rural Population</term><term>Sensitivity and Specificity</term><term>Urban Population</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Adulte</term><term>Détermination de l'admissibilité</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Numération des lymphocytes CD4</term><term>Pays en voie de développement</term><term>Population rurale</term><term>Population urbaine</term><term>SIDA</term><term>Maladie sexuellement transmissible</term><term>Antiviral</term><term>Antirétroviral</term><term>Sensibilité et spécificité</term><term>Traitement</term><term>Médecine</term><term>Homme</term><term>Valeur prédictive des tests</term><term>Évaluation des besoins</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Maladie sexuellement transmissible</term><term>Médecine</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">In industrialized countries, the initiation of antiretroviral therapy (ART) is based on virological, immunological and clinical markers. The objective of this study was to identify treatment gaps when ART initiation is based on clinical staging alone. The method employed was a retrospective study of 5784 patients enrolled in an HIV treatment programme in two urban and two rural sites in Ghana. Of the patients, 29.5% were in clinical Stages I and II and had a CD4+ T-lymphocyte count less than 200 cells/mm<sup>3</sup>. Significantly more patients in clinical Stage I from urban sites (37.0%) had a CD4+ T-lymphocyte count less than 200 cells/mm<sup>3</sup> as compared with patients from rural sites (23.8%) (P value <0.05). In addition, more men (39.9%) in clinical Stage I had a CD4+ T-lymphocyte count less than 200 cells/mm<sup>3</sup> when compared with women (27.4%) (P value <0.05). In conclusion, clinical staging cannot identify a relatively large number of patients who need ART. A wider availability of CD4+ T-lymphocyte count testing will optimize the identification of patients eligible for ART.</div></front></TEI><affiliations><list><country><li>Belgique</li><li>Ghana</li><li>Zambie</li><li>États-Unis</li></country><region><li>Région du Grand Accra</li><li>Virginie</li></region><settlement><li>Accra</li></settlement></list><tree><country name="Zambie"><noRegion><name sortKey="Torpey, K" sort="Torpey, K" uniqKey="Torpey K" first="K." last="Torpey">K. Torpey</name></noRegion></country><country name="Ghana"><noRegion><name sortKey="Lartey, M" sort="Lartey, M" uniqKey="Lartey M" first="M." last="Lartey">M. Lartey</name></noRegion><name sortKey="Addo, N A" sort="Addo, N A" uniqKey="Addo N" first="N. A." last="Addo">N. A. Addo</name><name sortKey="Amenyah, R" sort="Amenyah, R" uniqKey="Amenyah R" first="R." last="Amenyah">R. Amenyah</name><name sortKey="Obeng Baah, J" sort="Obeng Baah, J" uniqKey="Obeng Baah J" first="J." last="Obeng-Baah">J. Obeng-Baah</name><name sortKey="Rahman, Y" sort="Rahman, Y" uniqKey="Rahman Y" first="Y." last="Rahman">Y. Rahman</name></country><country name="États-Unis"><region name="Virginie"><name sortKey="Suzuki, C" sort="Suzuki, C" uniqKey="Suzuki C" first="C." last="Suzuki">C. Suzuki</name></region><name sortKey="Mukadi, Y D" sort="Mukadi, Y D" uniqKey="Mukadi Y" first="Y. D." last="Mukadi">Y. D. Mukadi</name></country><country name="Belgique"><noRegion><name sortKey="Colebunders, R" sort="Colebunders, R" uniqKey="Colebunders R" first="R." last="Colebunders">R. Colebunders</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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