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Zhu Z, Yang F, Wang L, Zhao R. Non-pharmacological fever management for persons living with HIV: a best practice implementation project. ACTA ACUST UNITED AC 2019. [PMID: 29521873 DOI: 10.11124/jbisrir-2017-003347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of this evidence implementation project was to integrate the best available evidence on non-pharmacological fever and febrile symptom management into nursing practice at the Shanghai Public Health Clinical Centre, China. INTRODUCTION Fever is challenging for patients with the human immunodeficiency virus (HIV). Guidelines assert that successful non-pharmacological fever management should be the standard of care. To introduce evidence into clinical practice, the Department of Infectious Disease of the Shanghai Public Health Clinical Centre implemented a best practice project. METHODS This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool. Seven audit criteria were established on the best available evidence. The project was divided into three phases and conducted over five months. RESULTS Follow-up audits showed significant improvements. The most significant improvements in compliance occurred in the assessment of suitability of external cooling methods (100%), education for nurses (100%) and patients (100%), and monitoring (93%). A moderate increase was noted in the assessment of fluid intake and output volume (73%). A small increase of 30% in compliance was found in hydration support. No changes in compliance were found in assessment of the cause of fever in the HIV-positive population. CONCLUSIONS This project led to various changes in the unit including a formal assessment of intake and output volume for PLWHs with chronic fever, a formal assessment of some factors related to the "cause of fever", tailored education programs and materials for both nurses and patients. All these changes are now part of routine nursing practice. Further audits will need to be carried out to sustain practice behavior change and monitor areas for further improvements.
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Affiliation(s)
- Zheng Zhu
- School of Nursing, Fudan University, Shanghai, P.R. China.,Fudan University Centre for Evidence-Based Nursing: a Joanna Briggs Institute Centre of Excellence, Shanghai, P.R. China
| | - Fengdan Yang
- The Shanghai Public Health Clinical Centre, Shanghai, P.R. China
| | - Lin Wang
- The Shanghai Public Health Clinical Centre, Shanghai, P.R. China
| | - Rui Zhao
- School of Nursing, Fudan University, Shanghai, P.R. China.,Fudan University Centre for Evidence-Based Nursing: a Joanna Briggs Institute Centre of Excellence, Shanghai, P.R. China
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Moon TD, Johnson M, Foster MA, Silva WP, Buene M, Valverde E, Morais L, Williams JV, Vermund SH, Brentlinger PE. Identification of Invasive Salmonella Enterica Serovar Typhimurium ST313 in Ambulatory HIV-Infected Adults in Mozambique. J Glob Infect Dis 2016; 7:139-42. [PMID: 26751031 PMCID: PMC4693304 DOI: 10.4103/0974-777x.170496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Despite evidence describing the burden of invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, iNTS is not recognized as a priority within global health policy institutions. Recently, Salmonella enterica serovar Typhimurium, sequence type (ST) 313, has been identified as the predominant cause of iNTS disease in multiple sub-Saharan African countries. Materials and Methods: We conducted multilocus sequence typing (MLST) to determine the prevalence of the ST313 genotype in a sample of blood isolates from ambulatory HIV-infected Mozambican adults with iNTS disease. Results: Of the 29 samples of NTS obtained and analyzed by MLST, all (29/29) were assigned the ST313 sequence type based on the set of allele types derived from each of the seven loci. For quality control, five randomly selected strains taken from the original cultures were confirmed as ST313, and the positive control strain SL3261 (taken from the original culture) was categorized as S. Typhimurium ST19. Conclusion: S. Typhimurium ST313 is an important example of a widely distributed pathogen that lacks a coordinated strategy for control. The highly vulnerable populations at risk for ST313 infection in Mozambique, and within the region, would benefit greatly from the development of new policy and on-the-ground capacity to support increased surveillance, prevention, and treatment initiatives.
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Affiliation(s)
- Troy D Moon
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville; Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical School, Nashville, Tennessee, United States; Friends in Global Health, Maputo, Mozambique
| | - Monika Johnson
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical School, Nashville, Tennessee, United States
| | - Monique A Foster
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical School, Nashville, Tennessee, United States
| | - Wilson P Silva
- Friends in Global Health, Maputo, Mozambique; Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, United States
| | | | - Emilio Valverde
- Friends in Global Health, Maputo, Mozambique; Department of Health Policy, Vanderbilt University Medical School, Nashville, Tennessee, United States
| | - Luís Morais
- Friends in Global Health, Maputo, Mozambique
| | - John V Williams
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical School, Nashville, Tennessee, United States; Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, United States
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville; Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical School, Nashville, Tennessee, United States; Friends in Global Health, Maputo, Mozambique
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Brentlinger PE, Silva WP, Vermund SH, Valverde E, Buene M, Moon TD. Practical Management of HIV-Associated Anemia in Resource-Limited Settings: Prospective Observational Evaluation of a New Mozambican Guideline. AIDS Res Hum Retroviruses 2016; 32:12-25. [PMID: 26178574 DOI: 10.1089/aid.2015.0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Mozambique's updated guideline for management of HIV-associated anemia prompts clinicians to consider opportunistic conditions, adverse drug reactions, and untreated immunosuppression in addition to iron deficiency, intestinal helminthes, and malaria. We prospectively evaluated this guideline in rural Zambézia Province. Likely cause(s) of anemia were determined through prespecified history, physical examination, and laboratory testing. Diagnoses were "etiologic" if laboratory confirmed (sputum microscopy, blood culture, Plasmodium falciparum malaria rapid test) or "syndromic" if not. To assess hemoglobin response, we used serial point-of-care measurements. We studied 324 ambulatory, anemic (hemoglobin <10 g/dl) HIV-infected adults. Study clinicians treated nearly all [315 (97.2%)] for suspected iron deficiency and/or helminthes; 56 (17.3%) had laboratory-confirmed malaria. Other assigned diagnoses included tuberculosis [30 (9.3%)], adverse drug reactions [26 (8.0%)], and bacteremia [13 (4.1%)]. Etiologic diagnosis was achieved in 79 (24.4%). Of 169 (52.2%) subjects who improved (hemoglobin increase of ≥1 g/dl without indications for hospitalization), only 65 (38.5%) received conventional management (iron supplementation, deworming, and/or antimalarials) alone. Thirty (9.3%) died and/or were hospitalized, and 125 (38.6%) were lost to follow-up. Multivariable linear and logistic regression models described better hemoglobin responses and/or outcomes in subjects with higher CD4(+) T-lymphocyte counts, pre-enrollment antiretroviral therapy and/or co-trimoxazole prophylaxis, discontinuation of zidovudine for suspected adverse reaction, and smear-positive tuberculosis. Adverse outcomes were associated with fever, low body mass index, bacteremia, esophageal candidiasis, and low or missing CD4(+) T cell counts. In this severely resource-limited setting, successful anemia management often required interventions other than conventional presumptive treatment, thus supporting Mozambique's guideline revision.
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Affiliation(s)
| | - Wilson P. Silva
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Sten H. Vermund
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Emilio Valverde
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Manuel Buene
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
| | - Troy D. Moon
- Friends in Global Health, LLC, Maputo, Mozambique, and Quelimane, Mozambique
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
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Abo Y, Zannou Djimon M, Messou E, Balestre E, Kouakou M, Akakpo J, Ahouada C, de Rekeneire N, Dabis F, Lewden C, Minga A. Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration. BMC Infect Dis 2015; 15:176. [PMID: 25885859 PMCID: PMC4396560 DOI: 10.1186/s12879-015-0910-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/18/2015] [Indexed: 11/25/2022] Open
Abstract
Background The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after ART initiation, based on data from an active surveillance system established within a network of specialized care facilities in West African cities. Methods Within the International epidemiological Database to Evaluate AIDS (IeDEA) - West Africa collaboration, we conducted a prospective, multicenter data collection that involved two facilities in Abidjan, Côte d’Ivoire and one in Cotonou, Benin. Among HIV-infected adults receiving ART, events were recorded using a standardized form. A simple case-definition of severe morbidity (death, hospitalization, fever > 38°5C, Karnofsky index < 70%) was used at any patient contact point. Then a physician confirmed and classified the event as WHO stage 3 or 4 according to the WHO clinical classification or as degree 3 or 4 of the ANRS scale. Results From December 2009 to December 2011, 978 adults (71% women, median age 39 years) presented with 1449 severe events. The main diagnoses were: non-AIDS-defining infections (33%), AIDS-defining illnesses (33%), suspected adverse drug reactions (7%), other illnesses (4%) and syndromic diagnoses (16%). The most common specific diagnoses were: malaria (25%), pneumonia (13%) and tuberculosis (8%). The diagnoses were reported as syndromic in one out of five events recorded during this study. Conclusions This study highlights the ongoing importance of conventional infectious diseases among severe morbid events occurring in patients on ART in ambulatory HIV care facilities in West Africa. Meanwhile, additional studies are needed due to the undiagnosed aspect of severe morbidity in substantial proportion. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0910-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yao Abo
- Programme PAC-CI, Centre Hospitalier Universitaire (CHU) de Treichville, 18 BP 1954, Abidjan 18, Côte d'Ivoire. .,Centre Médical de Suivi des Donneurs de Sang (CMSDS), Centre National de Transfusion Sanguine, Abidjan, Côte d'Ivoire.
| | - Marcel Zannou Djimon
- Centre de Traitement Ambulatoire (CTA), Centre National Hospitalier Universitaire (CNHU), Cotonou, Benin. .,Université d'Abomey-Calavi, Cotonou, Bénin.
| | - Eugène Messou
- University Bordeaux, ISPED, Bordeaux, France. .,Centre de Prise en charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire.
| | - Eric Balestre
- INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France. .,University Bordeaux, ISPED, Bordeaux, France.
| | - Martial Kouakou
- Centre de Prise en charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire.
| | - Jocelyn Akakpo
- Centre de Traitement Ambulatoire (CTA), Centre National Hospitalier Universitaire (CNHU), Cotonou, Benin.
| | - Carin Ahouada
- Centre de Traitement Ambulatoire (CTA), Centre National Hospitalier Universitaire (CNHU), Cotonou, Benin.
| | - Nathalie de Rekeneire
- INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France. .,University Bordeaux, ISPED, Bordeaux, France.
| | - François Dabis
- INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France. .,University Bordeaux, ISPED, Bordeaux, France.
| | - Charlotte Lewden
- INSERM, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France. .,University Bordeaux, ISPED, Bordeaux, France.
| | - Albert Minga
- Programme PAC-CI, Centre Hospitalier Universitaire (CHU) de Treichville, 18 BP 1954, Abidjan 18, Côte d'Ivoire. .,Centre Médical de Suivi des Donneurs de Sang (CMSDS), Centre National de Transfusion Sanguine, Abidjan, Côte d'Ivoire.
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Management of Fever in Ambulatory HIV-Infected Adults in Resource-Limited Settings. J Acquir Immune Defic Syndr 2014. [DOI: 10.1097/qai.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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