The Standardized Pediatric Expedited Encounters for ART Drugs Initiative (SPEEDI): description and evaluation of an innovative pediatric, adolescent, and young adult antiretroviral service delivery model in Tanzania

被引:5
作者
Bacha, Jason M. [1 ,2 ]
Aririguzo, Lynda C. [3 ]
Mng'ong'o, Veronica [1 ]
Malingoti, Beatrice [1 ]
Wanless, Richard S. [2 ]
Ngo, Katherine [3 ]
Campbell, Liane R. [1 ,2 ]
Schutze, Gordon E. [2 ,3 ]
机构
[1] Mbeya Zonal Referral Hosp, Pediat, Baylor Coll Med, Childrens Fdn Tanzania,Ctr Excellence, Box 2663, Mbeya, PO, Tanzania
[2] Texas Childrens Hosp, Baylor Coll Med, BIPAI, Houston, TX 77030 USA
[3] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA
来源
BMC INFECTIOUS DISEASES | 2018年 / 18卷
关键词
Pediatric HIV/AIDS; ART delivery; Expedited encounters; Differentiated models of care; Lost to follow up; Mortality; THERAPY PATIENTS; ADHERENCE CLUBS; HIV TREATMENT; CAPE-TOWN; RETENTION; CHILDREN; AFRICA; COSTS; TIME; CARE;
D O I
10.1186/s12879-018-3331-2
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: As countries scale up antiretroviral therapy (ART) for children, innovative strategies to deliver quality services to children are needed. Differentiated ART delivery models have been successful in adults, but no such program has been described in children. We describe the Standardized Pediatric Expedited Encounters for ART Drugs Initiative (SPEEDI). Methods: Descriptive analysis of patients eligible for SPEEDI was done via retrospective review of children, adolescents, and young adults on ART at the Baylor Centre of Excellence (COE) in Mbeya, Tanzania between January 2013 and December 2015. Eligibility for SPEEDI visits included the following: stable children, adolescents, and young adults on ART for approximately 3 months or longer, no medical or social complications, good adherence to ART, and presence of reliable caregiver. During a SPEEDI visit, patients were fast tracked in triage to collect medications directly without physically seeing a clinician. SPEEDI patients came to clinic every two months, and alternated SPEEDI visits with standard visits. Baseline characteristics, mortality, and lost-to-follow up rates of SPEEDI patients were analyzed. Results: One thousand one hundred sixty-four patients utilized SPEEDI, totaling 3493 SPEEDI visits. SPEEDI reached 51.3% (1164/2269) of pediatric ART patients, accounting for 7.7% (3493/44489) of total patient encounters. SPEEDI patients were 52% (605/1164) female, median age of 11.7 years (range 1.2-25.5 yr), median time on ART of 21 months (range 4-130 months) and 83.5% (964/1155) categorized as no or mild HIV-associated immunodeficiency. SPEEDI patients had good outcomes (98.8%), low LTFU (0.1%) and low mortality rates (0.61 deaths per 100 patient-years). Conclusion: SPEEDI was an effective model for delivering ART to children, adolescents, and young adults in our setting, leading to good clinical outcomes, low mortality, and low LTFU. The SPEEDI program safely and effectively expedited and spaced out ART visits for children, adolescents, and young adults, and can serve as an adaptable ART delivery model for other resource limited settings.
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页数:9
相关论文
共 37 条
[1]   90-90-90-Charting a steady course to end the paediatric HIV epidemic [J].
Abrams, Elaine J. ;
Strasser, Susan .
JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 2015, 18 :7-13
[2]  
Agarwal M, 7 IAS C HIV PATH TRE
[3]  
[Anonymous], 2006, WHO Multicentre Growth Reference Study Group: WHO Child Growth Standards: Length/Height for Age, Weight for Age, Weight for Length, Weight for Height and Body Mass Index for Age: Methods and Development, DOI DOI 10.1111/J.1651-2227.2006.TB02378.X
[4]  
[Anonymous], 2014, GAP REP
[5]   Community-supported models of care for people on HIV treatment in sub-Saharan Africa [J].
Bemelmans, Marielle ;
Baert, Saar ;
Goemaere, Eric ;
Wilkinson, Lynne ;
Vandendyck, Martin ;
van Cutsem, Gilles ;
Silva, Carlota ;
Perry, Sharon ;
Szumilin, Elisabeth ;
Gerstenhaber, Rodd ;
Kalenga, Lucien ;
Biot, Marc ;
Ford, Nathan .
TROPICAL MEDICINE & INTERNATIONAL HEALTH, 2014, 19 (08) :968-977
[6]   Time and Money: The True Costs of Health Care Utilization for Patients Receiving "Free" HIV/Tuberculosis Care and Treatment in Rural KwaZulu-Natal [J].
Chimbindi, Natsayi ;
Bor, Jacob ;
Newell, Marie-Louise ;
Tanser, Frank ;
Baltussen, Rob ;
Hontelez, Jan ;
de Vlas, Sake J. ;
Lurie, Mark ;
Pillay, Deenan ;
Baernighausen, Till .
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2015, 70 (02) :E52-E60
[7]  
Decroo T, 19 INT AIDS C WASH D
[8]   Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in sub-Saharan Africa: a systematic review [J].
Decroo, Tom ;
Rasschaert, Freya ;
Telfer, Barbara ;
Remartinez, Daniel ;
Laga, Marie ;
Ford, Nathan .
INTERNATIONAL HEALTH, 2013, 5 (03) :169-179
[9]   Barriers to accessing highly active antiretroviral therapy by HIV-positive women attending an antenatal clinic in a regional hospital in western Uganda [J].
Duff, Putu ;
Kipp, Walter ;
Wild, T. Cameron ;
Rubaale, Tom ;
Okech-Ojony, Joa .
JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 2010, 13
[10]   Improved virological suppression in children on antiretroviral treatment receiving community-based adherence support: A multicentre cohort study from South Africa [J].
Fatti, Geoffrey ;
Shaikh, Najma ;
Eley, Brian ;
Grimwood, Ashraf .
AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 2014, 26 (04) :448-453