Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa
Identifieur interne : 001640 ( Pmc/Corpus ); précédent : 001639; suivant : 001641Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa
Auteurs : Bruce A. Larson ; Alana Brennan ; Lynne Mcnamara ; Lawrence Long ; Sydney Rosen ; Ian Sanne ; Matthew P FoxSource :
- Bulletin of the World Health Organization [ 0042-9686 ] ; 2010.
Abstract
To estimate rates of completion of CD4+ lymphocyte testing (CD4 testing) within 12 weeks of testing positive for human immunodeficiency virus (HIV) at a large HIV/AIDS clinic in South Africa, and to identify clinical and demographic predictors for completion.
In our study, CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, we reviewed the records of all clinic patients who tested positive for HIV between January 2008 and February 2009. We identified predictors for completion through multivariate logistic regression.
Of the 416 patients who tested positive for HIV, 84.6% initiated CD4 testing within the study timeframe. Of these patients, 54.3% were immediately eligible for antiretroviral therapy (ART) because of a CD4 cell count ≤ 200/µl, but only 51.3% of the patients in this category completed CD4 testing within 12 weeks of HIV testing. Among those not immediately eligible for ART (CD4 cells > 200/µl), only 14.9% completed CD4 testing within 12 weeks. Overall, of HIV+ patients who initiated CD4 testing, 65% did not complete it within 12 weeks of diagnosis. The higher the baseline CD4 cell count, the lower the odds of completing CD4 testing within 12 weeks.
Patient losses between HIV testing, baseline CD4 cell count and the start of care and ART are high. As a result, many patients receive ART too late. Health information systems that link testing programmes with care and treatment programmes are needed.
Url:
DOI: 10.2471/BLT.09.068981
PubMed: 20865072
PubMed Central: 2930360
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Larson</name><affiliation><nlm:aff id="aff1">Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Brennan, Alana" sort="Brennan, Alana" uniqKey="Brennan A" first="Alana" last="Brennan">Alana Brennan</name><affiliation><nlm:aff id="aff1">Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Mcnamara, Lynne" sort="Mcnamara, Lynne" uniqKey="Mcnamara L" first="Lynne" last="Mcnamara">Lynne Mcnamara</name><affiliation><nlm:aff id="aff2">University of the Witwatersrand, Clinical HIV Research Unit, Johannesburg,<country>South Africa</country>.</nlm:aff></affiliation></author><author><name sortKey="Long, Lawrence" sort="Long, Lawrence" uniqKey="Long L" first="Lawrence" last="Long">Lawrence Long</name><affiliation><nlm:aff id="aff3">University of the Witwatersrand, Health Economics and Epidemiology Research Office, Johannesburg,<country>South Africa</country>.</nlm:aff></affiliation></author><author><name sortKey="Rosen, Sydney" sort="Rosen, Sydney" uniqKey="Rosen S" first="Sydney" last="Rosen">Sydney Rosen</name><affiliation><nlm:aff id="aff1">Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Sanne, Ian" sort="Sanne, Ian" uniqKey="Sanne I" first="Ian" last="Sanne">Ian Sanne</name><affiliation><nlm:aff id="aff2">University of the Witwatersrand, Clinical HIV Research Unit, Johannesburg,<country>South Africa</country>.</nlm:aff></affiliation></author><author><name sortKey="Fox, Matthew P" sort="Fox, Matthew P" uniqKey="Fox M" first="Matthew P" last="Fox">Matthew P Fox</name><affiliation><nlm:aff id="aff1">Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20865072</idno><idno type="pmc">2930360</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930360</idno><idno type="RBID">PMC:2930360</idno><idno type="doi">10.2471/BLT.09.068981</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">001640</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001640</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa</title><author><name sortKey="Larson, Bruce A" sort="Larson, Bruce A" uniqKey="Larson B" first="Bruce A" last="Larson">Bruce A. Larson</name><affiliation><nlm:aff id="aff1">Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Brennan, Alana" sort="Brennan, Alana" uniqKey="Brennan A" first="Alana" last="Brennan">Alana Brennan</name><affiliation><nlm:aff id="aff1">Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Mcnamara, Lynne" sort="Mcnamara, Lynne" uniqKey="Mcnamara L" first="Lynne" last="Mcnamara">Lynne Mcnamara</name><affiliation><nlm:aff id="aff2">University of the Witwatersrand, Clinical HIV Research Unit, Johannesburg,<country>South Africa</country>.</nlm:aff></affiliation></author><author><name sortKey="Long, Lawrence" sort="Long, Lawrence" uniqKey="Long L" first="Lawrence" last="Long">Lawrence Long</name><affiliation><nlm:aff id="aff3">University of the Witwatersrand, Health Economics and Epidemiology Research Office, Johannesburg,<country>South Africa</country>.</nlm:aff></affiliation></author><author><name sortKey="Rosen, Sydney" sort="Rosen, Sydney" uniqKey="Rosen S" first="Sydney" last="Rosen">Sydney Rosen</name><affiliation><nlm:aff id="aff1">Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</nlm:aff></affiliation></author><author><name sortKey="Sanne, Ian" sort="Sanne, Ian" uniqKey="Sanne I" first="Ian" last="Sanne">Ian Sanne</name><affiliation><nlm:aff id="aff2">University of the Witwatersrand, Clinical HIV Research Unit, Johannesburg,<country>South Africa</country>.</nlm:aff></affiliation></author><author><name sortKey="Fox, Matthew P" sort="Fox, Matthew P" uniqKey="Fox M" first="Matthew P" last="Fox">Matthew P Fox</name><affiliation><nlm:aff id="aff1">Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</nlm:aff></affiliation></author></analytic><series><title level="j">Bulletin of the World Health Organization</title><idno type="ISSN">0042-9686</idno><idno type="eISSN">1564-0604</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec><title>Objective</title><p>To estimate rates of completion of CD4+ lymphocyte testing (CD4 testing) within 12 weeks of testing positive for human immunodeficiency virus (HIV) at a large HIV/AIDS clinic in South Africa, and to identify clinical and demographic predictors for completion.</p></sec><sec><title>Methods</title><p>In our study, CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, we reviewed the records of all clinic patients who tested positive for HIV between January 2008 and February 2009. We identified predictors for completion through multivariate logistic regression.</p></sec><sec><title>Findings</title><p>Of the 416 patients who tested positive for HIV, 84.6% initiated CD4 testing within the study timeframe. Of these patients, 54.3% were immediately eligible for antiretroviral therapy (ART) because of a CD4 cell count ≤ 200/µl, but only 51.3% of the patients in this category completed CD4 testing within 12 weeks of HIV testing. Among those not immediately eligible for ART (CD4 cells > 200/µl), only 14.9% completed CD4 testing within 12 weeks. Overall, of HIV+ patients who initiated CD4 testing, 65% did not complete it within 12 weeks of diagnosis. The higher the baseline CD4 cell count, the lower the odds of completing CD4 testing within 12 weeks.</p></sec><sec><title>Conclusion</title><p>Patient losses between HIV testing, baseline CD4 cell count and the start of care and ART are high. As a result, many patients receive ART too late. Health information systems that link testing programmes with care and treatment programmes are needed.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Bull World Health Organ</journal-id><journal-id journal-id-type="publisher-id">BLT</journal-id><journal-title-group><journal-title>Bulletin of the World Health Organization</journal-title></journal-title-group><issn pub-type="ppub">0042-9686</issn><issn pub-type="epub">1564-0604</issn><publisher><publisher-name>World Health Organization</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20865072</article-id><article-id pub-id-type="pmc">2930360</article-id><article-id pub-id-type="publisher-id">BLT.09.068981</article-id><article-id pub-id-type="doi">10.2471/BLT.09.068981</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa</article-title><trans-title-group xml:lang="ar"><trans-title>الفرص الضائعة أمام اكتمال اختبار الخلايا اللمفاوية CD4+ بين المرضى الإيجابيين لاختبار فيروس الأيدز في جنوب أفريقيا</trans-title></trans-title-group><trans-title-group xml:lang="fr"><trans-title>Occasions perdues d'achever les tests de lymphocyte CD4+ parmi les patients séropositifs au VIH en Afrique du Sud </trans-title></trans-title-group><trans-title-group xml:lang="es"><trans-title>Oportunidades perdidas para completar las pruebas de linfocitos CD4+ entre pacientes que dieron positivo en las pruebas de VIH en Sudáfrica</trans-title></trans-title-group><alt-title alt-title-type="author-running-head">Bruce A Larson et al.</alt-title><alt-title alt-title-type="title-running-head">Lost opportunities to initiate HIV care in South Africa</alt-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Larson</surname><given-names>Bruce A</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Brennan</surname><given-names>Alana</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>McNamara</surname><given-names>Lynne</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Long</surname><given-names>Lawrence</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rosen</surname><given-names>Sydney</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sanne</surname><given-names>Ian</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fox</surname><given-names>Matthew P</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><aff id="aff1"><label>a</label>Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118,<country>United States of America</country>.</aff><aff id="aff2"><label>b</label>University of the Witwatersrand, Clinical HIV Research Unit, Johannesburg,<country>South Africa</country>.</aff><aff id="aff3"><label>c</label>University of the Witwatersrand, Health Economics and Epidemiology Research Office, Johannesburg,<country>South Africa</country>.</aff></contrib-group><author-notes><corresp id="cor1">Correspondence to Bruce A Larson (e-mail: <email xlink:href="blarson@bu.edu">blarson@bu.edu</email>).</corresp></author-notes><pub-date pub-type="ppub"><day>01</day><month>9</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>16</day><month>4</month><year>2010</year></pub-date><volume>88</volume><issue>9</issue><fpage>675</fpage><lpage>680</lpage><history><date date-type="received"><day>25</day><month>7</month><year>2009</year></date><date date-type="rev-recd"><day>08</day><month>1</month><year>2010</year></date><date date-type="accepted"><day>18</day><month>1</month><year>2010</year></date></history><permissions><copyright-statement>(c) World Health Organization (WHO) 2010. All rights reserved.</copyright-statement><copyright-year>2010</copyright-year></permissions><abstract><title>Abstract</title><sec><title>Objective</title><p>To estimate rates of completion of CD4+ lymphocyte testing (CD4 testing) within 12 weeks of testing positive for human immunodeficiency virus (HIV) at a large HIV/AIDS clinic in South Africa, and to identify clinical and demographic predictors for completion.</p></sec><sec><title>Methods</title><p>In our study, CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, we reviewed the records of all clinic patients who tested positive for HIV between January 2008 and February 2009. We identified predictors for completion through multivariate logistic regression.</p></sec><sec><title>Findings</title><p>Of the 416 patients who tested positive for HIV, 84.6% initiated CD4 testing within the study timeframe. Of these patients, 54.3% were immediately eligible for antiretroviral therapy (ART) because of a CD4 cell count ≤ 200/µl, but only 51.3% of the patients in this category completed CD4 testing within 12 weeks of HIV testing. Among those not immediately eligible for ART (CD4 cells > 200/µl), only 14.9% completed CD4 testing within 12 weeks. Overall, of HIV+ patients who initiated CD4 testing, 65% did not complete it within 12 weeks of diagnosis. The higher the baseline CD4 cell count, the lower the odds of completing CD4 testing within 12 weeks.</p></sec><sec><title>Conclusion</title><p>Patient losses between HIV testing, baseline CD4 cell count and the start of care and ART are high. As a result, many patients receive ART too late. Health information systems that link testing programmes with care and treatment programmes are needed.</p></sec></abstract><trans-abstract xml:lang="ar"><title>ملخص</title><sec><title>الغرض</title><p>تقدير معدلات اكتمال اختبار الخلايا اللمفاوية CD4+ (اختبار CD4+) خلال 12 أسبوعاً بعد اكتشاف إيجابية اختبار الإصابة بفيروس العوز المناعي البشري (فيروس الأيدز) في عيادة كبرى للأيدز والعدوى بفيروسه في جنوب أفريقيا، وتحديد المنبئات السريرية والديموغرافية لإكمال الاختبار.</p></sec><sec><title>الطريقة</title><p>اعتُبر في هذه الدراسة أن اختبار CD4+ أصبح مكتملاً فور تلقي المريض نتائج الاختبار. ولتحديد معدل اكتمال الاختبار، راجع الباحثون سجلات جميع المرضى في العيادة الذين تبين إيجابيتهم لاختبار فيروس الأيدز بين كانون الأول/يناير 2008 حتى شباط/فبراير 2009. وحدد الباحثون المنبئات لاكتمال الاختبار عن طريق تحوف لوجستي متعدد المتغيرات.</p></sec><sec><title>الموجودات</title><p>من 416 مريضاً كان اختبار فيروس الأيدز لديهم إيجابياً، بدأ 84.6% منهم إجراء اختبار CD4+ خلال الحدود الزمنية للدراسة. ومن هؤلاء المرضى، كان 54.3% مؤهلين على الفور لتلقي العلاج بمضادات الفيروسات القهقرية لأن عدد خلايا CD4+ كان أقل من أو يساوي 200 لكل مكرولتر، ولكن 51.3% فقط من المرضى في هذه الفئة أكملوا اختبار CD4+ خلال 12 أسبوعاً من ظهور نتائج اختبار فيروس الأيدز. ومن بين غير المؤهلين على الفور للعلاج بمضادات الفيروسات القهقرية (لأن عدد خلايا CD4+ لديهم كان أكبر من 200 لكل مكرولتر)، أكمل 14.9% فقط اختبار CD4+ خلال 12 أسبوعاً. وإجمالياً، من المرضى الإيجابيين لفيروس الأيدز الذين بدؤوا اختبار CD4+ ، لم يكمل 65% منهم الاختبار خلال 12 أسبوعاً من التشخيص. كلما ارتفع الخط القاعدي لعدد خلايا CD4+، قلت فرص إكمال اختبار CD4+ خلال 12 أسبوعاً.</p></sec><sec><title>الاستنتاج</title><p>هناك فقدان مرتفع للمرضى بين اختبار فيروس الأيدز، والخط القاعدي لعدد خلايا CD4+ وبدء الرعاية والمعالجة بمضادات الفيروسات القهقرية. ونتيجة لذلك، يتأخر كثير من المرضى في تلقي المعالجة بمضادات الفيروسات. وهناك حاجة لنظم معلومات صحية تربط بين برامج إجراء الاختبار وبرامج الرعاية والمعالجة.</p></sec></trans-abstract><trans-abstract xml:lang="fr"><title>Résumé </title><sec><title>Objectif</title><p>Estimer les taux de réalisation du test de lymphocytes CD4+ (test de CD4) dans les 12 semaines qui suivent un test positif au virus de l'immunodéficience humaine (VIH) dans une grande clinique VIH/SIDA d’Afrique du Sud, et identifier des variables cliniques et démographiques explicatives de cette réalisation. </p></sec><sec><title>Méthodes</title><p>Dans notre étude, le test de CD4 est considéré comme achevé lorsqu’un patient retire les résultats de l'analyse. Afin de déterminer le taux de réalisation du test de CD4, nous avons examiné les dossiers cliniques de l’ensemble des patients ayant eu un test positif au VIH entre janvier 2008 et février 2009. Nous avons identifié des variables explicatives de la réalisation par une régression logistique multivariable. </p></sec><sec><title>Résultats</title><p>Sur 416 patients testés positifs au VIH, 84,6% ont commencé un test de CD4 au cours de la période d’étude. Parmi ces patients, 54,3% ont été immédiatement éligibles pour une thérapie antirétrovirale (TARV) du fait d’une numération CD4 ≤ 200 cellules/µl, mais seulement 51,3% des patients dans cette catégorie ont achevé un test CD4 dans les 12 semaines qui ont suivi le test VIH. Parmi ceux non immédiatement éligibles au TARV (CD4 > 200 cellules/µl), 14,9% seulement ont achevé un test de CD4 dans les 12 semaines. Globalement, parmi les patients VIH+ ayant commencé un test de CD4, 65% ne l'ont pas achevé dans les 12 semaines qui ont suivi le diagnostic. Plus la numération cellulaire CD4 de base a été élevée, moins les chances d'achever un test de CD4 dans les 12 semaines ont été importantes. </p></sec><sec><title>Conclusion</title><p>Les pertes de patients entre le test VIH, la numération cellulaire CD4 de base et le début des soins et du TARV sont élevées. En conséquence, beaucoup de patients reçoivent le TARV trop tard. Des systèmes de renseignements sur la santé mettant en relation les programmes de test avec les programmes de soins et de traitement sont nécessaires.</p></sec></trans-abstract><trans-abstract xml:lang="es"><title>Resumen</title><sec><title>Objetivos</title><p>Calcular las tasas de finalización del análisis de linfocitos CD4 (análisis de CD4) en las 12 semanas tras las pruebas positivas para el virus de la inmunodeficiencia humana (VIH) en una importante clínica de tratamiento del VIH/SIDA en Sudáfrica, e identificar las variables independientes clínicas y demográficas para su finalización.</p></sec><sec><title>Métodos</title><p>En nuestro estudio, el análisis de CD4 se dio por finalizado una vez que el paciente estuvo en posesión de los resultados de la prueba. Para determinar la tasa de finalización del análisis de CD4 se revisaron las historias clínicas de todos los pacientes que dieron positivo en las pruebas del VIH entre enero de 2008 y febrero de 2009. Las variables independientes de finalización se identificaron mediante una regresión logística multivariable.</p></sec><sec><title>Resultados</title><p>De los 416 pacientes que dieron positivo en la prueba del VIH, el 84,6% inició los análisis de CD4 en el periodo de tiempo del estudio. De estos pacientes, el 54,3% fue apto de forma inmediata para el tratamiento antirretroviral (TAR) porque el recuento de linfocitos CD4 era ≤ 200/μl, si bien únicamente el 51,3% de los pacientes de esta categoría finalizó el análisis de CD4 en las 12 semanas siguientes a la prueba del VIH. De los pacientes que no fueron inmediatamente aptos para el TAR (linfocitos CD4 > 200/μl), sólo el 14,9% finalizó el análisis de CD4 en 12 semanas. En términos generales, el 65% de los pacientes VIH+ que iniciaron el análisis de CD4 no lo finalizó en las 12 semanas siguientes al diagnóstico. Cuanto mayor fue el recuento inicial de linfocitos CD4, menor fue la probabilidad de finalizar los análisis de CD4 en las 12 semanas. </p></sec><sec><title>Conclusión</title><p>La pérdida de pacientes entre las pruebas del VIH, el recuento inicial de linfocitos CD4 y el inicio de la asistencia y del TAR es elevada, por lo que muchos pacientes reciben el tratamiento antirretroviral demasiado tarde. Se requieren sistemas de información sanitaria que enlacen los programas de análisis con los programas de atención y tratamiento.</p></sec></trans-abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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