RESUMO
Résumé:l'utilisation des antirétroviraux (ARV) à grande échelle aux personnes vivant avec le VIH (PVVIH) s'accompagne d'un développement de résistance au VIH (R-ARV). Nous avons déterminé la performance de trois indicateurs d'alerte précoce (IAP) associés à un risque élevé d'émergence de R-ARV au Burkina Faso à travers une étude transversale répétée entre 2014 et 2017. Nous avons analysé l'évolution des IAP de l'émergence de R-ARVau cours de cette période. Il s'agissait de l'IAP1 (Retrait des ARV dans les délais),l'IAP2 (Rétention sous traitement ARV «TARV¼ à 12 mois) et de l'IAP4 (pratiques de prescription des ARV).Au total, 27 sites ont été évalués. La médiane des patients qui ont retiré le TARV dans les délais était respectivement de 61% en 2015, 60% en 2016 et à 58% en 2017. Aucun site n Ìa atteint le seuil d'au moins 95% dans les cohortes de 2014 et 2015. Les médianes de la rétention sous TARV à 12 mois pour les cohortes de 2014, 2015 et 2016 ont été de 70%, 69% et 65% respectivement. Le seuil de rétention dans le TARV à 12 mois d'au moins 85% n'a été atteint que dans deux sites. Même si la prescription des ARV est conforme aux directives nationales, la qualité des soins offerts aux PVVIH a régressé de 2014 à 2017 avec un risque élevé d'émergence de R-ARV. Pour minimiser ce risque, l'éducation thérapeutique des patients et le système de recherche des perdus de vue doivent être renforcés.
The widespread use of antiretrovirals (ARVs) to people living with HIV (PLHIV) is accompanied by the development of HIV resistance (R-ARV). We determined the performance of three early warning indicators (EWIs) associated with a high risk of R-ARV emergence in Burkina Faso through a repeated cross-sectional study between 2014 and 2017. We analyzed the evolution of the DPIs of R-ARV emergence over this period. These were DPI1 (Timely withdrawal of ARVs), DPI2 (Retention on ARV treatment "TARV" at 12 months) and DPI4 (ARV prescription practices). A total of 27 sites were evaluated. The median number of patients who withdrew ART on time changed from 61% in 2015, 60% in 2016 and 58% in 2017, respectively. No site reached the threshold of at least 95% in the 2014and 2015 cohorts. The medians of retention on ART at 12 months for the 2014, 2015 and 2016 cohorts were 70%, 69% and 65% respectively. The 12-month ART retention threshold of at least 85% was only reached at two sites. Although ARV prescribing is in line with national guidelines, the quality of care offered to PLHIV regressed from 2014 to 2017 with a high risk of R-ARV emergence. To minimize this risk, therapeutic patient education and the system for tracking lost patients need to be strengthened.
Assuntos
Terapêutica , Infecções por HIV , Farmacorresistência Viral , AntirretroviraisRESUMO
With the rapid scale-up in use of antiretroviral therapy (ART), monitoring the quality of care and factors that may lead to emergence of HIV drug resistance (HIVDR) is an important focus point for programme managers. The National AIDS Control Organisation of India embarked on strengthening the ART programme for continuous quality improvement (CQI), using defined quality-of-care indicators (QCIs), including World Health Organization (WHO) early-warning indicators (EWIs) for HIVDR. In this feasibility study, done during July 2014, an integrated QCI and EWI tool developed by WHO India was pilot tested across 18 purposively selected ART centres. At seven ART centres, the EWI 1 target of >90% on-time pill pick-up was achieved for adult patients, while among the paediatric age group (<15 years old) it was not achieved by any centre. EWI 2 (retention of patients in ART care at 12 months after initiation) showed that two centres had retention of both adult and paediatric patients of >85% at 12 months of ART, while 11 centres had retention between 75% and 85%. EWI 3 (pharmacy stock-out) for adult and paediatric patients showed that 11 ART centres reported a minimum of one stock-out for the first-line ART drugs in the reporting period, while EWI 4 targets (pharmacy dispensing practices) were achieved by all the centres, for both adults and children. Average retention in care at 6, 12 and 24 months after ART initiation was 82%, 77% and 71%, respectively. This feasibility study showed that EWI analyses were much simpler to conduct if information was sought only for patients receiving ART, for whom the quality of record-keeping is better and more consistent. The activity has highlighted the need for improved quality of recordkeeping at the facilities and implementation of specific interventions to ensure better patient follow-up. After modifications, use of the tool will be phased in across all the ART centres in India.
RESUMO
Background: India has rapidly scaled up its programme for antiretroviral therapy (ART). There is high potential for the emergence of HIV drug resistance (HIVDR), with an increasing number of patients on ART. It is not feasible to perform testing for HIVDR using laboratory genotyping, owing to economic constraints. This study piloted World Health Organization (WHO) early-warning indicators (EWIs) for HIVDR, and quality-of-care indicators (QCIs), in four ART clinics in Pune city. Methods: A retrospective study was conducted in 2015, among four ART clinics in Pune city, India. The data on four standardized EWIs (EWI 1: On-time pill pickup, EWI 2: Retention of patients in ART care at 12 months after initiation, EWI 3: Pharmacy stock-out, EWI 4: Pharmacy dispensing practices) and three QCIs (QCI 1: Regularity in CD4 testing in patients taking ART, QCI 2: Percentage of patients initiating ART within 30 days of medical eligibility, QCI 3: Percentage of patients initiating ART within 30 days of initiation of anti-tuberculosis therapy) were abstracted into WHO Excel HIV data abstractor tools, from the patient records from April 2013 to March 2014. Results: All four ART clinics met the EWI 4 target (100%) for ART dispensing practices. The target for EWIs on-time pill-pick (EWI 1 >90%) and pharmacy stockouts (EWI 3: no stock-outs, 100%) were achieved in one clinic. None of the clinics met the EWI 2 target for retention in care at 12 months (>90%) and the overall retention was 76% (95% confidence interval: 73% to 79%). The targets for QCI 1 and QCI 2 (>90% each) were achieved in one and two clinics respectively. None of the clinics achieved the target for QCI 3 (>90%). Conclusion: ART dispensing practices (EWI 4) were excellent in all clinics. Efforts are required to strengthen retention in care and timely pill pick-up and ensure continuity of clinic-level drug supply among the programme clinics in Pune city. The clinics should focus on regularity in testing CD4 count and timely initiation of ART.
RESUMO
Up to present,the research of the early-warning system for the risk of the medical quality has been carried out both at home and abroad.The majority of these researches aimed at providing theoretical guidance for the scientific decision-making of local health departments.In order to construct quality of medical care evaluation indicators system.On the bases of intelligence research,drawing on a series of internationally recognized quality of medical care evaluation system.The majority of these researches aimed at providing theoretical guidance for the scientific decision-making of local health departments.However,the hospital-related research is very limited.Therefore,hospitals were selected as objects in this study.33 experts from 6 three"A" hospitals were selected.And by using a series of internationally recognized quality health care system as a source of reference and focusing on process control and standardizing of management,the early-warning system for the risk of the medical quality has been constructed based on the combination of theory and practice.At the same time,Delphi method was used to verify the results repeatedly to form a set of early-warning system for the risk of the medical quality which is objective,scientific and approved by experts.