OBJECTIVES: Evaluating treatment failure is critical when deciding to modify antiretroviral therapy (ART). Virologic Assessment Forms (VAFs) were implemented in July 2008 as a prerequisite for ordering viral load. The form requires assessment of clinical and immunologic status. METHODS: Using the Electronic Medical Record (EMR), we retrospectively evaluated patients who met 2006 WHO guidelines for immunologic failure (≥15 years old; on ART ≥6 months; CD4 count <baseline OR CD4 count >50% drop from peak OR CD4 persistently <100 cells) at the Lighthouse Trust clinic from December 2007 to December 2009. We compared virologic screening, VAF implementation and ART modification during the same period using Fisher's exact tests and unpaired t-tests as appropriate. RESULTS: Of 7000 enrolled ART patients ≥15 years old with at least two CD4 counts, 10% had immunologic failure with a median follow-up time on ART of 1.4 years (IQR: 0.8-2.3). Forty (6%) viral loads were ordered: 14 (35%) were detectable (>400 HIV RNA copies/mL) and one (7%) patient was switched to second-line therapy. Overall, 259 VAFs were completed: 67% for immunologic failure and 33% for WHO Stage 4 condition. Before VAF implementation, 1% of patients had viral loads drawn during routine care, whereas afterwards, 8% did (P<0.0001; 95% CI: 0.03-0.08). CONCLUSIONS: Clinicians did not identify a large proportion of immunologic failure patients for screening. Implementation of VAFs produced little improvement in virologic screening during routine care. Better training and monitoring systems are needed.
OBJECTIVES: Evaluating treatment failure is critical when deciding to modify antiretroviral therapy (ART). Virologic Assessment Forms (VAFs) were implemented in July 2008 as a prerequisite for ordering viral load. The form requires assessment of clinical and immunologic status. METHODS: Using the Electronic Medical Record (EMR), we retrospectively evaluated patients who met 2006 WHO guidelines for immunologic failure (≥15 years old; on ART ≥6 months; CD4 count <baseline OR CD4 count >50% drop from peak OR CD4 persistently <100 cells) at the Lighthouse Trust clinic from December 2007 to December 2009. We compared virologic screening, VAF implementation and ART modification during the same period using Fisher's exact tests and unpaired t-tests as appropriate. RESULTS: Of 7000 enrolled ART patients ≥15 years old with at least two CD4 counts, 10% had immunologic failure with a median follow-up time on ART of 1.4 years (IQR: 0.8-2.3). Forty (6%) viral loads were ordered: 14 (35%) were detectable (>400 HIV RNA copies/mL) and one (7%) patient was switched to second-line therapy. Overall, 259 VAFs were completed: 67% for immunologic failure and 33% for WHO Stage 4 condition. Before VAF implementation, 1% of patients had viral loads drawn during routine care, whereas afterwards, 8% did (P<0.0001; 95% CI: 0.03-0.08). CONCLUSIONS: Clinicians did not identify a large proportion of immunologic failurepatients for screening. Implementation of VAFs produced little improvement in virologic screening during routine care. Better training and monitoring systems are needed.
Authors: Eran Bendavid; Sean D Young; David A Katzenstein; Ahmed M Bayoumi; Gillian D Sanders; Douglas K Owens Journal: Arch Intern Med Date: 2008-09-22
Authors: David M Moore; Anna Awor; Robert Downing; Jonathan Kaplan; Julio S G Montaner; John Hancock; Willy Were; Jonathan Mermin Journal: J Acquir Immune Defic Syndr Date: 2008-12-15 Impact factor: 3.731
Authors: Scott M Hammer; Joseph J Eron; Peter Reiss; Robert T Schooley; Melanie A Thompson; Sharon Walmsley; Pedro Cahn; Margaret A Fischl; Jose M Gatell; Martin S Hirsch; Donna M Jacobsen; Julio S G Montaner; Douglas D Richman; Patrick G Yeni; Paul A Volberding Journal: JAMA Date: 2008-08-06 Impact factor: 56.272
Authors: Andrew N Phillips; Deenan Pillay; Alec H Miners; Diane E Bennett; Charles F Gilks; Jens D Lundgren Journal: Lancet Date: 2008-04-26 Impact factor: 79.321
Authors: Sarah M Lofgren; Anne B Morrissey; Caroline C Chevallier; Anangisye I Malabeja; Sally Edmonds; Ben Amos; David J Sifuna; Lorenz von Seidlein; Werner Schimana; Wendy S Stevens; John A Bartlett; John A Crump Journal: AIDS Date: 2009-11-27 Impact factor: 4.177
Authors: Mina C Hosseinipour; Joep J G van Oosterhout; Ralf Weigel; Sam Phiri; Debbie Kamwendo; Neil Parkin; Susan A Fiscus; Julie A E Nelson; Joseph J Eron; Johnstone Kumwenda Journal: AIDS Date: 2009-06-01 Impact factor: 4.177
Authors: P Mugyenyi; A S Walker; J Hakim; P Munderi; D M Gibb; C Kityo; A Reid; H Grosskurth; J H Darbyshire; F Ssali; D Bray; E Katabira; A G Babiker; C F Gilks; H Grosskurth; P Munderi; G Kabuye; D Nsibambi; R Kasirye; E Zalwango; M Nakazibwe; B Kikaire; G Nassuna; R Massa; K Fadhiru; M Namyalo; A Zalwango; L Generous; P Khauka; N Rutikarayo; W Nakahima; A Mugisha; J Todd; J Levin; S Muyingo; A Ruberantwari; P Kaleebu; D Yirrell; N Ndembi; F Lyagoba; P Hughes; M Aber; A Medina Lara; S Foster; J Amurwon; B Nyanzi Wakholi; J Whitworth; K Wangati; B Amuron; D Kajungu; J Nakiyingi; W Omony; K Fadhiru; D Nsibambi; P Khauka; P Mugyenyi; C Kityo; F Ssali; D Tumukunde; T Otim; J Kabanda; H Musana; J Akao; H Kyomugisha; A Byamukama; J Sabiiti; J Komugyena; P Wavamunno; S Mukiibi; A Drasiku; R Byaruhanga; O Labeja; P Katundu; S Tugume; P Awio; A Namazzi; G T Bakeinyaga; H Katabira; D Abaine; J Tukamushaba; W Anywar; W Ojiambo; E Angweng; S Murungi; W Haguma; S Atwiine; J Kigozi; L Namale; A Mukose; G Mulindwa; D Atwiine; A Muhwezi; E Nimwesiga; G Barungi; J Takubwa; S Murungi; D Mwebesa; G Kagina; M Mulindwa; F Ahimbisibwe; P Mwesigwa; S Akuma; C Zawedde; D Nyiraguhirwa; C Tumusiime; L Bagaya; W Namara; J Kigozi; J Karungi; R Kankunda; R Enzama; A Latif; J Hakim; V Robertson; A Reid; E Chidziva; R Bulaya-Tembo; G Musoro; F Taziwa; C Chimbetete; L Chakonza; A Mawora; C Muvirimi; G Tinago; P Svovanapasis; M Simango; O Chirema; J Machingura; S Mutsai; M Phiri; T Bafana; M Chirara; L Muchabaiwa; M Muzambi; J Mutowo; T Chivhunga; E Chigwedere; M Pascoe; C Warambwa; E Zengeza; F Mapinge; S Makota; A Jamu; N Ngorima; H Chirairo; S Chitsungo; J Chimanzi; C Maweni; R Warara; M Matongo; S Mudzingwa; M Jangano; K Moyo; L Vere; N Mdege; I Machingura; E Katabira; A Ronald; A Kambungu; F Lutwama; I Mambule; A Nanfuka; J Walusimbi; E Nabankema; R Nalumenya; T Namuli; R Kulume; I Namata; L Nyachwo; A Florence; A Kusiima; E Lubwama; R Nairuba; F Oketta; E Buluma; R Waita; H Ojiambo; F Sadik; J Wanyama; P Nabongo; J Oyugi; F Sematala; A Muganzi; C Twijukye; H Byakwaga; R Ochai; D Muhweezi; A Coutinho; B Etukoit; C Gilks; K Boocock; C Puddephatt; C Grundy; J Bohannon; D Winogron; D M Gibb; A Burke; D Bray; A Babiker; A S Walker; H Wilkes; M Rauchenberger; S Sheehan; C Spencer-Drake; K Taylor; M Spyer; A Ferrier; B Naidoo; D Dunn; R Goodall; J H Darbyshire; L Peto; R Nanfuka; C Mufuka-Kapuya; P Kaleebu; D Pillay; V Robertson; D Yirrell; S Tugume; M Chirara; P Katundu; N Ndembi; F Lyagoba; D Dunn; R Goodall; A McCormick; A Medina Lara; S Foster; J Amurwon; B Nyanzi Wakholi; J Kigozi; L Muchabaiwa; M Muzambi; I Weller; A Babiker; S Bahendeka; M Bassett; A Chogo Wapakhabulo; J H Darbyshire; B Gazzard; C Gilks; H Grosskurth; J Hakim; A Latif; C Mapuchere; O Mugurungi; P Mugyenyi; C Burke; S Jones; C Newland; G Pearce; S Rahim; J Rooney; M Smith; W Snowden; J-M Steens; A Breckenridge; A McLaren; C Hill; J Matenga; A Pozniak; D Serwadda; T Peto; A Palfreeman; M Borok; E Katabira Journal: Lancet Date: 2009-12-08 Impact factor: 79.321