Characteristics and outcomes of HIV Patients starting ART in the era of routine screening for advanced HIV Disease at Lighthouse Trust, Lilongwe

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Kamuzu University of Health Sciences
Type of Research Study This is a retrospective cohort study that will focus on exploring the characteristics and outcomes of HIV patients starting ART in the era of routine screening for advanced HIV diseases at Lighthouse Trust, Malawi. Problem statement The department of HIV/AIDS in Malawi implemented the Advanced HIV Disease (AHD) package of care in 2018 to reduce deaths in People living with HIV (PLHIV). AHD laboratory screening for tuberculosis and cryptococcal infection using CD4 count of ≤200 cells/ul as a cut-off point was since enforced on every newly HIV diagnosed client before starting ART. However, it has been observed that despite the implementation of the AHD package, there is limited data in Malawi on the proportion of people initiated on ART with AHD and their specification on age segregation. Subsequently, the effect of CD4 screening and testing for opportunistic infections on antiretroviral Treatment (ART) outcomes has not been well described in Malawi. This study will address the knowledge gap on distribution of AHD in people newly diagnosed with HIV will help program implementors introduce approaches to reduce the prevalence of AHD in the general HIV population of PLHIV. Objectives The broad objective of the study is to describe the epidemiology of clients diagnosed with AHD in the Era of Routine advanced HIV disease screening at Lighthouse Clinic- Lilongwe. The specific objectives are: i. To estimate the proportion of people with CD4 count of ≤200 cells/ul. ii. To determine the demographic characteristics of people starting ART with CD4 count of ≤200 cells/ul. iii. To assess the ART outcomes of clients diagnosed with AHD conditions at ART initiation. Methodology This is a quantitative study of retrospective cohort design which will be conducted at Lighthouse Trust, Lilongwe. The study population will include all HIV newly diagnosed patients started ART at Lighthouse Trust from October 2020 to September 2021, with a CD4 count result before initiation. A suitable anonymized purposive sample of one-year initiations will be selected from the Electronic Medical Records System (EMRS) and all study records meeting the inclusion criteria. Secondary data will be collected from laboratory equipment, registers and the lighthouse electronic medical record keeping system, which will be entered in a tailored data collection tool (appendix A). Data will be analyzed through regression analysis. Expected Findings The study expects to find the proportion of people starting ART with AHD using CD4 count as a marker as well as WHO HIV clinical staging. It will assess the characteristics of individuals presenting with AHD at initiation and their clinical outcomes over a year. For instance, it is anticipated that males of older age groups (above 50 years) have higher risk of developing AHD due to their poor health seeking behaviors. Patients who started ART with existing AHD are expected to have poorer clinical outcomes; weight loss, elevated HIV Viral Load copies at 6 months, and higher mortality rates than their counterparts with higher CD4 count. Dissemination of results Presentation of the outcomes shall be in tables, charts, and graphs, the research findings will be presented to College of Medicine Research ethics Committee (COMREC) as well as Lighthouse Trust clinic.
ART initiation