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Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda
INTRODUCTION: Patients receiving antiretroviral therapy (ART) require routine monitoring to track response to treatment and assess for treatment failure. This study aims to identify gaps in monitoring practices in Kenya and Uganda. METHODS: We conducted a systematic retrospective chart review of adu...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537267/ https://www.ncbi.nlm.nih.gov/pubmed/26275151 http://dx.doi.org/10.1371/journal.pone.0135653 |
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author | Dansereau, Emily Gakidou, Emmanuela Ng, Marie Achan, Jane Burstein, Roy DeCenso, Brendan Gasasira, Anne Ikilezi, Gloria Kisia, Caroline Masters, Samuel H. Njuguna, Pamela Odeny, Thomas A. Okiro, Emelda A. Roberts, D. Allen Duber, Herbert C. |
author_facet | Dansereau, Emily Gakidou, Emmanuela Ng, Marie Achan, Jane Burstein, Roy DeCenso, Brendan Gasasira, Anne Ikilezi, Gloria Kisia, Caroline Masters, Samuel H. Njuguna, Pamela Odeny, Thomas A. Okiro, Emelda A. Roberts, D. Allen Duber, Herbert C. |
author_sort | Dansereau, Emily |
collection | PubMed |
description | INTRODUCTION: Patients receiving antiretroviral therapy (ART) require routine monitoring to track response to treatment and assess for treatment failure. This study aims to identify gaps in monitoring practices in Kenya and Uganda. METHODS: We conducted a systematic retrospective chart review of adults who initiated ART between 2007 and 2012. We assessed the availability of baseline measurements (CD4 count, weight, and WHO stage) and ongoing CD4 and weight monitoring according to national guidelines in place at the time. Mixed-effects logistic regression models were used to analyze facility and patient factors associated with meeting monitoring guidelines. RESULTS: From 2007 to 2012, at least 88% of patients per year in Uganda had a recorded weight at initiation, while in Kenya there was a notable increase from 69% to 90%. Patients with a documented baseline CD4 count increased from 69% to about 80% in both countries. In 2012, 83% and 86% of established patients received the recommended quarterly weight monitoring in Kenya and Uganda, respectively, while semiannual CD4 monitoring was less common (49% in Kenya and 38% in Uganda). Initiating at a more advanced WHO stage was associated with a lower odds of baseline CD4 testing. On-site CD4 analysis capacity was associated with increased odds of CD4 testing at baseline and in the future. DISCUSSION: Substantial gaps were noted in ongoing CD4 monitoring of patients on ART. Although guidelines have since changed, limited laboratory capacity is likely to remain a significant issue in monitoring patients on ART, with important implications for ensuring quality care. |
format | Online Article Text |
id | pubmed-4537267 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-45372672015-08-20 Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda Dansereau, Emily Gakidou, Emmanuela Ng, Marie Achan, Jane Burstein, Roy DeCenso, Brendan Gasasira, Anne Ikilezi, Gloria Kisia, Caroline Masters, Samuel H. Njuguna, Pamela Odeny, Thomas A. Okiro, Emelda A. Roberts, D. Allen Duber, Herbert C. PLoS One Research Article INTRODUCTION: Patients receiving antiretroviral therapy (ART) require routine monitoring to track response to treatment and assess for treatment failure. This study aims to identify gaps in monitoring practices in Kenya and Uganda. METHODS: We conducted a systematic retrospective chart review of adults who initiated ART between 2007 and 2012. We assessed the availability of baseline measurements (CD4 count, weight, and WHO stage) and ongoing CD4 and weight monitoring according to national guidelines in place at the time. Mixed-effects logistic regression models were used to analyze facility and patient factors associated with meeting monitoring guidelines. RESULTS: From 2007 to 2012, at least 88% of patients per year in Uganda had a recorded weight at initiation, while in Kenya there was a notable increase from 69% to 90%. Patients with a documented baseline CD4 count increased from 69% to about 80% in both countries. In 2012, 83% and 86% of established patients received the recommended quarterly weight monitoring in Kenya and Uganda, respectively, while semiannual CD4 monitoring was less common (49% in Kenya and 38% in Uganda). Initiating at a more advanced WHO stage was associated with a lower odds of baseline CD4 testing. On-site CD4 analysis capacity was associated with increased odds of CD4 testing at baseline and in the future. DISCUSSION: Substantial gaps were noted in ongoing CD4 monitoring of patients on ART. Although guidelines have since changed, limited laboratory capacity is likely to remain a significant issue in monitoring patients on ART, with important implications for ensuring quality care. Public Library of Science 2015-08-14 /pmc/articles/PMC4537267/ /pubmed/26275151 http://dx.doi.org/10.1371/journal.pone.0135653 Text en © 2015 Dansereau et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Dansereau, Emily Gakidou, Emmanuela Ng, Marie Achan, Jane Burstein, Roy DeCenso, Brendan Gasasira, Anne Ikilezi, Gloria Kisia, Caroline Masters, Samuel H. Njuguna, Pamela Odeny, Thomas A. Okiro, Emelda A. Roberts, D. Allen Duber, Herbert C. Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda |
title | Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda |
title_full | Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda |
title_fullStr | Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda |
title_full_unstemmed | Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda |
title_short | Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda |
title_sort | trends and determinants of antiretroviral therapy patient monitoring practices in kenya and uganda |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537267/ https://www.ncbi.nlm.nih.gov/pubmed/26275151 http://dx.doi.org/10.1371/journal.pone.0135653 |
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