Immediate treatment of acute HIV in a tertiary healthcare center: bridging gaps in communication using smartphones

Autor:	S. Navarro-Álvarez, Santiago Pérez-Patrigeon, Juan Sierra-Madero, Christian Hernández-León, Luis E. Soto-Ramírez, Brenda Crabtree-Ramírez, Juan J. Calva, Pablo F. Belaunzarán-Zamudio, Antonio Camiro-Zúñiga, M.D.R. Jaramillo-Jante, Juan L. Mosqueda-Gómez
Rok vydání:	2019
Předmět:	0301 basic medicine Acute HIV infection medicine.medical_specialty business.industry Health Policy Human immunodeficiency virus (HIV) medicine.disease_cause 030112 virology Antiretroviral therapy 03 medical and health sciences Chronic infection 0302 clinical medicine Infectious Diseases Emergency medicine Cohort Epidemiology Medicine Pharmacology (medical) 030212 general & internal medicine business Survival analysis Tertiary healthcare
Zdroj:	HIV Medicine. 20:308-316
ISSN:	1468-1293 1464-2662
DOI:	10.1111/hiv.12713
Popis:	Objectives Early initiation of antiretroviral therapy (ART) during acute HIV infection is associated with favourable clinical and epidemiological outcomes. Barriers to prompt treatment initiation limit the benefits of universal access to ART in Mexico. We sought to create an algorithm for the immediate detection and treatment of patients with acute HIV infection. Methods A nationwide cohort of patients with acute HIV infection was created in 2015. In order to identify cases and treat them promptly at our centre, an interdisciplinary group coordinated through an instant-messaging tool using smart phones was established. When a probable case was detected, a discussion was initiated to confirm the diagnosis and facilitate the administrative processes to initiate ART as soon as possible. We compared time to ART initiation with that in a comparison group of patients with chronic HIV infection enrolled during the same period (May 2015 to February 2017) through routine care, using survival analysis estimators and log-rank tests. Results We recruited 29 patients with acute HIV infection. The median time to ART initiation was 2 days in these patients, in contrast to 21 days for patients with chronic infection. There were no significant differences in the percentages of patients engaged in care, on treatment or virologically suppressed at 1 year of follow-up. Conclusions Implementing immediate ART initiation programmes is feasible in Mexico, in spite of the substantial administrative barriers that exist in the country. More extensive replication of this model in other centres and in patients with chronic infection is warranted to evaluate its effect on the continuum of care.
Databáze:	OpenAIRE
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