RESUMEN
Under National TB/HIV framework, all TB patients are referred by Revised National Tuberculosis Programme (RNTCP) service providers to Integrated Counseling and Testing Centers (ICTCs) for voluntary counseling and testing (C&T) and ICTC "TB-suspects" are referred to RNTCP facilities for TB diagnosis and treatment. HIV-TB coinfected patients are then referred to Anti Retroviral Treatment (ART) center for initiation of ART between two weeks and two months of initiating TB treatment. During the third phase of National AIDS Control Programme (NACP-III, April 2007-April 2012), 30749/130503 (23.6%) TB/HIV cross-referrals were lost to follow up (LTFU) and there was missed opportunity for 940/1884 (49.9%) HIV-TB coinfected patients for initiation of ART during TB treatment. This motivated Delhi State AIDS Control Society (DSACS) and State TB Cell (STC) to revise existing cross-referral strategy. The new strategy was launched in May 2012, wherein HIV-TB coinfected and HIV-positive "TB-suspects" were referred to nearest ART center for HIV care and investigations of TB at Chest Clinic/Designated Microscopy Centre (DMC) located within the same hospital instead of referral to area RNTCP facility. Outcome of the strategy was evaluated in March 2013. The new HIV-TB cross-referral strategy in Delhi has shown advantage over national strategy: first, improved retention of coinfected clients in HIV care; second, ensured timely initiation of TB-treatment and ART; and third, significantly improved survival of HIV-TB coinfected patients.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Antituberculosos/uso terapéutico , Servicios de Salud Comunitaria/organización & administración , Consejo , Infecciones por VIH/terapia , Derivación y Consulta , Tuberculosis/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Coinfección , Femenino , Programas de Gobierno/organización & administración , Infecciones por VIH/mortalidad , Conocimientos, Actitudes y Práctica en Salud , Política de Salud , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Tuberculosis/mortalidadRESUMEN
Three quassinoids, 1, 2 and 3, 4-dihydro excelsin 3 were isolated from the stem bark of Ailanthus excelsa, along with five known quassinoids excelsin, glaucarubine, ailanthinone, glaucarubinone and glaucarubolone. The glaucarubolone has been isolated for the first time from this plant. The structural elucidation is based on the analysis of spectroscopic data.