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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Date
2023-01-11
Authors
Journal Title
Journal ISSN
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Publisher
Kamuzu University of Health Sciences
Abstract
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.
Description
Keywords
ART initiation