Follow-up of HIV-infected women diagnosed by antenatal screening in Barbados from 1996-2004.

A follow-up study was undertaken to analyze the impact of the early diagnosis of HIV in women by antenatal voluntary counseling and testing (VCT) by way of making a difference to their health status and the social behavior of these women. This is a descriptive study. The study population included all HIV-infected women in this country who were diagnosed to be HIV infected by way of VCT during 1996-2004. Sixty-one (37.4%) never attended the HIV clinic for their care or treatment. The median delay between the time of diagnosis of HIV infection and the time of their presentation to the follow-up clinic was 36 months. Of the 79 women who reported to have been sexually active only 33 had a steady partner; 54 had had one or more casual sex partners at some point in time since their HIV diagnosis. One third never used condoms with their steady partner and one sixth never used condoms with casual partners. Overall, 89 women had one or more repeated pregnancy, mostly from different partners. In conclusion, many of the women diagnosed from antenatal VCT fail to utilize the available health care facilities and continue to engage in risk-taking behaviors.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6%) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4%) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4%) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004 / Utilización de los servicios de atención sanitaria y estado de salud de las mujeres seropositivas al VIH diagnosticadas mediante el tamizaje prenatal para el VIH en Barbados, 1996-2004

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6 percent) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4 percent) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4 percent) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

OBJETIVOS: Estudiar la utilización de los servicios de atención sanitaria relacionados con el VIH y describir el estado de salud de las mujeres infectadas con este virus, diagnosticadas mediante el asesoramiento y la prueba de detección del VIH de carácter voluntario (APDV) durante el período prenatal en Barbados. MÉTODOS: Este es un estudio descriptivo. La población de estudio abarcó a todas las mujeres infectadas por el VIH, diagnosticadas en Barbados mediante el APDV en 1996-2004. RESULTADOS: La mediana de la duración de la infección por el VIH -desde el diagnóstico hasta el momento de este informe- en las 163 mujeres diagnosticadas durante el período de estudio fue de 72 meses (nivel bajo: 9 meses; nivel alto: 117 meses). De las 163 mujeres, 102 (62,6 por ciento) asistieron a la clínica centralizada para el VIH/sida para su seguimiento (atención, tratamiento y monitoreo), mientras que 61 (37,4 por ciento) nunca asistieron a la clínica. La mediana del lapso entre el diagnóstico de la infección por el VIH y la primera presentación a la clínica para el VIH/sida fue de 36 meses (nivel bajo: 1 mes; nivel alto: 114 meses). Más de la cuarta parte de las mujeres infectadas que acudieron a la clínica presentaban inmunodeficiencia grave en el momento de su primera consulta de seguimiento. De las 53 mujeres que se sometieron al tratamiento antirretroviral de gran actividad (HAART) durante el estudio, 23 (43,4 por ciento) comenzaron el tratamiento en los tres meses siguientes a su primera visita de seguimiento. CONCLUSIONES: El diagnóstico temprano mediante el APDV no garantiza que las mujeres con VIH reciban una atención adecuada y oportuna para tratar esa infección. Estas mujeres sufren una mortalidad significativamente prematura, en gran parte debido al inadecuado seguimiento.

Profile of Hospitalized HIV-Infected Persons in the Highly Active Antiretroviral Therapy Era in Barbados.

OBJECTIVES: To investigate the reasons for hospitalization and its outcome in the era of highly active antiretroviral therapy (HAART) in Barbados. This report also describes the profiles of the HIV-infected persons who were hospitalized in the HAART era. METHODS: The authors examined the admission case notes to conduct an observational, retrospective study of all HIV-infected patients admitted to the Queen Elizabeth Hospital (QEH) during September 1, 2004, through March 31, 2005. Data collected included patients' profile, including the date of diagnosis of HIV infection. Outcome of the current admission in terms of discharge or death and the final diagnosis at the time of discharge or death was noted. RESULTS: Over the 6-month period, there were 160 adult admissions to the QEH where HIV/AIDS was at least one of the final diagnoses. Eighty-four (52.5%) admissions were in persons who were known to be HIV infected prior to the current admission, where a diagnosis of HIV infection was made for the first time during the current hospitalization in the remaining 76 (47.5%) cases. Nearly two thirds of those hospitalized and who had a CD4 count done had CD4 counts of < 200. Overall, opportunistic infection was the most common (38.1%), at discharge or as a final diagnosis, followed by serious bacterial infections, anemia, and HIV nephropathy. The outcome of these admissions was death in 30 (18.7%) cases, whereas the patient was discharged in the remaining 130 (81.3%) cases. CONCLUSIONS: A significant proportion of the hospitalized HIV-infected persons in the HAART era is newly diagnosed. The majority of those hospitalized had severe immunodeficiency, and consequently opportunistic infection was the most common final diagnosis.

Trends in the HIV related hospital admissions in the HAART era in Barbados, 2004-2006.

BACKGROUND: To investigate the reasons for hospitalizations and its outcome in the era of HAART in Barbados. This report also describes the profile of the HIV infected persons who are hospitalized in the HAART era. METHODS: This is a retrospective study of HIV related admissions in this country. We examined the admission case notes of all the adult admissions to the Queen Elizabeth Hospital where one of the discharge diagnosis was HIV infection during the April 2004 through March 2006. Data collected included patients' profile, including the date of diagnosis of HIV infection, outcome of the current admission in term of discharge or death and the final diagnosis at the time of discharge or death. RESULTS: Over the 24 months period there were 431 adult admissions to the medical wards of the Queen Elizabeth Hospital where one of the discharge diagnosis was HIV infection and this accounted for 5.9% of all medical admissions. 258(60%) admissions were in persons who were known to be HIV infected prior to the current admission, where as diagnosis of HIV infection was made for the first time during the current admission in case of remaining 76(47.5%) cases. Nearly half of those hospitalized, had a CD 4 cell counts of < 200/microL. Over all, opportunistic infection was the commonest (35%) discharge diagnosis, followed by serious bacterial infections, anemia and HIV nephropathy. The outcome of these admissions was death in 30 (14.2%) cases where as patient was discharged out in the remaining 181 (85.8%) cases. Of the medical admissions with HIV as one of the discharge diagnosis during the period April 04 through March 05, 43% were newly diagnosed HIV infection and the corresponding figure for the period April 05 through March 06 was 35% (P = 0.54). During the April 05 through March 04 significantly higher proportion of HIV infected adults had Anemia with a Hemoglobin less than 10 g/dL (P = 0.044), HIV related nephropathy (P = 0.0003), HAART toxicity (P = < 0.0001) and a Non-AIDS related conditions (P = 0.043) as one of the final discharge diagnosis. CONCLUSION: A significant proportion of patients admitted with HIV infection were the newly diagnosed and severely immuno-suppressed. An opportunistic infection continues to be the commonest discharge diagnosis, although there was a growing trend in the proportion of the discharge diagnosis being HAART toxicity and Non-AIDS related conditions. Over all hospitalization of HIV infected persons still carries a significant risk of mortality.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004.

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6%) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4%) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4%) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

Changing HIV infection-related mortality rate and causes of death among persons with HIV infection before and after the introduction of highly active antiretroviral therapy: analysis of all HIV-related deaths in Barbados, 1997-2005.

OBJECTIVES: To compare the trends in death rates and the causes of deaths before and after the introduction of highly active antiretroviral therapy. METHODS: This is a retrospective study based on chart review of all HIV-related deaths between January 1997 and December 2005. RESULTS: The HIV-specific death rate declined from 34.12 per 100,000 adult population during 1997-1999 to 17.21 per 100,000 adult population during 2003-2005 when highly active anti-retroviral therapy was available. The proportion of all HIV-related deaths among persons newly diagnosed with HIV during the terminal hospitalization decreased from 93% during 1997-1999 to 28% during 2003-2005. Opportunistic infection was at least one of the causes of death in nearly half of all cases. CONCLUSIONS: Although, the HIV-specific death rates have declined significantly since the introduction of highly active antiretroviral therapy, HIV infection continues to contribute to the premature deaths among adults, mainly because of the late presentation.

CD4 cell counts in adults with newly diagnosed HIV infection in Barbados

OBJETIVO: Evaluar los recuentos de células CD4 de toda persona con un diagnóstico reciente de infección por VIH que acudió a la Unidad de Remisión Ladymeade (URL), que es el centro nacional de Barbados para la remisión y el tratamiento de casos de infección por VIH y sida. MÉTODOS: El grupo de estudio se compuso de adultos con infección por VIH en quienes el diagnóstico y la remisión a la URL se habían hecho entre enero y diciembre de 2002. A todos los pacientes remitidos a la URL se les había efectuado un recuento de células CD4 en su primera consulta a la unidad como parte de la serie habitual de pruebas realizadas para determinar en qué estado se encontraba la enfermedad y si había necesidad de administrar antirretrovíricos. RESULTADOS: De los 106 adultos con un diagnóstico reciente, 62 (58,5%) eran varones y tenían una edad mediana de 40 años cuando enfermaron; los otros 44 (41,5%) eran mujeres y tenían una edad mediana de 36 años al enfermar. Casi una quinta parte (18,2%) de las mujeres se encontraban entre los 16 y 25 años de edad, mientras que solamente 8,1% de los varones pertenecían a ese grupo etario. A la mayoría (57,6%) de las personas en el grupo de estudio se les hizo el diagnóstico cuando consultaron por trastornos asociados con la infección por VIH o el sida. En general, el recuento mediano de células CD4 cuando se hizo el diagnóstico fue de 183/µL; 52 de 103 adultos (50,5%) con un diagnóstico reciente de infección por VIH tenían un recuento de células CD4 < 200/µL. En los varones, el recuento mediano de células CD4 fue de 161/µL, y 32 de 60 varones (53,3%)...

CD4 cell counts in adults with newly diagnosed HIV infection in Barbados.

OBJECTIVE: To evaluate the absolute CD4 cell counts of all the newly diagnosed HIV-infected persons who presented at the Ladymeade Reference Unit (LRU), which serves as the national HIV/AIDS referral and treatment center for the country of Barbados. DESIGN AND METHODS: The study group was comprised of HIV-infected adults who had been diagnosed with HIV infection and referred to the LRU between January and December 2002. All the patients referred to the LRU had a CD4 cell count done at their first visit to the unit, as part of the routine workup to assess their disease status and need for antiretroviral therapy. RESULTS: Of the 106 newly diagnosed adults, 62 of them (58.5%) were males, who had a median age at presentation of 40 years; the other 44 of them (41.5%) were females, and their median age at presentation was 36 years. Nearly one-fifth (18.2%) of the females were aged 16-25 years, whereas only 8.1% of the males were in this age group. The majority (57.6%) of the study group were diagnosed because they presented with an HIV/AIDS-related illness. Overall, the median CD4 cell count at the time of diagnosis was 183/microL; 52 of 103 adults (50.5%) with a newly diagnosed HIV infection had a CD4 cell count that was < 200. Among males, the median CD4 cell count was 161/microL, and 32 (53.3%) of 60 males had CD4 cell counts < 200. In contrast, among females, the median CD4 cell count was 223, and 20 (46.5%) of 43 females had a CD4 cell count that was < 200/microL. However, this difference in the proportion of males and females with a CD4 cell count less than 200/microL was not statistically significant (P = 0.63). CONCLUSIONS: At the time of HIV diagnosis, over one-half of the adults had an initial CD4 cell count that was consistent with relatively advanced disease. Proportionally more women than men presented at a younger age, and proportionally more women than men presented in the early stages of the disease. These patterns indicate a clear need for enhanced educational efforts regarding the importance of HIV testing for at-risk individuals across Barbados. This testing could improve efforts to reduce transmission as well as the prognosis for patients who receive antiretroviral therapy.