Pathways to care and outcomes among hospitalised HIV-seropositive persons with cryptococcal meningitis in South Africa

Autor: for Germs-Sa, Sophie Candfield, Charlotte Sriruttan, Verushka Chetty, Sandra Toro-Silva, Vanessa Quan, Alison D. Grant, Violet N. Chihota, Nelesh P. Govender, Anna Vassall
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
RNA viruses
Pediatrics
Health Care Providers
Nurses
Meningitis
Cryptococcal
Pathology and Laboratory Medicine
South Africa
0302 clinical medicine
Immunodeficiency Viruses
Maintenance therapy
Infectious Diseases of the Nervous System
Interquartile range
Antiretroviral Therapy
Highly Active
Reflexes
HIV Seropositivity
Health care
Medicine and Health Sciences
Medical Personnel
030212 general & internal medicine
Multidisciplinary
Fungal Diseases
Eukaryota
HIV diagnosis and management
Cryptococcosis
Middle Aged
Patient Discharge
Hospitals
3. Good health
Hospitalization
Cryptococcal Meningitis
Professions
Treatment Outcome
Infectious Diseases
Neurology
Medical Microbiology
Viral Pathogens
Viruses
Critical Pathways
Medicine
Female
Pathogens
medicine.symptom
Meningitis
Research Article
Adult
medicine.medical_specialty
Science
030231 tropical medicine
Microbiology
Asymptomatic
03 medical and health sciences
Retroviruses
medicine
Humans
Lost to follow-up
Microbial Pathogens
Clinical Audit
business.industry
Lentivirus
Organisms
Fungi
Biology and Life Sciences
HIV
Patient Acceptance of Health Care
medicine.disease
Diagnostic medicine
Integrated care
Health Care
Cryptococcus
Health Care Facilities
People and Places
Population Groupings
Health Facilities
Patient Care
business
Follow-Up Studies
Neuroscience
Zdroj: PLoS ONE, Vol 14, Iss 12, p e0225742 (2019)
PLoS ONE
ISSN: 1932-6203
Popis: Introduction Cryptococcus causes 15% of AIDS-related deaths and in South Africa, with its high HIV burden, is the dominant cause of adult meningitis. Cryptococcal meningitis (CM) mortality is high, partly because patients enter care with advanced HIV disease and because of failure of integrated care following CM diagnosis. We evaluated pathways to hospital care, missed opportunities for HIV testing and initiation of care. Methods We performed a cross-sectional study at five public-sector urban hospitals. We enrolled adults admitted with a first or recurrent episode of cryptococcal meningitis. Study nurses conducted interviews, supplemented by a prospective review of medical charts and laboratory records. Results From May to October 2015, 102 participants were enrolled; median age was 40 years (interquartile range [IQR] 33.9–46.7) and 56 (55%) were male. In the six weeks prior to admission, 2/102 participants were asymptomatic, 72/100 participants sought care at a public-sector facility, 16/100 paid for private health care. The median time from seeking care to admission was 4 days (IQR, 0–27 days). Of 94 HIV-seropositive participants, only 62 (66%) knew their status and 41/62 (66%) had ever taken antiretroviral treatment. Among 13 participants with a known previous CM episode, none were taking fluconazole maintenance therapy. In-hospital management was mostly amphotericin B; in-hospital mortality was high (28/92, 30%). Sixty-four participants were discharged, 92% (59/64) on maintenance fluconazole, 4% (3/64) not on fluconazole and 3% (2/64) unknown. Twelve weeks post-discharge, 31/64 (48%) participants were lost to follow up. By 12 weeks post discharge 7/33 (21%) had died. Interviewed patients were asked if they were still on fluconazole, 11% (2/18) were not. Conclusions Among hospitalised participants with CM, there were many missed opportunities for HIV care and linkage to ART prior to admission. Universal reflex CrAg screening may prompt earlier diagnosis of cryptococcal meningitis but there is a wider problem of timely linkage to care for HIV-seropositive people.
Databáze: OpenAIRE
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