Original Research

Late stage presentation of HIV-positive patients to antiretroviral outpatient clinic in Zambia

Timothy Martin, Morgan Mweene
Southern African Journal of HIV Medicine | Vol 18, No 1 | a717 | DOI: https://doi.org/10.4102/sajhivmed.v18i1.717 | © 2017 Timothy Martin, Morgan Mweene | This work is licensed under CC Attribution 4.0
Submitted: 09 January 2017 | Published: 30 November 2017

About the author(s)

Timothy Martin, The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom
Morgan Mweene, Zambia Medical Association, Lusaka, Zambia; Zambia College of Physicians, Zambia; East Central and Southern Africa College of Physicians, Zambia; International Society of Nephrology, Brussels, Belgium

Abstract

Background: The World Health Organization (WHO) and the Zambian Ministry of Health set out new guidelines on combination antiretroviral therapy (cART) in 2013 expanding the eligibility criteria for patients with HIV.

Objectives: The primary objective were to determine when cART was initiated in HIV-positive outpatients according to clinical and immunological criteria, and to identify what proportion of patients who were eligible for cART according to 2013 WHO and 2013 Zambian cART guidelines were currently on cART.

Methodology: This was a clinical audit of HIV-positive outpatients attending the cART clinic at Ndola Central Hospital in Ndola, Zambia, with retrospective cross-sectional chart review and survey design. Data were collected from clinical records and interviews with patients.

Results: A total of 99% of patients eligible for cART according to 2013 guidelines were on treatment. Clinical staging of patients at initiated on cART (n = 206) was as follows: 28% clinical stage I, 21% clinical stage II, 36% clinical stage III and 15% clinical stage IV. The median CD4 count when patients were started on cART was 147 cells/mm3 .

Conclusion: The results show that a majority of patients were initiated on cART late in their disease course according to immunological (CD4 < 200 cell/mm3 ) and clinical criteria (stage III or IV). However, the vast majority of patients eligible for cART were currently on treatment. The late initiation of cART appears to be a result of late diagnosis of HIV.


Keywords

HIV; AIDS; cART; combination antiretroviral therapy; clinical audit; WHO cART guidelines; Zambian ministry of health cART guidelines

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Crossref Citations

1. Concurrent advanced HIV disease and viral load suppression in a high-burden setting: Findings from the 2015–6 ZIMPHIA survey
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