scholarly journals Impact of a child -friendly clinic on retention of HIV-infected children in care: an intervention study

1970 ◽  
Vol 44 (4) ◽  
pp. 175-179
Author(s):  
OR Ugwu
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Retention Rate ◽  
Retention In Care ◽  
Hiv Care ◽  
Satisfaction Survey ◽  
Loss To Follow Up ◽  
Child Friendly ◽  
Children In Care ◽  
The Impact

Background: Certain researchers have reported that a child-friendly clinic may improve patient/caregiver satisfaction at clinic attendance. This could serve as an innovation for reducing loss-to-follow up and increasing retention in care.Aim: To assess the impact of making the clinic more child-friendly on clinic experience, retention in care and loss-to-follow up of HIV -infected children.Method: The study was carried out in three phases. Phase one was a satisfaction survey to find out the patient/caregivers’ satisfaction of the clinic environment and services provided using a selfadministered questionnaire. Phase two was the creation of the childfriendly environment and phase three was a post-provision of child-friendly clinic satisfaction survey. The loss-to-follow up rate (failure to return to clinic ≥3months after the last scheduled clinic appointment in a child not known to be dead or transferred out of the facility) and retention rate (remaining alive and receiving highly active antiretroviral therapy) were also determined before and after setting up the childfriendly clinic.Results: There were 146 respondents before the study and 206 respondents after the intervention. The retention rate increased from 62.5% to 82% (p=0.02), while the loss-to-follow up rate dropped from 27.7% to 7.0% (p=0.00).Conclusion: Making the clinic area child-friendly can impact greatly on HIV care by improving patient satisfaction and retention of HIVinfected children in care and reducing loss-to-follow up.Key words: HIV, child-friendly environment, retention in care, loss to follow-up.

scholarly journals The expansion of a patient tracer programme to identify and return patients loss to follow up at a large HIV clinic in Trinidad

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
R. Jeffrey Edwards ◽  
Nyla Lyons ◽  
Wendy Samaroo-Francis ◽  
Leon-Omari Lavia ◽  
Isshad John ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Targeted Interventions ◽  
The Status ◽  
Care Models ◽  
Clinic Medical ◽  
Lost To Follow Up

Abstract Background Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study assessed the outcomes of retention in care and viral suppression by expansion of an intervention using two patient tracers to track patients lost to follow up at a large HIV clinic in Trinidad. Methods Two Social Workers were trained as patient tracers and hired for 15 months (April 2017–June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016–May 2018 at the HIV clinic Medical Research Foundation of Trinidad and Tobago. Results Over the 15-month period, of the of 2473 patients who missed their scheduled visits for 1 month or more, 261 (10.6%) patients were no longer in active care—89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2212 patients eligible for tracing, 1869 (84.5%) patients were returned to care, 1278 (68.6%) were virally unsuppressed (viral load > 200 copies/ml) and 1727 (92.4%) were re-initiated on ART. Twelve months after their return, 1341 (71.7%) of 1869 patients were retained in care and 1154 (86.1%) of these were virally suppressed. Multivariate analysis using logistic regression showed that persons were more likely to be virally suppressed if they were employed (OR, 1.39; 95% CI 1.07–1.80), if they had baseline CD4 counts < 200 cells/mm3 (OR, 1.71; 95% CI 1.26–2.32) and if they were retained in care at 12 months (OR, 2.48; 95% CI 1.90–3.24). Persons initiated on ART for 4–6 years (OR, 3.09; 95% CI 1.13–8.48,), 7–9 years (OR, 3.97; 95% CI 1.39–11.31), > 10 years (OR, 5.99; 95% CI 1.74–20.64 were more likely to be retained in care. Conclusions Patient Tracing is a feasible intervention to identify and resolve the status of patients who are loss to follow up and targeted interventions such as differentiated care models may be important to improve retention in care.

scholarly journals OPT-In For Life: A Mobile Technology–Based Intervention to Improve HIV Care Continuum for Young Adults Living With HIV

2020 ◽  
Vol 21 (5) ◽  
pp. 727-737
Author(s):  
John Zurlo ◽  
Ping Du ◽  
Alexander Haynos ◽  
Verbenia Collins ◽  
Tarek Eshak ◽  
...  
Keyword(s):  
Mobile Technology ◽  
Mobile Application ◽  
Viral Suppression ◽  
Retention Rate ◽  
Retention In Care ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Study Participants ◽  
Living With Hiv

Young adults living with HIV (YALH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YALH in care. We developed and implemented a multifaceted, mobile application-based intervention, “OPT-In for Life,” by targeting YALH to encourage retention in care and eventually viral suppression. The app integrated multiple user-friendly features for YALH to manage their HIV care, including a two-way secure messaging function, HIV-related laboratory results, and appointment or medication reminders. We recruited 92 YALH who were 18 to 34 years old and were newly diagnosed with HIV, had a history of falling out of care, or had a detectable HIV viral load into this intervention. Study participants used the app to manage their HIV care and to communicate and interact with their HIV care team. During the intervention period, the retention rate among our study participants increased from 41.3% at baseline to 78.6% at 6-month follow-up, maintained at 12-month follow-up (79.8%), and slightly decreased to 73.4% at 18-month follow-up but it was still significantly higher than the baseline retention rate ( p < .0001). The viral suppression rate (HIV RNA <200 copies/ml) increased from 64.1% at baseline to about 85% at 6-month and at 12-month follow-up and reached 91.4% at 18-month ( p = .0002) among participants who were retained in care. Our study demonstrated using a HIPAA-compliant mobile application as an effective intervention to engage YALH in care. This mobile technology–based intervention can be incorporated into routine clinical practice to improve HIV care continuum.

scholarly journals The Impact of Same-Day Antiretroviral Therapy Initiation under the WHO Treat-All Policy

2021 ◽  
Author(s):  
Bernhard Kerschberger ◽  
Andrew Boulle ◽  
Rudo Kuwengwa ◽  
Iza Ciglenecki ◽  
Michael Schomaker
Keyword(s):  
Antiretroviral Therapy ◽  
Directed Acyclic Graphs ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Unfavourable Outcome ◽  
Old Patients ◽  
Loss To Follow Up ◽  
Treat All ◽  
The Impact

Abstract Rapid initiation of antiretroviral therapy (ART) is recommended for people living with HIV, with the option to start treatment on the day of diagnosis (same-day-ART). However, the effect of same-day-ART remains unknown in realistic public sector settings. We established a cohort of ≥16-year-old patients who initiated first-line ART under Treat-All in Nhlangano (Eswatini) between 2014-2016, either on the day of HIV care enrolment (same-day-ART) or 1–14 days thereafter (early-ART). Directed acyclic graphs, flexible parametric survival analysis and targeted maximum likelihood estimation (TMLE) were used to estimate the effect of same-day-ART initiation on the composite unfavourable treatment outcome (loss to follow-up;death;viral failure). Of 1328 patients, 839 (63.2%) initiated same-day ART. The adjusted hazard ratio of the unfavourable outcome was increased by 1.48 (95% CI:1.16–1.89) for same-day-ART compared with early-ART. TMLE suggested that after 1 year, 28.9% of patients would experience the unfavourable outcome under same-day-ART compared with 21.2% under early-ART (difference: 7.7%; 1.3–14.1%). This estimate was driven by loss to follow-up and varied over time, with a higher hazard during the first year after HIV care enrolment and a similar hazard thereafter. We found an increased risk with same-day-ART. A limitation was possible silent transfers that were not captured.

Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing

2021 ◽  
pp. 019459982199338
Author(s):  
Flora Yan ◽  
Dylan A. Levy ◽  
Chun-Che Wen ◽  
Cathy L. Melvin ◽  
Marvella E. Ford ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Sleep Disordered Breathing ◽  
Healthy Children ◽  
Loss To Follow Up ◽  
Cox Regression Analysis ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Objective To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Study Design Retrospective cohort study. Setting Tertiary children’s hospital. Methods A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. Results In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance ( P < .001) and had a median driving distance of 74.8 vs 16.8 miles ( P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Conclusion Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.

scholarly journals Trends in mortality and loss to follow-up in HIV care at the Nkongsamba Regional hospital, Cameroon

2013 ◽  
Vol 6 (1) ◽  
Author(s):  
Cavin Epie Bekolo ◽  
Jayne Webster ◽  
Moses Batenganya ◽  
Gerald Etapelong Sume ◽  
Basile Kollo
Keyword(s):  
Regional Hospital ◽  
Hiv Care ◽  
Loss To Follow Up

scholarly journals The impact of smoking on tuberculosis treatment outcomes: a meta-analysis

2020 ◽  
Vol 24 (2) ◽  
pp. 170-175 ◽  
Author(s):  
E. Y. Wang ◽  
R. A. Arrazola ◽  
B. Mathema ◽  
I. B. Ahluwalia ◽  
S. R. Mase
Keyword(s):  
Cigarette Smoking ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Loss To Follow Up ◽  
Tb Treatment ◽  
The Impact ◽  
Culture Conversion

BACKGROUND: Cigarette smoking contributes to tuberculosis (TB) epidemiology. However, limited evidence exists on how smoking impacts TB treatment outcomes such as treatment loss to follow-up and culture conversion.METHODS: This meta-analysis assessed current evidence of the impact of active cigarette smoking on TB treatment outcomes. PubMed, Scopus, Embase, and the Cochrane Library were searched for English-language articles published from database inception through 2017. Articles addressing active pulmonary TB and cigarette smoking were identified and data abstracted. Smokers were defined as those who smoked every day or some days at the time of interview/diagnosis. Non-smokers did not smoke at the time of interview/diagnosis. Unfavorable outcomes included any outcome other than cure or completion of TB treatment. Three different data sets were examined: 8 articles addressing unfavorable treatment outcomes, 9 analyzing only treatment loss to follow-up, and 5 addressing delayed smear or culture conversion. Studies that had <20 subjects or that addressed only populations with comorbidities were excluded.RESULTS: We identified 1030 studies; 21 studies fulfilled the inclusion/exclusion criteria. Smokers had greater odds of unfavorable outcomes (pooled odds ratio [pOR] 1.23, 95%CI 1.14–1.33), delayed smear or culture conversion (pOR 1.55, 95%CI 1.04–2.07), and treatment loss to follow-up (pOR 1.35, 95%CI 1.21–1.50).CONCLUSION: Cigarette smoking is associated with negative treatment results and delayed conversion to negative smear or culture, suggesting smoking is an important factor for consideration in TB elimination efforts.

Factors Predicating Loss to Follow-Up With Rescreening in Early Hearing Detection and Intervention Programs

2019 ◽  
Vol 100 (2) ◽  
pp. 213-223 ◽  
Author(s):  
Wendy Zeitlin ◽  
Charles Auerbach ◽  
Susan Mason ◽  
Lynn Spivak ◽  
Andrew Erdman
Keyword(s):  
Hearing Loss ◽  
Maternal Depression ◽  
Hospital Discharge ◽  
The United States ◽  
Prospective Longitudinal Study ◽  
Loss To Follow Up ◽  
Two Factors ◽  
Prospective Longitudinal ◽  
The Impact

Most infants born in the United States are screened for hearing loss prior to hospital discharge in Early Hearing Detection and Intervention (EHDI) programs; however, many infants who do not pass their screening do not return for recommended rescreening and are considered lost to follow-up (LTF). This research addresses this by examining factors related to LTF at the point of rescreening. A prospective longitudinal study tracked 166 families whose newborns were referred for additional testing upon hospital discharge. Analysis identified two factors related to being LTF: parents’ perceptions of hearing loss as having the potential to impact their child’s future and maternal depression; however, social support moderated the impact of maternal depression. Specific implications for working with families is discussed.

scholarly journals Patterns and patient factors associated with loss to follow-up in the Muhimbili sickle cell cohort, Tanzania

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Upendo Masamu ◽  
Raphael Z. Sangeda ◽  
Daniel Kandonga ◽  
Jesca Ondengo ◽  
Flora Ndobho ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Sickle Cell ◽  
Retention Rate ◽  
Clinical Care ◽  
Parametric Method ◽  
Comprehensive Care ◽  
Rank Test ◽  
Mean Cell Volume ◽  
Loss To Follow Up

Abstract Background Monitoring patient’s clinical attendance is a crucial means of improving retention in care and treatment programmes. Sickle cell patients’ outcomes are improved by participation in comprehensive care programmes, but these benefits cannot be achieved when patients are lost from clinical care. In this study, patients are defined as loss to follow-up when they did not attend clinic for more than 9 months. Precise information on the retention rate and characteristics of those who are not following their clinic appointments is needed to enable the implementation of interventions that will be effective in increasing the retention to care. Method This was a retrospective study involving sickle cell patients registered in the Muhimbili Sickle Cohort in Tanzania. Descriptive and survival analysis techniques both non-parametric methods (Kaplan-Meier estimator and Log-rank test) and semi-parametric method (Cox’s proportional hazard model), were used. A p-value of 0.05 was considered significant to make an inference from the analysis. Results A total of 5476 patients were registered in the cohort from 2004 to 2016. Of these, 3350 (58.13%) were actively participating in clinics, while 2126 (41.87%) were inactive, of which 1927 (35.19%) were loss to follow-up. We used data from 2004 to 2014 because between 2015 and 2016, patients were referred to other government hospitals. From the survival analysis results, pediatric (HR: 14.29,95% CI: 11.0071–18.5768, p <  0.001) and children between 5 and 17 years [HR:2.61,95% CI:2.2324–3.0705, p <  0.001] patients were more likely to be loss to follow-up than the adult (18 and above years) patients. It was found that patients with above averages for hematocrit (HR: 2.38, 95% CI: 1.0076–1.0404, p = 0.0039) or mean cell volume (HR: 4.28, (95% CI: 1.0260–1.0598, p < 0.001) were more likely to be loss to follow-up than their counterparts. Conclusion Loss to follow-up is evident in the cohort of patients in long term comprehensive care. It is, therefore, necessary to design interventions that improve patients’ retention. Suggested solutions include refresher training for health care workers and those responsible for patient follow-up on techniques for retaining patients and comprehensive transition programs to prepare patients who are moving from pediatric to adult clinics.

Sorafenib in hepatocellular carcinoma (HCC): Is there a role for starting patients on a total daily dose of 400mg daily?

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 364-364
Author(s):  
Olugbenga Olanrele Olowokure ◽  
Brian Singeltary ◽  
Abhimanyu Ghose, ◽  
Michelle Lynn Mierzwa ◽  
Tahir Latif ◽  
...  
Keyword(s):  
Asia Pacific ◽  
Locoregional Therapy ◽  
Total Daily Dose ◽  
Rank Test ◽  
Loss To Follow Up ◽  
Kaplan Meier ◽  
Daily Dose ◽  
Ecog Ps ◽  
The Impact

364 Background: S at a starting daily dose of 400mg twice daily (800mg) is considered the standard systemic therapy for HCC, in pts with well preserved liver function and advanced stage HCC, based largely on data reported by the SHARP and Asia-pacific trials. Due to complaints regarding SE and reluctance to start at full dose, we decide to retrospectively look at our HCC data base. This single institution retrospective review, evaluated the impact of starting S at a 400mg daily (200mg twice daily). Methods: From 06/01/09-09/01/13, using ICD code 155, newly registered advanced HCC pts, ECOG PS 2, Childs Pugh (CP) class A or B who were started on S 400mg daily were identified : CT scans and AFP levels were followed. PFS was estimated from the date of commencing therapy to date of progression or death if this occurred first and OS was estimated from date of commencing therapy until date of death or loss to follow up. Kaplan Meier survival estimates were obtained with 95% (CI). Log rank test was used to compare the PFS according to CP class. Results: 33 pts (M:F, 21:12), mean age of 59.8y (SD: 12.40) met inclusion criteria, the median duration (MD) of follow up was 8.7 m ( 1.07-27.43). 23(69.7%) pts were CP-A. 70% had abnormal AFP and this decreased > 50% from baseline in 8 (35%). 96% of the pts received prior locoregional therapy in CP-A and 50% in CP-B. Initial dose tolerance was observed in 23 (69.7%) pts. 16 pts (48.5%) needed dose reduction (CP-A: 56.5%, CP-B: 30%) while 19 (57.6%) pts were able to escalate their dose at some point (CP-A: 60.9%, CP-B: 50%). MD of (400mg/d) was 3m prior to any adjustment (CP-A: 3, CP-B: 2). Mean duration of S use was 8.88m (A-10.04, B-6.2). During follow up, 26 pts had POD and 24 pts died. There was no difference in PFS between CP-A and B and following POD 10/19 evaluable pts continued S. OS was 79 % (95%CI: 61-89%) at 3m, 67% (95%CI: 48-80%) at 6m, 50% (95%CI: 32-66%) at 9m, and 40% (95%CI: 23-57%) at 12m. The most common reported toxicities were fatigue 87.5%, diarrhea 53.1% and HFS/rash 43.8% Conclusions: In this cohort of pts S started at 400mg/d did not seem to result in worse outcomes compared to historic controls possibly due to the ability to tolerate therapy for a longer period of time.

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