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Lees EA, Tickner N, Lyall H, Mcmaster P, Smith B, Cliffe L, Taylor G, Foster C. Infant postnatal prophylaxis following maternal viraemia during breastfeeding. AIDS 2023; 37:1185-1186. [PMID: 37139658 DOI: 10.1097/qad.0000000000003532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Emily A Lees
- University of Oxford, Department of Paediatrics, Oxford Children's Hospital, Oxford
- Fitzwilliam College, University of Cambridge, Cambridge
| | - Neil Tickner
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - Hermione Lyall
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London
| | - Paddy Mcmaster
- Manchester University NHS Foundation Trust, North Manchester General Hospital, Manchester, UK
| | - Birgitte Smith
- Department of Pediatrics, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lucy Cliffe
- Nottingham University NHS Foundation Trust, Nottingham Children's Hospital, Nottingham
| | - Graham Taylor
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London
- Department of Retrovirology, Imperial College London, London, UK
| | - Caroline Foster
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London
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2
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Johnson SM, Piñera C, Whittaker E, Kirkhope N, Kon OM, Satta G, Balcells ME, Foster C. Rare Mycobacteria and HIV in Children: Two Case Reports. Clin Drug Investig 2022; 42:541-547. [PMID: 35578004 DOI: 10.1007/s40261-022-01153-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Sarah M Johnson
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, W2 1NY, UK. .,Imperial College London, London, UK.
| | - Cecilia Piñera
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.,Imperial College London, London, UK
| | - Natalie Kirkhope
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Onn M Kon
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.,Imperial College London, London, UK
| | - Giovanni Satta
- Centre for Clinical Microbiology, University College London, London, UK
| | | | - Caroline Foster
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.,Imperial College London, London, UK
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Manglani M, Gabhale Y, Lala MM, Balakrishnan S, Bhuyan K, Rewari BB, Setia MS. Assessing the Effectiveness of a Telemedicine Initiative in Clinical Management of Children Living with HIV/AIDS in Maharashtra, India. Curr HIV Res 2021; 19:201-215. [PMID: 33397239 DOI: 10.2174/1573399817666210104102825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the effectiveness of telemedicine in the clinical management of children living with HIV/AIDS in resource-limited settings ; Background: Telemedicine is an important mechanism for service delivery in health care settings, both in resource-rich and resource-poor settings. Such service delivery mechanisms have shown to be associated with virologic suppression and higher CD4 counts. These services are also associated with improved access, shorter visiting times, and higher patient satisfaction. ; Objective: We designed the present two-group comparison study to compare the clinical evaluation and management of children in the anti-retroviral therapy (ART) centres linked to telemedicine facility with those who are not linked to this facility in Maharashtra, India. ; Methods: We analysed clinical records from six ART centres in Maharashtra; of these, 250 children were in the linked ART centres and 301 were in the non-linked ART centres. The outcomes were classified according to investigations, management, and monitoring. For management, we evaluated: 1) Initiation of cotrimoxazole prophylaxis; 2) Children not initiated on ART when required; 3) ART regime after appropriate investigations; and 4) Change of regime (if immunologically indicated). For monitoring, we assessed the haematological monitoring of children on ART. ; Results: The mean (SD) ages of children in linked and non-linked ART centres were 10.8 (4.6) and 10.9 (4.6) years, respectively (p=0.80). After adjusting for individual and structural level variables, physical examination (OR: 2.0, 95% CI; 1.2, 3.2), screening for tuberculosis (OR: 12.9, 95% CI: 2.0, 82.9) and cotrimoxazole prophylaxis were significantly more likely in the linked centres compared with non-linked centres (OR: 1.8, 95% CI: 1.4, 2.2). A higher proportion of children eligible for ART were not initiated on treatment in the non-linked centres compared with linked centres (26% vs. 8%, p=0.06). Children were less likely to be initiated on zidovudine-based regimens without baseline haemoglobin or with baseline haemoglobin of less than 9 gm% in linked centres (OR: 0.7, 95% CI: 0.6, 0.8). Similarly, children in the linked centres were less likely to have been started on nevirapine-based regimens without baseline liver enzymes (OR: 0.8, 95% CI: 0.7, 0.9). ; Conclusion: Thus, the overall clinical management of Children Living with HIV/ AIDS (CLHA) was better in ART centres linked with the telemedicine initiative compared with those who were not linked. Children in the linked ART centres were more likely to have a complete baseline assessment (physical, hematological, radiological, and screening for TB); the presence of a pediatrician in the centres was helpful.
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Affiliation(s)
- Mamta Manglani
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | - Yashwant Gabhale
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | - Mamatha Murad Lala
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | | | - Khanindra Bhuyan
- UNICEF, Near 73, Lodhi Gardens, Lodhi Estate, New Delhi, 110003, India
| | - Bharat Bhushan Rewari
- WHO Regional Office of South East Asea, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India
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Pappalardo M, Fanelli U, Chiné V, Neglia C, Gramegna A, Argentiero A, Esposito S. Telemedicine in Pediatric Infectious Diseases. CHILDREN-BASEL 2021; 8:children8040260. [PMID: 33800549 PMCID: PMC8066295 DOI: 10.3390/children8040260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Telemedicine is the remote practice of medicine through the use of information and communication technologies for the prevention, diagnosis, treatment and management of diseases. In this narrative review, we illustrate how telemedicine technologies are increasingly integrated into pediatric infectious disease programs with the aim of facilitating access to specialist care and reducing costs. There is widespread use of telemedicine for the management of acute and chronic infectious diseases, particularly in countries in which the majority of the population lives in rural areas, far from third-level hospital centers located in large urban centers. Obviously, telemedicine is also used in developed countries, and its importance has been further increased recently given the COVID-19 pandemic. It has many advantages for patients, such as saving time, money and working hours, and reducing cancelled appointments and delays, while there are also many advantages for doctors, allowing collaborations with specialists and continuous updating. Among the disadvantages are the limitation in carrying out an objective examination, which is particularly important for children under 2 years of age, and the need for cutting-edge technology and reliable connectivity. Telemedicine increasingly represents the future and the beginning of a new healthcare system that also will redefine medical care for the treatment of infectious diseases, both acute and chronic. However, the majority of the experience has involved adults, and its validation in pediatric care, as well as its application in real-life practices, are urgently needed.
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Affiliation(s)
- Marco Pappalardo
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Umberto Fanelli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Vincenzo Chiné
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Cosimo Neglia
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
- Correspondence: ; Tel.: +39-0521-704790
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Reaching the Unreached: Providing Quality Care to HIV-Infected Children through Telemedicine-An Innovative Pilot Initiative from Maharashtra, India. Int J Pediatr 2020; 2020:6432476. [PMID: 33149744 PMCID: PMC7603602 DOI: 10.1155/2020/6432476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/11/2020] [Accepted: 10/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background The National AIDS Control Organization (NACO) of India created the Regional Pediatric Antiretroviral Therapy (ART) Center; this was subsequently upgraded to seven Pediatric Centers of Excellence (PCoEs) to strengthen the quality of treatment and care of children living with HIV/AIDS (CLHAs). In October 2013, the pediatric HIV telemedicine initiative, an e-decentralized (care provided by local healthcare providers and support provided by a central agency through telemedicine facilities) model of expert pediatric HIV care and referral services, was established as a pilot project at the Pediatric Center of Excellence for HIV Care in Maharashtra. We designed the present study to compare management, compliance to ART, and mortality in children in the ART centers linked to the PCoE through telemedicine versus those that are not linked to the PCoE. Methods It was a retrospective cross-sectional study of secondary data from CLHAs from October 2013 through August 2015 in the ART centers to document the intermediate outcomes and to determine if the initiative has improved the quality of care for the CLHAs enrolled in the linked ART centers with nonlinked ART centers. The centers in which the telemedicine sessions were conducted regularly were called linked-regular centers and in whom it was conducted irregularly (less than the median of 12 videoconference cases), it was called a linked-irregular center. Data from 2803 children in 31 linked (1365 in irregular and 1438 in regular centers) and 2608 children in 28 nonlinked centers were analyzed. The outcomes in children in the pre-ART group (ART naïve) were (1) alive on pre-ART, (2) lost to follow-up on pre-ART, (3) death during the pre-ART period, (4) eligible but not initiated on ART, and (5) missing baseline and latest CD4 counts. The outcomes of children on ART were (1) alive on ART, (2) lost to follow-up on ART, (3) death on ART, and (4) missing baseline and latest CD4 counts. Results We found that a higher proportion of children in the linked-regular centers (79% vs. 70%, p < 0.001) and linked-irregular centers (76% vs. 70%, p = 0.04) was alive compared with that in the nonlinked centers in the pre-ART group. In this group, the proportion of children with missing baseline CD4 counts and latest CD4 counts was significantly low in linked (regular centers) centers. In the ART group, we found that a higher proportion of children in the linked-regular centers was alive compared with that in the linked-irregular centers (77% vs. 69%, p < 0.001); the proportion was not significantly different in nonlinked centers (77% vs. 78%, p = 0.56). In this group, the proportion of missing baseline CD4 counts was significantly lower in the linked-regular centers (3% vs 13%, p<0.001) and linked-irregular centers (1% vs. 13%, p < 0.001) compared with that in the nonlinked centers. Furthermore, the latest CD4 counts were missing in a significantly lower proportion of children in the linked-regular centers compared with those in the linked-irregular centers (6% vs. 18%, p < 0.001) and nonlinked centers (6% vs. 18%, p < 0.001). Conclusion Our study shows that the centers linked through telemedicine performed better in terms of patient care and treatment, with a lesser loss to follow-up and lesser deaths in CLHA. Overall, this pilot project of telemedicine for pediatric HIV has been proven to be acceptable, feasible, and effective in improving the quality of care for children living with HIV across the state of Maharashtra.
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Zombori L, Kirkhope N, Busari T, Tickner N, Weston R, Foster C. Novel Adherence Interventions in Perinatally Acquired HIV: PEG Insertion and Pill Glide. Clin Drug Investig 2020; 40:765-772. [PMID: 32519251 DOI: 10.1007/s40261-020-00918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Children, adolescents and young adults (CAYA) with perinatally acquired human immunodeficiency virus (PaHIV) need lifelong antiretroviral therapy (ART) to suppress viral load (VL), maintain health and prevent onward transmission. Many struggle with adherence despite multidisciplinary input. We assessed ART adherence outcomes following two novel interventions: percutaneous endoscopic gastrostomy (PEG) and Pill Glide®, a fruit-flavoured lubricant spray aiding tablet swallowing. METHODS Retrospective cohort analysis by database and case-note review of PaHIV CAYA aged < 25 years receiving PEG or Pill Glide® between 1995 and 2017 at a single tertiary centre. RESULTS Nineteen PEGs were inserted in 15 CAYA at a median age of 17 (IQR 6-22) years, median CD4 count 40 cells/µL (IQR 10-220). A viral load (VL) < 50 copies/mL was achieved in 93% with PEG ART. At last follow-up all were alive, median age 23 years (IQR 22-28). Nine had PEG removed, after a median of 3.3 years (range 0.5-6.8), with a current VL < 50 copies/mL, median CD4 count 940 cells/µL (IQR 261-1353) sustained post PEG removal median was 5.4 years (range 1.5-17.8) previously. From 2017 seven CAYA received Pill Glide®, median age 10 years (IQR 7-14), median CD4 count 898 cells/µL (range 148-1943), 6/7 with a suppressed VL. All reported increased ease in tablet swallowing and transitioned successfully from crushed tablets/liquids to tablets. At follow-up, all patients had a suppressed VL. CONCLUSIONS Whilst PEG insertion markedly improved rates of viral suppression in CAYA struggling with ART adherence, the use of novel less invasive aids such as Pill Glide® requires further exploration.
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Affiliation(s)
- Luca Zombori
- Department of Paediatrics, Royal London Hospital, Barts Health NHS Trust, 6c ward, Whitechapel Road, Whitechapel, London, E1 1FR, UK.
| | - Natalie Kirkhope
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Temitope Busari
- Department of Paediatrics, Chelsea and Westminster Hospital, Chelsea and Westminster Hospital, NHS Trust, London, UK
| | - Neil Tickner
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Rosy Weston
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Caroline Foster
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Rutherford E, Noray R, Ó hEarráin C, Quinlan K, Hegarty A, Ekpotu L, Arize C, Fabamwo F, Alrubaiaan A, Bhupalan A, Alshehhi A, Power C, Hill ADK. Potential Benefits and Drawbacks of Virtual Clinics in General Surgery: Pilot Cross-Sectional Questionnaire Study. JMIR Perioper Med 2020; 3:e12491. [PMID: 33932277 PMCID: PMC7728406 DOI: 10.2196/12491] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 06/05/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Escalating demand for specialist health care puts considerable demand on hospital services. Technology offers a means by which health care providers may increase the efficiency of health care delivery. Objective The aim of this study was to conduct a pilot study of the feasibility, benefits, and drawbacks of a virtual clinic (VC) in the general surgical service of a busy tertiary center. Methods Patient satisfaction with current care and attitudes to VC were surveyed prospectively in the general surgical outpatient department (OPD; n=223). A subset of patients who had undergone endoscopy and day surgery were recruited to follow-up in a VC and subsequently surveyed with regard to their satisfaction (20/243). Other outcomes measured included a comparison of consultation times in traditional and virtual outpatient settings and financial cost to both patients and the institution. Results Almost half of the patients reported barriers to prospective use of VCs. However, within the cohort who had been followed-up in the VC, satisfaction was higher than the traditional OPD (100% as compared with 187/223, 83.9%). Significant savings in both time (P=.003) and financial costs to patients and the institution were found. Conclusions For an appropriately selected group of patients, VCs offer a viable alternative to traditional OPD. This alternative can improve both patient satisfaction and efficiency of patient care.
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Affiliation(s)
- Emily Rutherford
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roghinio Noray
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caolán Ó hEarráin
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kevin Quinlan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling Hegarty
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lenin Ekpotu
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chinedum Arize
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiyinfoluwa Fabamwo
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Avinash Bhupalan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Abdulla Alshehhi
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colm Power
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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8
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Abstract
PURPOSE OF REVIEW Novel technologies, such as high-definition cameras, encryption software, electronic stethoscopes, microfluidic diagnostic systems, and widely available broadband Internet have expanded the potential for telemedicine. This narrative review presents current and future uses of telemedicine in the prevention, diagnosis, treatment, stewardship, and management of infectious disease. RECENT FINDINGS Beginning in the 1990s, early approaches to telemedicine in infectious disease focused largely on treatment of HIV/AIDS, hepatitis C, and tuberculosis. However, recent innovations allow for targeting of additional diseases and in increasingly remote settings. Telemedicine allows virtual visits between patients in the home and remote providers, permitting outpatient management of complex conditions, such as post-surgical site monitoring, and non-urgent infectious maladies, such as uncomplicated urinary tract infection. Remote provider education by videoconference and integrated clinical decision support tools create avenues to improve inpatient care, including antimicrobial stewardship. Technological strides from miniaturization of diagnostic tests to robotic telepresence physical exams improve access to infectious disease care in isolated and infrastructure-poor environments, from cargo ships to other resource-limited settings. Telemedicine in the field of infectious disease is rapidly expanding in clinical, technological, geographical, and human capacity. Recent innovations narrow gaps in access to care for populations traditionally underserved, stigmatized, isolated by remote geography, or lacking technological infrastructure. Current and future approaches will transform inpatient, outpatient, and remote care.
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Rout SK, Gabhale YR, Dutta A, Balakrishnan S, Lala MM, Setia MS, Bhuyan K, Manglani MV. Can telemedicine initiative be an effective intervention strategy for improving treatment compliance for pediatric HIV patients: Evidences on costs and improvement in treatment compliance from Maharashtra, India. PLoS One 2019; 14:e0223303. [PMID: 31593580 PMCID: PMC6782091 DOI: 10.1371/journal.pone.0223303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 09/19/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND India has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services. METHODS We selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost. RESULTS The average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers. DISCUSSION AND CONCLUSION The telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative.
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Affiliation(s)
| | - Yashwant R. Gabhale
- Pediatric Centre of Excellence for HIV Care, Department of Pediatrics, LTM Medical College and General Hospital, Sion, Mumbai, India
| | - Ambarish Dutta
- Indian Institute of Public Health, Bhubaneswar, Odisha, India
| | | | - Mamatha M. Lala
- Pediatric Centre of Excellence for HIV Care, Department of Pediatrics, LTM Medical College and General Hospital, Sion, Mumbai, India
| | | | | | - Mamta V. Manglani
- Pediatric Centre of Excellence for HIV Care, Department of Pediatrics, LTM Medical College and General Hospital, Sion, Mumbai, India
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10
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Dobson G, Klein N, Veys P, Qasim W, Silva J, Cheng IL, Shingadia D, Tudor-Williams G, Watters SA, Lyall H, Rao A, Foster C, Bamford A. Persistence of HIV reservoir following successful haematopoietic stem cell transplant for juvenile myelomonocytic leukaemia in a child with perinatally acquired HIV. J Virus Erad 2019; 5:174-177. [PMID: 31700667 PMCID: PMC6816122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This report describes a case of juvenile myelomonocytic leukaemia (JMML) on a background of both perinatally acquired HIV infection and congenital cytomegalovirus, and management of antiretroviral therapy during haematopoietic stem cell transplant. Peripheral blood HIV viral load remained below the lower limit of detection throughout and following transplant and is currently <20 RNA copies/mL. The child is currently in remission from JMML, but HIV DNA remains detectable despite myeloablative conditioning and sustained plasma HIV viral suppression.
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Affiliation(s)
- G Dobson
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK
| | - N Klein
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - P Veys
- UCL Great Ormond Street Institute of Child Health,
London,
UK,Paediatric Bone Marrow Transplant Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - W Qasim
- UCL Great Ormond Street Institute of Child Health,
London,
UK,Paediatric Immunology Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - J Silva
- Paediatric Bone Marrow Transplant Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - IL Cheng
- Paediatric Pharmacy Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - D Shingadia
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - G Tudor-Williams
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK,Division of Infectious Diseases,
Imperial College London,
London,
UK
| | - SA Watters
- UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - H Lyall
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK
| | - A Rao
- Paediatric Haematology Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - C Foster
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK
| | - A Bamford
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK,Corresponding author: Alasdair Bamford
Paediatric Infectious Diseases Department,
Great Ormond Street Hospital,
Great Ormond Street,
LondonWC1N 3JH,
UK
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Paediatric Integrase Inhibitor Use in a Real-Life Setting: A Single-Centre Cohort Experience 2009-2018. Clin Drug Investig 2019; 39:585-590. [PMID: 30976998 DOI: 10.1007/s40261-019-00783-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Integrase strand transfer inhibitors (INSTIs) have become the preferred first-line antiretroviral therapy in adults. There is paucity of published data on their use in children outside of clinical trials, particularly long-term safety and tolerability. This study aimed to describe INSTI use including the number of, and reasons for INSTI discontinuation. METHODS We conducted a retrospective cohort analysis by database and electronic record review of children aged under 18 years with perinatally acquired human immunodeficiency virus who started INSTI-based antiretroviral therapy between May 2009 and March 2018, in a single tertiary centre. RESULTS Fifty-six INSTI-based regimens were prescribed in 54 children, 64.9% from 2015 onwards. Twenty-one of 56 (37.5%) regimens commenced with raltegravir, 29 (51.8%) with dolutegravir and six (10.7%) with elvitegravir. The median age at the start of treatment was 15 years (interquartile range 13.5-16.4) with a median duration of INSTI-antiretroviral therapy of 1.65 years (range 0.01-8.8). Twenty-four children had a detectable viral load at the start INSTI therapy; 20 (83%) achieving viral suppression in a median of 26 days (interquartile range 19.5-34.5). There were 26 discontinuations of INSTI-based antiretroviral therapy after a median of 183 days; 9/26 because of adverse events. Four of nine adverse events were attributed to INSTI use, all in patients taking dolutegravir and the adverse events were neuropsychiatric and gastrointestinal in nature. CONCLUSIONS INSTI-based regimens were generally efficacious and well tolerated in this paediatric cohort, with 4/26 discontinuations due to INSTI-attributed adverse events. Further post-marketing surveillance of INSTI use in children is warranted.
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Dobson G, Klein N, Veys P, Qasim W, Silva J, Cheng I, Shingadia D, Tudor-Williams G, Watters S, Lyall H, Rao A, Foster C, Bamford A. Persistence of HIV reservoir following successful haematopoietic stem cell transplant for juvenile myelomonocytic leukaemia in a child with perinatally acquired HIV. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ruano Camps M, Brentlinger PE, Augusto G, Nguimfack A, Mudender F. Association of HIV/AIDS Clinician Warm Line Utilization with Diagnosis and Management of Antiretroviral Treatment Failure in Mozambique: A Retrospective Analysis of Program Data. J Int Assoc Provid AIDS Care 2017; 16:396-404. [PMID: 28560889 PMCID: PMC5510686 DOI: 10.1177/2325957417710720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In accordance with global HIV/AIDS goals, Mozambique is attempting to improve management of antiretroviral treatment failure (TF). We sought to determine whether the utilization of a national HIV/AIDS clinician telephone consultation service increased recognition and reporting of TF. In a retrospective analysis of routinely collected program data from telephone consultation logs and Mozambique’s national registry of second-line antiretroviral requests, we used linear mixed methods to describe the association between TF-related telephone consultations and submission of second-line requests, which required documentation of the TF diagnosis. The unit of analysis was the health facility. Available data included 1417 consultations (390 [27.5%] TF related) and 2662 second-line requests from 1011 health units (2015-2016 data). In multivariable analyses, each TF-related consultation was associated with an increase of 0.61 (95% confidence interval 0.15 to 1.06) second-line requests. In this setting, TF-related telephone consultation was positively and significantly associated with diagnosis and reporting of antiretroviral TF.
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Affiliation(s)
- Maria Ruano Camps
- 1 International Training and Education Center for Health, Maputo, Mozambique
| | | | - Gerito Augusto
- 1 International Training and Education Center for Health, Maputo, Mozambique
| | - Alexandre Nguimfack
- 1 International Training and Education Center for Health, Maputo, Mozambique
| | - Florindo Mudender
- 1 International Training and Education Center for Health, Maputo, Mozambique
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Fraser-Taliente T, Mackie NE, Kaye S, Nyirenda M, Foster C. Off-licence use of once-daily maraviroc in children and adolescents with perinatally acquired HIV-1 infection. HIV Med 2016; 18:311-313. [PMID: 27981720 DOI: 10.1111/hiv.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - N E Mackie
- Imperial College Healthcare NHS Trust, London, W2 1NY
| | - S Kaye
- Imperial College, London, W2 1NY
| | - M Nyirenda
- Imperial College Healthcare NHS Trust, London, W2 1NY
| | - C Foster
- Imperial College Healthcare NHS Trust, London, W2 1NY
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Genotype-guided antiretroviral regimens in children with multidrug-resistant HIV-1 infection. Pediatr Res 2016; 80:54-9. [PMID: 26999770 DOI: 10.1038/pr.2016.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/28/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Genotyping tests were developed to attenuate the impact of viral resistance. Information about the efficacy in genotype base antiretroviral therapy in children is rare and even more in low- and middle-income countries. METHODS Sixteen children with antiretroviral therapy (ART) failure and triple-class drug-resistant viruses were included in this study. Protease and retrotranscriptase genotypes were available for all patients. Switch of ART regimen was guided by genotyping data. The primary end point was virological suppression (<50 copies/ml) and immunological improvement after 48 wk of treatment with the new ART regimen. RESULTS The median age of the patients was 14.5 y (interquartile range (IQR) 11-16.5). Median HIV-1 RNA viral load was 4.2 log10 (IQR: 3.4-4.8). The primary end point was found in 11 children (69%), and 13 children (81%) had an HIV-1 RNA viral load <200 copies/ml. Median (IQR) for the baseline CD4(+) cell count was 382 cells/μl (281-686 cells/μl), whereas after 48 wk of treatment with the new ART regimen, it was 640 cells/μl (361-936 cells/μl) (P < 0.001). CONCLUSION Darunavir/ritonavir, raltegravir, and etravirine were well tolerated in the present pediatric population. These drugs provide good options for children exposed to extensive ART. Regimens guided by genotyping data were effective for children who had ART failure and multidrug-resistant HIV-1 infection.
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