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http://hdl.handle.net/2445/103926
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DC Field | Value | Language |
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dc.contributor.author | Gamell, Anna | - |
dc.contributor.author | Glass, Tracy R. | - |
dc.contributor.author | Luwanda, Lameck B. | - |
dc.contributor.author | Mapesi, Herry | - |
dc.contributor.author | Samson, Leila | - |
dc.contributor.author | Mtoi, Tom | - |
dc.contributor.author | Nyamtema, Angelo | - |
dc.contributor.author | Muri, Lukas | - |
dc.contributor.author | Ntamatungiro, Alex J. | - |
dc.contributor.author | Tanner, Marcel | - |
dc.contributor.author | Hatz, Christoph | - |
dc.contributor.author | Battegay, Manuel | - |
dc.contributor.author | Letang, Emilio | - |
dc.contributor.author | KIULARCO Study Group | - |
dc.date.accessioned | 2016-11-18T12:22:12Z | - |
dc.date.available | 2016-11-18T12:22:12Z | - |
dc.date.issued | 2016-12-15 | - |
dc.identifier.issn | 1525-4135 | - |
dc.identifier.uri | http://hdl.handle.net/2445/103926 | - |
dc.description.abstract | BACKGROUND: Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa. METHODS: From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally. To assess the impact of this strategy, clinical characteristics and outcomes were compared between the period before (2008-2012) and during/after the implementation (2013-2014). RESULTS: After the intervention, the number of mothers and children enrolled into care almost doubled. Compared with the pre-intervention period (2008-2012), in 2013-2014, children presented lower CD4% (16 vs. 16.8, P = 0.08) and more advanced disease (World Health Organization stage 3/4 72% vs. 35%, P < 0.001). The antiretroviral treatment coverage rose from 80% to 98% (P < 0.001), the lost-to-follow-up rate decreased from 20% to 11% (P = 0.002), and mortality ascertainment improved. During 2013-2014, 261 HIV-exposed infants were enrolled, and the early mother-to-child transmission rate among mother-infant pairs accessing PMTCT was 2%. CONCLUSIONS: This strategy resulted in an increased number of mothers and children diagnosed and linked into care, a higher detection of children with AIDS, universal treatment coverage, lower loss to follow-up, and an early mother-to-child transmission rate below the threshold of elimination. This study documents a feasible and scalable model for family-centered HIV care in sub-Saharan Africa. | - |
dc.format.extent | 9 p. | - |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | Wolters Kluwer | - |
dc.relation.isformatof | Reproducció del document publicat a: http://dx.doi.org/10.1097/QAI.0000000000001178 | - |
dc.relation.ispartof | Journal of Acquired Immune Deficiency Syndromes, 2016, vol. 73, num. 5, p. e67-e75 | - |
dc.relation.uri | http://dx.doi.org/10.1097/QAI.0000000000001178 | - |
dc.rights | (c) Wolters Kluwer Health, 2016 | - |
dc.source | Articles publicats en revistes (ISGlobal) | - |
dc.subject.classification | VIH (Virus) | - |
dc.subject.classification | Nens | - |
dc.subject.other | HIV (Viruses) | - |
dc.subject.other | Children | - |
dc.title | Implementation and Operational Research: An Integrated and Comprehensive Service Delivery Model to Improve Pediatric and Maternal HIV Care in Rural Africa | - |
dc.type | info:eu-repo/semantics/article | - |
dc.type | info:eu-repo/semantics/publishedVersion | - |
dc.date.updated | 2016-11-16T19:01:14Z | - |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | - |
dc.identifier.pmid | 27846070 | - |
Appears in Collections: | Articles publicats en revistes (ISGlobal) |
Files in This Item:
File | Description | Size | Format | |
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gamell2016_2293.pdf | 288.94 kB | Adobe PDF | View/Open |
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