BACKGROUND: Recommendations for universal antiretroviral therapy have greatly increased the number of HIV-infected patients who qualify for treatment, particularly with early clinical disease. Less intensive models of care are needed for clinically stable patients. SETTING: A rapid pathway (RP) model of expedited outpatient care for clinically stable patients was implemented at the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) Center, Port-au-Prince, Haiti. Expedited visits included nurse-led assessments and point-of-service antiretroviral therapy dispensing. METHODS: We conducted a retrospective analysis including patients who initiated RP care between June 1, 2014, and September 30, 2015, comparing outcomes of patients with timely visit attendance (never >3 days late) with patients with ≥1 nontimely visit within 6 months before RP enrollment. We calculated retention in care and adherence at 12 months, and assessed predictors of both outcomes. RESULTS: Of the 2361 patients who initiated RP care during the study period, 1429 (61%) had timely visit attendance and 932 (39%) had ≥1 nontimely visit before RP enrollment. Among RP-enrolled patients, 94% were retained at 12 months and 75% had ≥90% adherence, with higher proportions in those with timely pre-RP visits (95% vs. 92%; 87% vs. 55%). In multivariable analysis, pre-RP visit timeliness was associated with both retention (adjusted odds ratio: 1.67; 95% confidence interval: 1.08 to 2.59) and adherence (adjusted odds ratio: 4.53; 95% confidence interval: 3.58 to 5.72). CONCLUSIONS: RP care was associated with high levels of retention and adherence for clinically stable patients. Timeliness of pre-RP visits was predictive of outcomes after RP initiation.
BACKGROUND: Recommendations for universal antiretroviral therapy have greatly increased the number of HIV-infectedpatients who qualify for treatment, particularly with early clinical disease. Less intensive models of care are needed for clinically stable patients. SETTING: A rapid pathway (RP) model of expedited outpatient care for clinically stable patients was implemented at the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) Center, Port-au-Prince, Haiti. Expedited visits included nurse-led assessments and point-of-service antiretroviral therapy dispensing. METHODS: We conducted a retrospective analysis including patients who initiated RP care between June 1, 2014, and September 30, 2015, comparing outcomes of patients with timely visit attendance (never >3 days late) with patients with ≥1 nontimely visit within 6 months before RP enrollment. We calculated retention in care and adherence at 12 months, and assessed predictors of both outcomes. RESULTS: Of the 2361 patients who initiated RP care during the study period, 1429 (61%) had timely visit attendance and 932 (39%) had ≥1 nontimely visit before RP enrollment. Among RP-enrolled patients, 94% were retained at 12 months and 75% had ≥90% adherence, with higher proportions in those with timely pre-RP visits (95% vs. 92%; 87% vs. 55%). In multivariable analysis, pre-RP visit timeliness was associated with both retention (adjusted odds ratio: 1.67; 95% confidence interval: 1.08 to 2.59) and adherence (adjusted odds ratio: 4.53; 95% confidence interval: 3.58 to 5.72). CONCLUSIONS: RP care was associated with high levels of retention and adherence for clinically stable patients. Timeliness of pre-RP visits was predictive of outcomes after RP initiation.
Authors: Claudia Hawkins; Guerino Chalamilla; James Okuma; Donna Spiegelman; Ellen Hertzmark; Eric Aris; Tarcila Ewald; Ferdinand Mugusi; Deo Mtasiwa; Wafaie Fawzi Journal: AIDS Date: 2011-06-01 Impact factor: 4.177
Authors: Alana T Brennan; Lawrence Long; Mhairi Maskew; Ian Sanne; Imogen Jaffray; Patrick MacPhail; Matthew P Fox Journal: AIDS Date: 2011-10-23 Impact factor: 4.177
Authors: Tsitsi Mutasa-Apollo; Ray W Shiraishi; Kudakwashe C Takarinda; Janet Dzangare; Owen Mugurungi; Joseph Murungu; Abu Abdul-Quader; Celia J I Woodfill Journal: PLoS One Date: 2014-01-29 Impact factor: 3.240
Authors: Shabbar Jaffar; Barbara Amuron; Susan Foster; Josephine Birungi; Jonathan Levin; Geoffrey Namara; Christine Nabiryo; Nicaise Ndembi; Rosette Kyomuhangi; Alex Opio; Rebecca Bunnell; Jordan W Tappero; Jonathan Mermin; Alex Coutinho; Heiner Grosskurth Journal: Lancet Date: 2009-11-24 Impact factor: 79.321
Authors: Katharina Kranzer; Darshini Govindasamy; Nathan Ford; Victoria Johnston; Stephen D Lawn Journal: J Int AIDS Soc Date: 2012-11-19 Impact factor: 5.396
Authors: Aaron Richterman; Fernet Leandre; J Gregory Jerome; Alexander C Tsai; Louise C Ivers Journal: Open Forum Infect Dis Date: 2020-08-11 Impact factor: 3.835
Authors: Ingrid Eshun-Wilson; Mpande Mukumbwa-Mwenechanya; Hae-Young Kim; Arianna Zannolini; Chanda P Mwamba; David Dowdy; Estella Kalunkumya; Mwansa Lumpa; Laura K Beres; Monika Roy; Anjali Sharma; Steph M Topp; Dave V Glidden; Nancy Padian; Peter Ehrenkranz; Izukanji Sikazwe; Charles B Holmes; Carolyn Bolton-Moore; Elvin H Geng Journal: J Acquir Immune Defic Syndr Date: 2019-08-15 Impact factor: 3.731