Use of WHO clinical stage for assessing patient eligibility to antiretroviral therapy in a routine health service setting in Jinja, Uganda

被引：24

作者：

Jaffar S. ^{[1
]}

Birungi J. ^{[2
]}

Grosskurth H. ^{[3
]}

Amuron B. ^{[3
]}

Namara G. ^{[3
]}

Nabiryo C. ^{[2
]}

Coutinho A. ^{[2
]}

机构：

[1] Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, Keppel Street

[2] The AIDS Support Organisation, Kampala

[3] Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe

来源：

AIDS Research and Therapy | / 5卷 / 1期

基金：

英国医学研究理事会;

关键词：

Plasma Viral Load; Pyomyositis; Oral Hairy Leukoplakia; High Plasma Viral Load; Uganda Virus Research Institute;

D O I：

10.1186/1742-6405-5-4

中图分类号：

学科分类号：

摘要：

In a routine service delivery setting in Uganda, we assessed the ability of the WHO clinical stage to accurately identify HIV-infected patients in whom antiretroviral therapy should be started. Among 4302 subjects screened for ART, the sensitivity and specificity (95% CI) of WHO stage III, IV against a CD4 count < 200 × 106/l were 52% (50, 54%) and 68% (66, 70%) respectively. Plasma viral load was tested in a subset of 1453 subjects in whom ART was initiated. Among 938 subjects with plasma viral load of 100,000 copies or more, 391 (42%, 95% CI 39, 45%) were at WHO stage I or II. In this setting, a large number of individuals could have been denied access to antiretroviral therapy if eligibility to ART was assessed on the basis of WHO clinical stage. There is an urgent need for greater CD4 count testing and evaluation of the utility of plasma viral load prior to initiation of ART to accompany the roll-out of ART. © 2008 Jaffar et al; licensee BioMed Central Ltd.

引用

共 12 条

[1]

Gazzard B., Bernard A.J., Boffito M., Churchill D., Edwards S., Fisher N., Geretti A.M., Johnson M., Leen C., Peters B., Pozniak A., Ross J., Walsh J., Wilkins E., Youle M., British HIV Association (BHIVA) guidelines for the treatment of HIV-infected adults with antiretroviral therapy (2006), HIV Med, 7, 8, pp. 487-503, (2006)

[2]

Antiretroviral Therapy for HIV-infections in Adults and Adolescents: Recommendations for a Public Health Approach, (2006)

[3]

Towards Universal Access: Scaling Up Priority HIV/AIDS in the Health Sector. Progress Report, (2007)

[4]

Kassa E., Rinke de Wit T.F., Hailu E., Girma M., Messele T., Mariam H.G., Yohannes S., Jurriaans S., Yeneneh H., Coutinho R.A., Fontanet A.L., Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: Association between clinical stages and laboratory markers, Aids, 13, 3, pp. 381-389, (1999)

[5]

Malamba S.S., Morgan D., Clayton T., Mayanja B., Okongo M., Whitworth J., The prognostic value of the World Health Organisation staging system for HIV infection and disease in rural Uganda, Aids, 13, 18, pp. 2555-2562, (1999)

[6]

Spacek L.A., Gray R.H., Wawer M.J., Sewankambo N.K., Serwadda D., Wabwire-Mangen F., Kiwanuka N., Kigozi G., Nalugoda F., Quinn T.C., Clinical illness as a marker for initiation of HIV antiretroviral therapy in a rural setting, Rakai, Uganda, Int J STD AIDS, 17, 2, pp. 116-120, (2006)

[7]

Lynen L., Thai S., De Munter P., Leang B., Sokkab A., Schrooten W., Huyst V., Kestens L., Jacques G., Colebunders R., Menten J., van den Ende J., The added value of a CD4 count to identify patients eligible for highly active antiretroviral therapy among HIV-positive adults in Cambodia, J Acquir Immune Defic Syndr, 42, 3, pp. 322-324, (2006)

[8]

Kagaayi J., Makumbi F., Nakigozi G., Wawer M.J., Gray R.H., Serwadda D., Reynolds S.J., WHO HIV clinical staging or CD4 cell counts for antiretroviral therapy eligibility assessment? An evaluation in rural Rakai district, Uganda, Aids, 21, 9, pp. 1208-1210, (2007)

[9]

Amuron B., Coutinho A., Grosskurth H., Nabiryo C., Birungi J., Namara G., Levin J., Smith G.P., Jaffar S., A cluster randomised trial to compare home-based with health facility-based antiretroviral treatment in Uganda: Study design and baseline findings, The Open AIDS Journal, 1, pp. 21-27, (2007)

[10]

Jaffar S., Amuron B., Birungi J., Namara G., Nabiryo C., Coutinho A., Grosskurth H., Integrating research into routine service delivery in a antiretroviral treatment programme: Lessons learnt from a cluster randomised trial comparing different strategies of HIV care in Jinja, Uganda, Trop Med Int Health

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