HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations]
Background: A study of patient records in four HIV clinics in three sub-Saharan African countries examined routine clinical care patterns and variations. Methods: Clinic characteristics were described, and patient data extracted from a sample of medical records. Data on treatment, CD4 count and vira...
| Main Authors: | , , , , , , |
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| Format: | Article |
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F1000 Research Ltd
2019-01-01
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| Series: | F1000Research |
| Online Access: | https://f1000research.com/articles/7-713/v3 |
| _version_ | 1828489739468013568 |
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| author | Baba M Musa Everistus Ibekwe Stanley Mwale Daniel Eurien Catherine Oldenburg Gary Chung Richard F Heller |
| author_facet | Baba M Musa Everistus Ibekwe Stanley Mwale Daniel Eurien Catherine Oldenburg Gary Chung Richard F Heller |
| author_sort | Baba M Musa |
| collection | DOAJ |
| description | Background: A study of patient records in four HIV clinics in three sub-Saharan African countries examined routine clinical care patterns and variations. Methods: Clinic characteristics were described, and patient data extracted from a sample of medical records. Data on treatment, CD4 count and viral load (VL) were obtained for the last visit in the records, dates mainly between 2015 and 2017, patient demographic data were obtained from the first clinic visit. Results: Four clinics, two in Nigeria, one in Zambia and one in Uganda, all public facilities, using national HIV treatment guidelines were included. Numbers of patients and health professionals varied, with some variation in stated frequency of testing for CD4 count and VL. Clinical guidelines were available in each clinic, and most drugs were available free to patients. The proportion of patients with a CD4 count in the records varied from 84 to 100 percent, the latest median count varied from 269 to 593 between clinics. 35% had a record of a VL test, varying from 1% to 63% of patients. Lamivudine (3TC) was recorded for more than 90% of patients in each clinic, and although there was variation between clinics in the choice of antiretroviral therapy (ART), the majority were on first line drugs consistent with guidelines. Only about 2% of the patients were on second-line ARTs. In two clinics, 100% and 99% of patients were prescribed co-trimoxazole, compared with 7% and no patients in the two other clinics. Conclusions: The wide variation in available clinic health work force, levels and frequency of CD4 counts, and VL assessment and treatment indicate sub-optimal adherence to current guidelines in routine clinical care. There is room for further work to understand the reasons for this variation, and to standardise record keeping and routine care of HIV positive patients. |
| first_indexed | 2024-12-11T10:31:20Z |
| format | Article |
| id | doaj.art-ce10e2b91eb946778eeadf941e6505ef |
| institution | Directory Open Access Journal |
| issn | 2046-1402 |
| language | English |
| last_indexed | 2024-12-11T10:31:20Z |
| publishDate | 2019-01-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | F1000Research |
| spelling | doaj.art-ce10e2b91eb946778eeadf941e6505ef2022-12-22T01:10:55ZengF1000 Research LtdF1000Research2046-14022019-01-01710.12688/f1000research.15169.319421HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations]Baba M Musa0Everistus Ibekwe1Stanley Mwale2Daniel Eurien3Catherine Oldenburg4Gary Chung5Richard F Heller6Department of Medicine, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, NigeriaFaculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, M15 6GX, UKCentre for Infectious Disease Research in Zambia, Lusaka, 10101, ZambiaAdvanced Field Epidemiology Training Program , Kampala, UgandaThe Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, CA, 94143, USAJohnson & Johnson, New Brunswick, NJ, 08901, USAPeople’s Open Access Education Initiative, Manchester, M30 9ED, UKBackground: A study of patient records in four HIV clinics in three sub-Saharan African countries examined routine clinical care patterns and variations. Methods: Clinic characteristics were described, and patient data extracted from a sample of medical records. Data on treatment, CD4 count and viral load (VL) were obtained for the last visit in the records, dates mainly between 2015 and 2017, patient demographic data were obtained from the first clinic visit. Results: Four clinics, two in Nigeria, one in Zambia and one in Uganda, all public facilities, using national HIV treatment guidelines were included. Numbers of patients and health professionals varied, with some variation in stated frequency of testing for CD4 count and VL. Clinical guidelines were available in each clinic, and most drugs were available free to patients. The proportion of patients with a CD4 count in the records varied from 84 to 100 percent, the latest median count varied from 269 to 593 between clinics. 35% had a record of a VL test, varying from 1% to 63% of patients. Lamivudine (3TC) was recorded for more than 90% of patients in each clinic, and although there was variation between clinics in the choice of antiretroviral therapy (ART), the majority were on first line drugs consistent with guidelines. Only about 2% of the patients were on second-line ARTs. In two clinics, 100% and 99% of patients were prescribed co-trimoxazole, compared with 7% and no patients in the two other clinics. Conclusions: The wide variation in available clinic health work force, levels and frequency of CD4 counts, and VL assessment and treatment indicate sub-optimal adherence to current guidelines in routine clinical care. There is room for further work to understand the reasons for this variation, and to standardise record keeping and routine care of HIV positive patients.https://f1000research.com/articles/7-713/v3 |
| spellingShingle | Baba M Musa Everistus Ibekwe Stanley Mwale Daniel Eurien Catherine Oldenburg Gary Chung Richard F Heller HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations] F1000Research |
| title | HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations] |
| title_full | HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations] |
| title_fullStr | HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations] |
| title_full_unstemmed | HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations] |
| title_short | HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations] |
| title_sort | hiv treatment and monitoring patterns in routine practice a multi country retrospective chart review of patient care version 3 referees 1 approved 2 approved with reservations |
| url | https://f1000research.com/articles/7-713/v3 |
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