score under a short-scheduled hospitalization program in HIV infected children
R.R. Hirsch, V. Curras, J. Goldberg, M. Sosa, M. García, V. Fernández Abello, A. Comerci, C.D. Hirsch, G.J. Hirsch, B.S. Alonso
Hospital Muñiz, Infectious Diseases, Buenos Aires, Argentina
Background: An adherence predictive score was designed to assess vulnerability and to adapt the health teamwork to children needs, in order to improve therapeutic outcomes in HIV-1 infected children in the paediatrics inpatient unit of an infectious disease hospital in Argentina.
Methods: It has been established a Short-Scheduled Hospitalization Program, consisting in four hospitalizations per year, from 1 to 3 days each, where children are evaluated by a multidisciplinary health care team, in terms of clinical condition, antiretroviral drugs dosing schedules and adverse drug reactions. An Adherence Vulnerability Score was applied to 70 HIV infected children under 19 years old during 2008.
The score consists of 12 items divided in 3 categories that evaluate nutritional, social, psychological and clinical characteristics of children. Each item is categorized so that a higher value obtained, implies a higher vulnerability in terms of antiretroviral drug adherence. The maximum value obtainable is 36 points and it implies the maximum vulnerability risk.
Results: The score was applied to 70 HIV infected children, from 3 months to 18 years old. 19 patients (27.1 %) obtained scores corresponding to low risk for non - adherence, 22 patients (31.4%) obtained mild risk scores, 25 patients (35.7%) achieved moderate scores and finally 4 patients (5.7 %) obtained high - risk scores.
Conclusions: This assessment of adherence vulnerability would allow us to estimate the individual and population risks, identifying weaknesses in adherence issues, and individualizing the health care strategy according to psycho-social determinants that may influence in clinical outcomes and progression to AIDS and death. The health care team should focus their efforts on patients who obtained scores corresponding to moderate and high risk of non-adherence.
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