TITLE

Changing clinical needs of people living with AIDS and receiving home based care in Malawi - the Bangwe Home Based Care Project 2003-2008 - a descriptive study

AUTHOR(S)
Bowie, Cameron; Gondwe, Norton; Bowie, Claire
PUB. DATE
January 2010
SOURCE
BMC Public Health;2010, Vol. 10, p370
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Home based care (HBC) has been an important component of the response to the AIDS epidemic in Africa, and particularly so before antiretroviral therapy (ART) became available. Has HBC become unnecessary now that ART is available in many African countries? One way to investigate this is to assess the changing need for comprehensive HBC as an ART programme becomes available. The Bangwe HBC programme in Malawi has been collecting data since 2003 before ART became available in 2005/6. Has the introduction of ART changed the clinical needs for HBC? Methods: Information obtained at initial assessment and follow up visits of patients receiving HBC were combined to assess case severity, survival and the response to treatment. This information was used to assess trends in mortality and the incidence, duration and severity of common symptoms over a six year period in a defined urban population in Malawi. Results: 1266 patients, of whom 1190 were followed up and of whom 652 (55%) died, were studied. 282 (25%) patients died within two months of being first seen with an improvement between 2003-2005 and 2006-2008 of reduced mortality from 28% to 20%. 341 (27%) patients were unable to care for themselves on first assessment and 675 (53%) had stage 4 AIDS disease. Most patients had a mix of symptoms at presentation. Self care increased somewhat over the six years although case severity as measured by WHO staging and nutritional status did not. 350 patients were on ART either started before or after initial assessment. There were significant barriers to accessing ART with 156 (51%) of 304 stage 3 or 4 patients first assessed in 2007 or 2008 not receiving ART. Over the six year period new HBC cases reduced by 8% and follow up visits increased by 9% a year. Between 4 and 5 people sought HBC for the first time each week from an urban health centre catchment of 100,000, which required 37.3 follow up visits each week. Conclusions: Since the availability of ART in the local health facilities and despite strenuous efforts to persuade people to seek HIV testing and ART, in practice barriers existed and half the eligible HBC patients did not have access to ART. This is one reason why the clinical need for HBC services had not changed much. In terms of quantity of care the number of new patients seeking HBC reduced by 8% a year. In terms of content of care, while there had been a marginal increase in self care the severity of illness had not changed and the survival of a significant proportion of patients generated the need for repeat visits, which increased by 9% a year. In conclusion, although the content has changed the need for HBC has not diminished despite the availability of ART.
ACCESSION #
52840049

 

Related Articles

  • Increase in the Non-HIV-Related Deaths Among Aids Cases in the HAART Era. Novoa, Ana M.; De Olalla, Patricia G.; Clos, Roser; Orcau, Angels; Rodr�guez-Sanz, Maica; Cayl�, Joan A. // Current HIV Research;Jan2008, Vol. 6 Issue 1, p77 

    Objective: To analyze the factors associated with survival and to describe the specific causes of death in a large cohort of individuals with Acquired Immune Deficiency Syndrome (AIDS) in the Highly Active Antiretroviral Therapy (HAART) era. Methods: Subjects over 13 years old recorded in the...

  • Intravitreal Ganciclovir Injections for Cytomegalovirus Retinitis in Acquired Immune Deficiency Syndrome Patients on Highly Active Antiretroviral Therapy. Jalil, Nor Fadzillah Abd; Shaharuddin, Bakiah; Zakariah, Sakinah // International Medical Journal;Jul2008, Vol. 15 Issue 3, p217 

    Objective: To report a case series of intravitreal ganciclovir injections for cytomegalovirus retinitis in acquired immune deficiency syndrome patients on highly active antiretroviral therapy (HAART). Materials and Method: Case report. Results: Four case series of successful treatment of...

  • HAART and CMV Retinitis Progression. Thorne, Jennifer E. // Review of Ophthalmology;Oct2006, Vol. 13 Issue 10, p61 

    The article presents information on impact of highly active antiretroviral therapy (HAART) on the patients with Cytomegalovirus (CMV) Retinitis. The AIDS patients with HAART induced immune recovery show 50 percent lower risk of visual acuity loss resulting in a 75 percent reduction in the number...

  • Management of HIV-1 infection in adults. Nguyen, Thien Huong // Baylor University Medical Center Proceedings;Jan2009, Vol. 22 Issue 1, p62 

    The article presents information related to the management of human immunodeficiency virus (HIV) infection. According to the Joint United Nations Programme on HIV/AIDS 2008 report on the global AIDS epidemic, 30.8 million adults and 2 million children suffered HIV at the end of 2007. Due to the...

  • The Safety of Interruption of HAART in Patients Who Never Met the Current Criteria for HIV Treatment Initiation. Deresinski, Stan // Clinical Infectious Diseases;9/15/2006, Vol. 43 Issue 6, pvi 

    The article discusses the research "Safe Treatment interruptions in patients with nadir CD4 counts of more than 350 cells/μL: a randomized trial," published in the 2006 issue of the "Journal of Acquired Immune Deficiency Syndrome" which evaluates the safety of the discontinuation of highly...

  • Neurotoxicity and Side-Effects of Highly Active Antiretroviral Therapy [HAART] on the Central and Peripheral Nerve System. Husstedt, I. W.; Reichelt, D.; Neuen-Jakob, E.; Kästner, F.; Von Einsiedel, R.; Vielhaber, B.; Arendt, G.; Evers, S.; Hahn, K. // Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry;Jun2009, Vol. 8 Issue 2, p192 

    Highly active antiretroviral therapy [HAART] has increased the mean survival time in the AIDS stage by up to more than 10 years. Five different groups of antiretroviral medications are known, of which integrase and entry inhibitors represent the latest and most modern substances. The long...

  • Importance of Dose Timing to Achieving Undetectable Viral Loads. Gill, Christopher J.; Sabin, Lora L.; Hamer, Davidson H.; Xu Keyi; Zhang Jianbo; Tao Li; Wan-Ju Wu; Wilson, Ira B.; DeSilva, Mary Bachman // AIDS & Behavior;Aug2010, Vol. 14 Issue 4, p785 

    Little is known about the importance of dose timing to successful antiretroviral therapy (ART). In a cohort comprised of Chinese HIV/AIDS patients, we measured adherence among subjects for 6 months using three methods in parallel: self-report using a visual analog scale (SR-VAS), pill count, and...

  • HIV Antiretroviral Drug Resistance. Campo, Jose E.; Jamjian, Christine; Goulston, Claudia // Journal of AIDS & Clinical Research;Special2012, Vol. 3 Issue S, Special section p1 

    The article describes some of the challenges in the use of highly active antiretroviral therapy (HAART) from the perspective of HIV resistance. It defines drug resistance in HIV as a reduced susceptibility to a specific antiretroviral (ARV) and has been documented since the introduction of ARV...

  • HIV-1 replication and immune dynamics are affected by raltegravir intensification of HAART-suppressed subjects. Buzón, Maria J.; Massanella, Marta; Llibre, Josep M.; Esteve, Anna; Dahl, Viktor; Puertas, Maria C.; Gatell, Josep M.; Domingo, Pere; Paredes, Roger; Sharkey, Mark; Palmer, Sarah; Stevenson, Mario; Clotet, Bonaventura; Blanco, Julià; Martinez-Picado, Javier // Nature Medicine;Apr2010, Vol. 16 Issue 4, p460 

    Highly active antiretroviral therapy (HAART) results in potent and durable suppression of HIV-1 viremia. However, HIV-1 replication resumes if therapy is interrupted. Although it is generally believed that active replication has been halted in individuals on HAART, immune activation and...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics