Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study..pdf (321.69 kB)
Download file

Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study

Download (321.69 kB)
journal contribution
posted on 11.03.2016, 14:26 by David Burtle, William Welfare, Susan Elden, Canaan Mamvura, Joris Vandelanotte, Emily PetherickEmily Petherick, John Walley, John Wright
Objective: To implement and evaluate a formal pre-antiretroviral therapy (ART) care service at a district hospital in Swaziland. Design: Operational research. Setting: District hospital in Southern Africa. Participants: 1171 patients with a previous diagnosis of HIV. A baseline patient group consisted of the first 200 patients using the service. Two follow-up groups were defined: group 1 was all patients recruited from April to June 2009 and group 2 was 200 patients recruited in February 2010. Intervention: Introduction of pre-ART care-a package of interventions, including counselling; regular review; clinical staging; timely initiation of ART; social and psychological support; and prevention and management of opportunistic infections, such as tuberculosis. Primary and secondary outcome measures: Proportion of patients assessed for ART eligibility, proportion of eligible patients who were started on ART and proportion receiving defined evidence-based interventions (including prophylactic co-trimoxazole and tuberculosis screening). Results: Following the implementation of the pre-ART service, the proportion of patients receiving defined interventions increased; the proportion of patient being assessed for ART eligibility significantly increased (baseline: 59%, group 1: 64%, group 2: 76%; p=0.001); the proportion of ART-eligible patients starting treatment increased (baseline: 53%, group 1: 81%, group: 2, 81%; p<0.001) and the median time between patients being declared eligible for ART and initiation of treatment significantly decreased (baseline: 61 days, group 1: 39 days, group 2: 14 days; p<0.001). Conclusions: This intervention was part of a shift in the model of care from a fragmented acute care model to a more comprehensive service. The introduction of structured pre-ART was associated with significant improvements in the assessment, management and timeliness of initiation of treatment for patients with HIV.

Funding

This document is an output from a project funded by UK Aid from the UK Department for International Development (DFID) for the benefit of developing countries.

History

School

  • Sport, Exercise and Health Sciences

Published in

BMJ Open

Volume

2

Issue

2

Citation

BURTLE, D. ... et al, 2012. Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study. BMJ Open, 2, e000195.

Publisher

BMJ Publishing Group

Version

VoR (Version of Record)

Publisher statement

This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial 2.0 Unported (CC BY-NC 2.0) licence. Full details of this licence are available at: http://creativecommons.org/licenses/by-nc/2.0/

Publication date

2012

Notes

This is an Open Access article and is available for use under the terms of the Creative Commons Attribution Non-Commercial 2.0 Licence (https://creativecommons.org/licenses/by-nc/2.0/)

eISSN

2044-6055

Language

en

Usage metrics

Keywords

Exports