Adherence to antiretroviral therapy by adults living with HIV/aids: a cross-sectional study

ABSTRACT Objective: To verify the association between adherence to antiretroviral treatment by adults with HIV/AIDS and sociodemographic factors, social and clinical support. Methods: Cross-sectional study, with a quantitative approach. Participation of 230 patients. Questionnaires of sociodemographic characterization, social and clinical support, and assessment of adherence to antiretroviral treatment were used. Descriptive and inferential statistics were performed. Results: Adherence was classified as good/adequate. An association with sex, income, employment, and level of education was noted. In social support: having access to health services; communication with health professionals; health education; having support to allow venting/talking about issues; information on HIV/AIDS; and company for leisure. In the clinical profile: non-interruption of the drug treatment due to absence from the service or due to changes in the medical prescription. Conclusion: Adherence was classified as good/adequate and especially associated with social support factors, which should be enhanced in clinical practice.

Collaboration With the State Department of Health

COVID-19 disproportionately affected older adults, creating opportunities for experts in geriatrics and gerontology to support public policy. In Indiana, the Probari team, composed of a geriatrician and a team of nurses with geriatrics and palliative care expertise, supported the state government response to long-term care facilities during the pandemic. The team was involved in helping coordinate all staff testing (534 nursing homes) by the State Department of Health in June and in August, prior to the Federal mandated testing and the distribution of antigen machines. The Probari team also fielded surveys on behalf of the State regarding staff attitudes towards testing and willingness to be vaccinated, to inform state policy and resource efforts. In addition, Probari collaborated with the State Department of Health and the Indiana National Guard by training over 1600 service members to provide non-clinical support in nursing facilities, and monitoring and evaluating that 3 month deployment.

Integrating Hepatitis C Care for opioid substitution treatment patients attending general practice: Feasibility, Clinical and Cost Effectiveness (Preprint)

BACKGROUND Hepatitis C (HCV) infection is common among people who inject drugs (PWID), yet well described barriers mean that a minority have accessed HCV treatment. OBJECTIVE The aim of this study was to examine feasibility, acceptability, clinical and cost effectiveness of an integrated model of HCV care for opioid substitution treatment (OST) patients in general practice. METHODS A pre-and-post intervention design with an embedded economic analysis was used to establish the feasibility, acceptability, clinical and cost effectiveness of a complex intervention to optimise HCV identification and linkage to HCV treatment among patients prescribed methadone in primary care. The ‘complex intervention’ comprised General Practitioner (GP) / practice staff education, nurse-led clinical support, and enhanced community-based HCV assessment of patients. General practices in North Dublin were recruited from the professional networks of the research team and from GPs who attended educational sessions. RESULTS Fourteen practices, 135 patients participated. Follow-up data was collected six-months post-intervention on 131(97.0%) patients. With regards to clinical effectiveness, among HCV antibody-positive patients, there was a significant increase in the proportions of who had a liver fibroscan (17/101(16.8%) vs 52/100 (52.0%); p<0.001), had attended hepatology/infectious diseases services (51/101(50.5%) vs 61/100 (61.0%); p=0.002), and initiated treatment (20/101(19.8%) vs 30/100 (30.0%); p=0.004). The mean incremental cost-effectiveness ratio of the intervention was €13,255 per quality adjusted life year gained at current full drug list price (€39,729 per course), which would be cost saving if these costs are reduced by 88%. CONCLUSIONS The complex intervention involving clinical support, access to assessment and practitioner education has the potential to enhance patient care, improving access to assessment and treatment in a cost effective manner.

Designing Support Structures Post Sepsis in Children: Perspectives of the Queensland Paediatric Sepsis Program

Introduction: Paediatric post sepsis syndrome is poorly defined and causes physical, neurocognitive, psychosocial morbidity, and family dysfunction. Families of sepsis survivors report unmet needs during care. Worldwide, the provision of post sepsis care is in its infancy with limited evidence to design clinical support pathways.Perspective: The Queensland Paediatric Sepsis Program (QPSP) developed a family support structure (FSS) to improve care during all stages of childhood sepsis. It was designed in partnership with consumers guided by information from consumers and it is partly delivered by consumers. Key areas include online, multimodal education for families and the ability to connect with other families affected by sepsis. The FSS is delivered by a multidisciplinary team (MDT) acting with clinicians local to the child. Families can join the FSS registry at any stage of their sepsis journey which connects them to our MDT team and opens opportunities to participate in future research and other initiatives. Improving public awareness is a critical outcome for our consumers and they have co-designed media and digital campaigns.Discussion: The ideal FSS for post sepsis syndrome management is a clinical pathway designed in partnership with consumers of interventions proven to improve outcomes from sepsis that meets their requirements. The QPSP FSS is novel as it is co-designed with, and partly delivered by, consumers with interventions aimed to improve the entire spectrum of morbidities suffered by survivors and their families, not just physical sequelae. Evaluation is embedded in the program and outcomes will guide evolution of the FSS.

Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya: An Observational Analysis (Preprint)

BACKGROUND To support quality of care improvements, iDeliver, a digital clinical support system for maternal and neonatal care, was developed. OBJECTIVE Taking an implementation research lens, we evaluated the adoption and fidelity of iDeliver and assessed the feasibility of its use to provide routine Ministry of Health reports. METHODS We analyzed routinely collected data from the iDeliver implemented at Trans Mara West sub-county Hospital (Kenya), from December 2018 to October 2020. To evaluate its adoption, we assessed the proportion of total facility deliveries over time. To examine the fidelity of iDeliver usage, we studied data completion to assess the plausibility of data entry by care providers during each stage of the labor and delivery workflow and if the usage reflected iDeliver’s envisioned function. We also examined the data completeness of maternal and neonatal indicators prioritized by the Kenyan Ministry of Health. RESULTS 1164 deliveries were registered in iDeliver, capturing 47.3% of the facility’s deliveries over 22 months. Registration improved significantly from 32.3% in the first to 62.2% in the second phase of implementation (P=0.003). Across iDeliver’s workflow, the overall completion rate of all variables improved significantly from 34.1% to 48.0% in the second phase (P<0.001). Data completion was highest for the Discharge-Labor Summary (67.7%) and was lowest for Labor Signs (14.4%). The completion rate of the key Ministry of Health indicators also improved significantly (P<0.001). CONCLUSIONS iDeliver’s adoption and data completeness improved significantly over time. Assessment of iDeliver’ usage fidelity suggested that some features were more easily utilized because providers had time to enter data, versus lower utilization during active childbirth when providers are necessarily engaged with the woman and baby. These insights on the adoption and fidelity of iDeliver usage prompted the team to adapt the application to reflect the users’ culture of use and further improve the implementation of iDeliver. CLINICALTRIAL newborn; neonatal health; maternal health; intrapartum care; labor and delivery; Kenya; digital clinical decision support; health information systems; digital health; implementation research

A Comprehensive Review on the Biomarkers of Bone Remodeling in Vitamin D Deficiency

Vitamin D (Vit.D) has been well regarded as one of the essential micronutrients for several biological functions in humans, including bone structure and function. The deficiency of Vit.D due to various environmental, lifestyle, and genetic factors affect bone remodeling, including bone mineralization and resorption. Consequently, several changes occur in the level of biochemicals which are implied in bone remodeling, either directly or via secondary pathways. Intriguingly, the levels of these biomolecules are hypothesized to have a strong association with the prognosis of Vit. D deficiency (VDD) related health complications. However, the precise association of various bone turnover-derived biomolecules with VDD-related effects are largely elusive. Thus, the in-depth understanding of specific associations of VDD and bone mineralization, would establish novel bioanalytical approaches for early detection and devise alternative strategies to provide symptomatic clinical support to VDD patients. Hence this review collates the available literature to elucidate the association of various bone resorption biomarkers and their relevance to VDD.