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Archives of Disease in Childhood ; 107(Supplement 2):A65-A66, 2022.
Article in English | EMBASE | ID: covidwho-2064017


Aims By necessity, our trust was unable to complete gold standard ADOS (Autism Diagnostic Observation Schedule) assessments as part of the ASD diagnostic pathway during the Coronavirus pandemic. We, therefore, implemented the BOSA as a stop-gap. This retrospective audit compares the need for further assessments and the outcomes from BOSA assessments against those achieved by our unit when the 'gold standard' ADOS was in use. Our audit standard was to achieve equivalent results pre- and during the pandemic. Methods Data from a random sample of 120 children who completed an ADOS assessment August - December 2019 was compared with data from a random sample of 118 children who completed a BOSA August 2020 - January 2021. Statistical analysis was performed using the 2 tailed Fisher's exact test. Results In school age children, further assessment was significantly more likely to be required when a BOSA assessment was used (25.6% vs. 8.9%, p=0.01). There was a less significant difference between the need for further assessment in the pre-school age group between the ADSO and BOSA groups (14.3% vs. 0%, p=0.048). In this audit, the wait time for a BOSA assessment was 372 days vs. for an ADOS assessment 278 days. However, due to the complex disruption caused by the pandemic, any difference in pathway duration could not meaningfully be evaluated by this audit. An additional ADOS was needed in 14.3% of cases undergoing the BOSA assessment. This will have affected the duration of the assessment process due to delays in arranging and completing further assessments. Children were slightly more likely to receive a positive autism diagnosis using the BOSA. However, this was not statistically significant (p=0.31 for school age, p= 1.0 for preschool age). Conclusion The BOSA assessment seems to be effective when used with pre-school children, with a minimally significant difference in rates of children requiring further assessment and no significant difference in final diagnosis rates. BOSA assessment appears to be less useful in school age children - with a greater proportion then requiring a subsequent ADOS assessment, but, again, with no significant difference in final diagnosis rates. This audit supports the recommendation that the BOSA assessment is not intended to be used long-term or to replace the ADOS, which remains the gold standard assessment. However, in the context of a pandemic, where ADOS assessments were not possible, the BOSA assessment allowed 86% of preschool age and 74% of school age children to receive a confirmed diagnosis (positive or negative), using an assessment method whose diagnosis rates were similar to the ADOS assessment.

Topics in Antiviral Medicine ; 30(1 SUPPL):326, 2022.
Article in English | EMBASE | ID: covidwho-1880585


Background: The 2013 WHO antiretroviral guidelines recommended routine testing of HIV viral load (VL) (concentration of HIV RNA copies/mL of blood) as the preferred method for monitoring treatment in people living with HIV (PLHIV). The 2020 UNAIDS targets proposed that all PLHIV receiving antiretroviral therapy (ART) have access to HIV viral load testing (VLT) as part of public health programs aiming to reduce HIV transmission. In limited-resource countries, PLHIV are facing various challenges to VLT access, and some might be associated with health-related facility factors. Methods: To identify characteristics of facilities associated with low VLT coverage (VLTC)), we analyzed data reported to the Monitoring, Evaluation, and Reporting (MER) System by 17 PEPFAR-supported sub-Saharan African countries in 2019 and 2020. We used ordinal logistic regression model accounting for clustering with assumption of random effect model on facility. Outcome variable was VLTC (proportion of the number of PLHIV with a VL in the medical record or laboratory record/laboratory information system within the past 12 months divided by the number of PLHIV receiving ART six months earlier) categorized as Low (< 70%), Medium (70% to < 90%), and High (>= 90%). Independent variables were region (Eastern, Southern, Western/Central Africa), age (0-9, 10-19, 20-29, 30-39, 40-49, 50+ years), sex (male, female), and volume (low volume: <100 PLHIV on ART vs. high volume: >=100 PLHIV on ART) by facility. Results: The odds of VLTC were higher in the Southern region (adjusted odds ratio [AOR] = 1.95;95% CI 1.92, 1.97) and lower in the Western/Central region (AOR = 0.86;95% CI 0.85, 0.88) as compared with Eastern region. The AOR for VLTC was lower for high volume as compared with low volume facilities (AOR = 0.69;95% CI 0.67, 0.70). The year 2020 had a lower AOR for VLTC (AOR = 0.98;95% CI 0.97, 0.99) than 2019. Males had an AOR for VLTC of 1.00 compared with females, and as age increased so did AOR for VLTC (AOR = 1.02;95% CI 1.02, 1.02). Conclusion: Gaps in HIV VL testing coverage have increased since 2019, potentially due to the COVID-19 pandemic. Regional gaps were seen in Western/Central Africa and with increased facility volume. Potential gaps might be seen in younger PLHIV. Identifying barriers to scale-up of HIV VL monitoring in facilities with low volume to develop and implement effective public health strategies could help to improve PLHIV outcomes and accelerate progress toward HIV epidemic control in these regions.

Canadian Journal of Learning and Technology ; 47(4), 2021.
Article in English, French | Scopus | ID: covidwho-1498212