Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay.

BACKGROUND: Opportunistic infections (OIs) are common causes of mortality among people living with HIV (PLHIV). We determined prevalence and 30-day mortality due to histoplasmosis, cryptococcosis, and TB in PLHIV with advanced HIV disease (AHD). METHODS: PLHIV 18 years and older, with a CD4 + T-cell count of less than 350 cells/mm3 newly diagnosed with HIV infection or re-engaged in care after being without ART for more than 90 days (Group A). The second group included symptomatic PLHIV regardless of ART status or CD4 + T-cell count (Group B); all followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was done by enzyme immunoassay (EIA), Cryptococcus antigen (CrAg) was detected in serum and cerebrospinal fluid (CSF) specimens by lateral flow assay (LFA), and lipoarabinomannan (LAM) detection in urine was by LFA (TB LAM) and in sputum by GeneXpert for diagnosis of Mycobacterium infections. RESULTS: From August 2021 to June 2022, 491 PLHIV were enrolled; 482 (98%) had a CD4 + T-cell result, and 381 patients (79%) were classified with AHD according to CD4 + T-cell count (< 200 CD4/mm3). Frequency of an OI was 38% (n = 145/381). Antigen test positivity rate was 16% (72/467) for TB-LAM, 9% (43/464) for HisAg, and 11% (51/484) for CrAg. Twenty-one of 34 (62%) patients receiving CSF CrAg tests were positive, confirming meningitis. Significant differences in 30-day mortality were observed in patients with an OI (16%) vs. no OI (7%) (p = 0.002). Mortality was highest in patients with histoplasmosis (25%), co-infection (22%), cryptococcosis (18% overall; 19% for cryptococcal meningitis), and TB (10%). CONCLUSIONS: TB and fungal OIs, including co-infection, were common in PLHIV in Paraguay and had high associated mortality. Laboratories and health facilities need access to CD4 + T-cell testing and rapid diagnostic assays.

Primer Consenso Nacional Intersociedades de Inmunización del Adulto. 2023

Las vacunas previenen millones de muertes cada año y su eficacia y seguridad han sido ampliamente establecidas. En términos económicos, la vacunación es una de las intervenciones sanitarias más costo efectivas, generando un importante ahorro y crecimiento económico que supone a largo plazo. Se ha demostrado que la vacunación de adultos disminuye la morbilidad y la mortalidad asociadas a enfermedades infecciosas prevenibles, reduciendo las complicaciones y las hospitalizaciones, incluidos los ingresos a las unidades de cuidados intensivos. Hemos elaborado este documento de consenso con el objeto de diseñar un esquema de vacunación pragmático, accesible y estandarizado del adulto, según categoría de riesgo y edad, sobre la base de la evidencia disponible de vacunas accesibles y nuevas vacunas habiendo utilizado el Tercer Consenso de la Sociedad Paraguaya de Infectología del 2019 como base para las recomendaciones finales.

SUMMARY Vaccines prevent millions of deaths each year, and their efficacy and safety have been widely established. In economic terms, vaccination is one of the most cost-effective health interventions, generating significant savings and long-term economic growth. Adult vaccination has been shown to decrease morbidity and mortality associated with preventable Infectious diseases, reducing complications and hospitalizations, including admissions to intensive care units. We have prepared this consensus document in order to design a pragmatic, accessible and standardized vaccination scheme for adults, according to risk category and age, based on the available evidence of available vaccines and new vaccines, having used the third consensus of the Paraguayan Infectious Diseases Society of 2019 as a basis for the final recommendations.

Evaluación de costos de internación en terapia intensiva de pacientes con diagnóstico de SIDA

The current growth in the cost of health care production need for appropriate responses by policy-makers and health managers that run them and it is necessary to identify the costs of production by studying the monetary cost of inputs, functions and processes of production. Materials and Methods. We included all patients diagnosed with AIDS admitted at Intensive Care Unit (ICU) from June 2007 to June 2009. And we evaluated the total cost of each hospitalization impacted like disposable supplies, injectables, studies and expense of inpatient bed/day. Results. Entered a total of 18 patients (2.3% of total admitted ptes ICU) who settled in 20 chances, dominated ptes of 26 to 39 years (44%) and male (61%), average hospitalization time was 8 days, the survival rate was 44%, there was a significant difference in the lack of adherence to antiretroviral therapy in patients who died vs. those who survived. The total cost of patients in this series was US$. 133.173. of this total, the average hospitalization of AIDS patients was US$. 6.659. and US$. 870. equivalent to US$/day. The largest expenditure represents the cost of hospitalizations day/bed in ICU, US$. 816. followed by the diagnostic studies and control. Conclusion. The daily hospitalization cost of AIDS patients in ICU at the IMT is US$. 870. The lack of adherence to antiretroviral therapy prior to admission was shown as an important factor in mortality of patients.

El crecimiento actual del costo en la producción de servicios de salud necesita respuestas apropiadas por parte de los planificadores de las políticas de salud y de los gerentes que las ejecutan y para ello es necesario identificar los costos de producción mediante el estudio del costo monetario de los insumos, de las funciones y de los procesos de producción. Materiales y Métodos. Se incluyeron todos los pacientes con diagnostico de SIDA que ingreson en la UTI desde junio de 2007 a junio de 2009. Y se evaluaron los gastos totales que repercutieron de cada internación como ser, insumos descartables, inyectables, estudios realizados y el gasto de internación cama/día. Resultados. Ingresaron en total 18 pacientes (2,3% del total de ptes ingresados en UTI) que se internaron en 20 oportunidades, predominan ptes de 26 a 39 años (44%) y sexo masculino (61%), El tiempo de internación promedio fue de 8 días, la tasa de sobrevivencia fue del 44%, se observó una diferencia significativa en la falta de adherencia al tratamiento antirretroviral de los paciente que fallecieron vs. los que sobrevivieron. El total de gastos de los pacientes en esta serie fue de US$. 133.173. de este total, la internación promedio de pacientes con SIDA fue de US$. 6.659. y equivale a 870. US$/día. El mayor gasto en las internaciones representa el costo dia/cama en UTI, US$. 816. seguido de los estudios de diagnóstico y control. Conclusión. El gasto de internación diario de los pacientes con SIDA en UTI en el IMT es del US$. 870. La falta de adherencia al tratamiento antirretroviral antes de la internación se mostró como un factor importante en la mortalidad de los pacientes.