7 research outputs found
Leveraging Telehealth to Improve Health Care Access in Rural America: It Takes More Than Bandwidth
No full textPLoS One
Get PDFObjectivesVietnam has significantly scaled up its national antiretroviral therapy (ART) program since 2005. With the aim of improving Vietnam\u2019s national ART program, we conducted an outcome evaluation of the first five years of the program in this concentrated HIV epidemic where the majority of persons enrolled in HIV care and treatment services are people who inject drugs (PWID). The results of this evaluation may have relevance for other national ART programs with significant PWID populations.DesignRetrospective cohort analysis of patients at 30 clinics randomly selected with probability proportional to size among 120 clinics with at least 50 patients on ART.MethodsCharts of patients whose ART initiation was at least 6 months prior to the study date were abstracted. Depending on clinic size, either all charts or a random sample of 300 charts were selected. Analyses were limited to treatment-na\uefve patients. Multiple imputations were used for missing data.ResultsOf 7,587 patient charts sampled, 6,875 were those of treatment-na\uefve patients (74.4% male, 95% confidence interval [CI]: 72.4\u201376.5, median age 30, interquartile range [IQR]: 26\u201334, 62.0% reported a history of intravenous drug use, CI: 58.6\u201365.3). Median baseline CD4 cell count was 78 cells/mm3 (IQR: 30\u2013162) and 30.4% (CI: 25.8\u201335.1) of patients were at WHO stage IV. The majority of patients started d4T/3TC/NVP (74.3%) or d4T/3TC/EFV (18.6%). Retention rates after 6, 12, 24, and 36 months were 88.4% (CI: 86.8\u201389.9), 84.0% (CI: 81.8\u201386.0), 78.8% (CI: 75.7\u201381.6), and 74.6% (CI: 69.6\u201379.0). Median CD4 cell count gains after 6, 12, 24, and 36 months were 94 (IQR: 45\u2013153), 142 (IQR: 78\u2013217), 213 (IQR: 120\u2013329), and 254 (IQR: 135\u2013391) cells/mm3. Patients who were PWID showed significantly poorer retention.ConclusionsThe study showed good retention and immunological response to ART among a predominantly PWID group of patients despite advanced HIV infections at baseline.2013D43 TW001042/TW/FIC NIH HHS/United States1U2GPS000747/PHS HHS/United StatesD43 TW01042/TW/FIC NIH HHS/United StatesPEPFAR/United States23457477PMC35740161056
Healthcare capacity strengthening in conflict settings through virtual emergency medical training and outreach: Ukraine and Sudan case studies
Get PDFThe use of digital learning in healthcare is expanding in a range of contexts including for settings of armed conflict. Humanitarian emergencies and war often lead to a surge of traumatic injuries, emotional distress, and disruption to health systems risking neglect and exacerbations of chronic illness, and acute infectious disease outbreaks, often requiring an international response. On the ground humanitarian response is often essential though logistical and security challenges can delay these responses, and the reliance on an international workforce unfamiliar with local cultures can create challenges in response efforts. In crises where local healthcare workers have limited training, or experience in emergency care, digital health care education can augment in-person response and training efforts. In recent years digital emergency care education programs have been deployed to both Ukraine and Sudan. A review of each of these programs demonstrates successes in and potential utility of remote healthcare capacity strengthening through digital education in settings of war. These programs provide important lessons in strengths of and challenges in developing and delivering just in time learning programs to settings of active armed conflict suggesting similar potential utility in a variety of humanitarian emergency contexts
Project extension for community healthcare outcomes improves care and treatment for multidrug-resistant tuberculosis patients in Tanzania
No full textBackground: Project Extension for Community Healthcare Outcomes (Project ECHO) is a telementoring, case based virtual community of practice training and education model connecting experts to primary care clinicians (PCCs). Project ECHO has good evidence for favorable treatment outcomes on wide range of diseases. Since 2017, Tanzania hosts multidrug resistant tuberculosis (MDR TB) ECHO with hub at Kibong\u27oto Infectious Diseases Hospital. However, little is known on outcomes of MDR TB ECHO. This study aimed to describe the outcomes of MDR TB ECHO in managing MDR TB patients in Tanzania. Methods: Review of case studies was conducted at MDR TB ECHO hub in Tanzania. Up to June 2020, a total of 134 sessions and 60 patient cases were presented in MDR TB ECHO. This article describes outcomes of MDR TB ECHO in managing three selected complicated MDR TB patient cases presented. Case 1: Child with MDR TB, neck abscess, and anemia secondary to chronic illness. Case 2: Adult with MDR TB and end stage renal disease co morbidity. Case 3: Adult failing standard MDR TB treatment. Results: Anemia resolved in Case 1; surgical dressing was done to neck abscess and neck healed. Case 2 was initiated with end stage renal disease management; uremic encephalopathy and lower limb edema resolved. Case 3 was initiated with individualized MDR TB treatment. All three patients attained smear and culture conversion and continue with MDR TB treatment. Conclusions: To our knowledge, this is the first report on effectiveness of project ECHO in supporting PCCs in bringing favorable treatment outcomes to MDR TB patients. We advocate adaptation and scale up of ECHO model as an effective approach for strengthening management of MDR TB and other infectious diseases
Outcomes of antiretroviral therapy in Vietnam: results from a national evaluation.
No full textVietnam has significantly scaled up its national antiretroviral therapy (ART) program since 2005. With the aim of improving Vietnam's national ART program, we conducted an outcome evaluation of the first five years of the program in this concentrated HIV epidemic where the majority of persons enrolled in HIV care and treatment services are people who inject drugs (PWID). The results of this evaluation may have relevance for other national ART programs with significant PWID populations.Retrospective cohort analysis of patients at 30 clinics randomly selected with probability proportional to size among 120 clinics with at least 50 patients on ART.Charts of patients whose ART initiation was at least 6 months prior to the study date were abstracted. Depending on clinic size, either all charts or a random sample of 300 charts were selected. Analyses were limited to treatment-naïve patients. Multiple imputations were used for missing data.Of 7,587 patient charts sampled, 6,875 were those of treatment-naïve patients (74.4% male, 95% confidence interval [CI]: 72.4-76.5, median age 30, interquartile range [IQR]: 26-34, 62.0% reported a history of intravenous drug use, CI: 58.6-65.3). Median baseline CD4 cell count was 78 cells/mm(3) (IQR: 30-162) and 30.4% (CI: 25.8-35.1) of patients were at WHO stage IV. The majority of patients started d4T/3TC/NVP (74.3%) or d4T/3TC/EFV (18.6%). Retention rates after 6, 12, 24, and 36 months were 88.4% (CI: 86.8-89.9), 84.0% (CI: 81.8-86.0), 78.8% (CI: 75.7-81.6), and 74.6% (CI: 69.6-79.0). Median CD4 cell count gains after 6, 12, 24, and 36 months were 94 (IQR: 45-153), 142 (IQR: 78-217), 213 (IQR: 120-329), and 254 (IQR: 135-391) cells/mm(3). Patients who were PWID showed significantly poorer retention.The study showed good retention and immunological response to ART among a predominantly PWID group of patients despite advanced HIV infections at baseline
Abstracts of Tanzania Health Summit 2020
Get PDFThis book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future.
Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25–26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS)
