Primary health care: an opportunity for early identification of people living with undiagnosed HIV infection

Abstract Background: There are few shared assistance programs with Primary Health Care (PHC) in PLWH. The aim was to develop a Pilot Program of shared HIV care in PLWH ensuring proper HIV control. Methods: Design: Prospective pilot project of a shared care intervention.Setting: HIV specialized outpatient consultations for HIV infection at Son Espases University Hospital which serves 2000 patients. Subjects: Patients who attended HIV specialized consultation between January 1st and June 30th, 2017. Intervention: Basal questionnaire on health services used by patients. HIV Training Program on HIV in Primary Health Care (PHC). Pilot Program of shared assistance (PPAC) with PHC. Main Outcomes: Maintenance of undetectable HIV viral load, antiretroviral therapy (ART) adherence, AIDS and non-AIDS events, loss of follow up, and satisfaction questionnaire. Results: The basal questionnaire was filled out by 918 patients, with 108 (11.7%) patients reporting neither knowing nor having been visited by their GP. A total of 93 patients were included in the PPAC, with a mean age of 49.9 years (SD 11.7), and an average of 14.6 years since the HIV diagnosis. Eleven patients were followed up for less than six months and were excluded from the analysis. Median follow-up during the PPAC of the remaining 82 patients was 728 days (IQR 370-1070). Sixteen patients dropped out of the PPAC (19.5%), three died, three were lost to follow up, one was withdrawn due to medical criteria, and nine withdrew voluntarily.No patient presented any AIDS defining events, although eight patients presented non-AIDS events. All the patients had undetectable viral load (VL) and average ART adherence was 99.4% (SD1.4). The patient’s satisfaction score with PPAC was 8.64 (SD2.5).Conclusion: It is possible to establish shared care programs with PHC in selected patients with HIV infection, thereby reducing hospital visits while maintaining good adherence and virological control and achieving high patient satisfaction.

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High-risk alcohol use and associated socio-demographic, health and psychosocial factors in patients with HIV infection in three primary health care clinics in South Africa

International Journal of STD & AIDS ◽

10.1177/0956462416660016 ◽

2016 ◽

Vol 28 (7) ◽

pp. 651-659 ◽

Cited By ~ 6

Author(s):

Diana Huis in ‘t Veld ◽

Supa Pengpid ◽

Robert Colebunders ◽

Linda Skaal ◽

Karl Peltzer

Keyword(s):

South Africa ◽

Health Care ◽

Primary Health Care ◽

High Risk ◽

Alcohol Use ◽

Hiv Infection ◽

Psychosocial Factors ◽

Low Risk ◽

Health Care Clinics ◽

Primary Health

Alcohol use may have a negative impact on the course of HIV disease and the effectiveness of its treatment. We studied patients with HIV who use alcohol and associated socio-demographic, health and psychosocial factors. Outcomes from this study may help in selecting patients from clinical practice with high-risk alcohol use and who are likely to benefit most from alcohol reduction interventions. In a cross sectional study in three primary health care clinics in Pretoria, South Africa, from January 2012 to June 2012, patients with HIV infection were interviewed and patients’ medical files were reviewed to obtain data on levels of alcohol use (Alcohol Use Disorder Identification Test), patients’ socio-demographic characteristics, HIV-related information, health related quality of life (WHOQoL-HIVBref), internalized AIDS stigma, symptoms of depression and adherence to antiretroviral therapy. Analyses consisted of descriptive statistics, bi- and multivariate logistic regression models. A total of 2230 patients (1483 [66.5%] female) were included. The median age was 37 years (interquartile range 31–43), 99.5% were black Africans, 1975 (88.6%) had started ART and the median time on ART was 22 months (interquartile range 9–40). No alcohol was used by 64% of patients, 8.9% were low risk drinkers, 25.1% of patients were hazardous or harmful drinkers and 2.0% had possible alcohol dependence. In multivariate analysis high-risk drinking was positively associated with male gender, never being married, tobacco use, a higher score for the ‘level of independence’-domain measured with the WHOQoL-HIVBref questionnaire, and with more depressive symptoms compared to low-risk drinking. This study shows a high prevalence of hazardous or harmful drinking in patients with HIV infection (especially men) attending primary health care clinics in South Africa. Routine screening for alcohol use should be introduced in these clinics and harm reduction interventions should be evaluated, taking into account associated factors.

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A survey on the early identification and brief intervention for hazardous and harmful alcohol consumption in primary health care: the European Alcohol Measures for Public Health Research Alliance (AMPHORA) project

Addiction Science & Clinical Practice ◽

10.1186/1940-0640-8-s1-a66 ◽

2013 ◽

Vol 8 (S1) ◽

Author(s):

Emanuele Scafato ◽

Claudia Gandin ◽

Silvia Ghirini ◽

Lucia Galluzzo ◽

Sonia Martire ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Primary Health Care ◽

Alcohol Consumption ◽

Brief Intervention ◽

Early Identification ◽

Public Health Research ◽

Primary Health ◽

Harmful Alcohol ◽

Research Alliance

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A Well Woman Clinic in Bangalore: one strategy to attempt to decrease the transmission of HIV infection

International Journal of STD & AIDS ◽

10.1258/0956462981922520 ◽

1998 ◽

Vol 9 (7) ◽

pp. 418-423 ◽

Cited By ~ 3

Author(s):

C M Baksi ◽

I Harper ◽

Margaret Raj

Keyword(s):

Health Care ◽

Primary Health Care ◽

Hiv Infection ◽

Sex Workers ◽

Pilot Project ◽

Care Staff ◽

Vulnerable Groups ◽

Health Care Staff ◽

Governmental Organization ◽

Primary Health

Samraksha, a non governmental organization NGO in Bangalore, South India, was established in 1993 to take steps to control the spread of HIV infection. As a result of their interactions the Samraksha team recognized the urgent need for management of sexually transmitted diseases STDs as a crucial component of their work. Samraksha approached Action Health, a UK based charity, for assistance. This paper outlines the needs assessment and the process of setting up a Well Woman Clinic for commercial sex workers CSWs and other vulnerable groups in Bangalore. The pilot project has been running for over a year and has gained credibility both with vulnerable women and with professionals. Furthermore it has officially become a government resource centre for the training of doctors and health care staff in the management of STDs, and provides formal training sessions for the staff at each of the primary health care centres in Bangalore. Thus STD management is being integrated with the current primary health care provision for women throughout Bangalore. Factors influencing the successful development of such a service are considered.

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Chronic Cough in Primary Health Care Attendees, Harare, Zimbabwe: Diagnosis and Impact of HIV Infection

Clinical Infectious Diseases ◽

10.1086/429912 ◽

2005 ◽

Vol 40 (12) ◽

pp. 1818-1827 ◽

Cited By ~ 16

Author(s):

S. S. Munyati ◽

T. Dhoba ◽

E. D. Makanza ◽

S. Mungofa ◽

M. Wellington ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Hiv Infection ◽

Chronic Cough ◽

Primary Health

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Does a brief work-stress intervention prevent sick-leave during the following 24 months? A randomized controlled trial in Swedish primary care

Work ◽

10.3233/wor-205029 ◽

2021 ◽

pp. 1-10

Author(s):

Jenny Hultqvist ◽

Pernilla Bjerkeli ◽

Gunnel Hensing ◽

Kristina Holmgren

Keyword(s):

Health Care ◽

Primary Health Care ◽

Sick Leave ◽

Early Identification ◽

Controlled Trial ◽

Intervention Group ◽

Training Session ◽

Control Group ◽

Treatment As Usual ◽

Primary Health

BACKGROUND: Work-related stress (WRS) presents a risk for sick leave. However, effective methods to identify people at risk for sick leave due to WRS at an early stage are lacking in primary health care. OBJECTIVE: To evaluate whether a systematic early identification of WRS can prevent sick leave over 24 months after the intervention. METHODS: Study participants (n = 132 intervention; n = 139 control) were employed, non-sick-listed persons seeking care at primary health care centres. The intervention included early identification of WRS by a validated instrument, general practitioner (GP) awareness supported by a brief training session, patients’ self-reflection by instrument completion, GP giving the patient feedback at consultation and GP identifying preventive measures. The control group received treatment as usual. Outcome data were retrieved from the Swedish Social Insurance Agency. RESULTS: The intervention group had less registered median sick leave days (n = 56) than the control group (n = 65) but the difference was not statistically significant. CONCLUSIONS: The brief intervention was not proven effective in preventing sick leave in the following 24 months compared to treatment as usual. Further research on how to identify, advice and treat those at high risk for sick leave in primary health care is needed.

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