Newly diagnosed HIV patients in Lima, Peru: a comparison of individuals diagnosed through an intervention program versus self-referred individuals - implications for clinical care
J. Hidalgo, C. Agurto, N. Castillo
Via Libre, Lima, Peru
Background: An extensive intervention program to promote awareness, HIV testing, diagnosis and access to medical care in at-risk populations was developed by Via Libre between Nov 2007 and Oct 2009 in Lima, Peru. It is not clear what the impact of this type of interventions on the presenting patients' clinical conditions is.
Methods: Retrospective medical records review of newly diagnosed individuals with HIV infection at an outpatient HIV Clinic. A comparison of the initial condition was made between self-referred individuals and persons diagnosed through the intervention program. Cases included had completed a baseline clinical and laboratory evaluation, and had a decision made by the treating physician regarding whether HAART was required or not.
Results: During the study period, 523 HIV persons presented for care at our clinic. We reviewed 220 records, out of which 165 were eligible for analysis. One hundred and five corresponded to the self-referred group (Group 1) and 60 to the intervention group (Group 2). Both groups had similar mean age (35.5 yrs., Group 1; 28.8 yrs., Group 2; p:0.44) and time between diagnosis and presentation to clinical evaluation (1.8 mos., Group 1, 1.0 mos., Group 2). Mean baseline CD4+ cell count was lower in Group 1 (287.6 +/- 217.6 vs. 392.56 +/- 249.8, p< 0.5). A higher number of patients in Group 1 presented with AIDS-related clinical symptoms (Group 1: 44.8%, n=47; Group 2: 18.3%, n=11) and required initiation of antiretroviral therapy (Group 1: 65.7%, n=69, Group 2: 45.0%, n=27).
Conclusions: Patients diagnosed through the intervention program presented with less advanced HIV infection and had chance to earlier initiation of HAART. Intervention programs to actively diagnose HIV give a significant opportunity to provide timely medical care to HIV-infected individuals in resource-limited settings. These initiatives should be sustainable and incorporated to national HIV care programs.
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