Trends in the HIV related hospital admissions in the HAART era in Barbados, 2004-2006.

BACKGROUND: To investigate the reasons for hospitalizations and its outcome in the era of HAART in Barbados. This report also describes the profile of the HIV infected persons who are hospitalized in the HAART era. METHODS: This is a retrospective study of HIV related admissions in this country. We examined the admission case notes of all the adult admissions to the Queen Elizabeth Hospital where one of the discharge diagnosis was HIV infection during the April 2004 through March 2006. Data collected included patients' profile, including the date of diagnosis of HIV infection, outcome of the current admission in term of discharge or death and the final diagnosis at the time of discharge or death. RESULTS: Over the 24 months period there were 431 adult admissions to the medical wards of the Queen Elizabeth Hospital where one of the discharge diagnosis was HIV infection and this accounted for 5.9% of all medical admissions. 258(60%) admissions were in persons who were known to be HIV infected prior to the current admission, where as diagnosis of HIV infection was made for the first time during the current admission in case of remaining 76(47.5%) cases. Nearly half of those hospitalized, had a CD 4 cell counts of < 200/microL. Over all, opportunistic infection was the commonest (35%) discharge diagnosis, followed by serious bacterial infections, anemia and HIV nephropathy. The outcome of these admissions was death in 30 (14.2%) cases where as patient was discharged out in the remaining 181 (85.8%) cases. Of the medical admissions with HIV as one of the discharge diagnosis during the period April 04 through March 05, 43% were newly diagnosed HIV infection and the corresponding figure for the period April 05 through March 06 was 35% (P = 0.54). During the April 05 through March 04 significantly higher proportion of HIV infected adults had Anemia with a Hemoglobin less than 10 g/dL (P = 0.044), HIV related nephropathy (P = 0.0003), HAART toxicity (P = < 0.0001) and a Non-AIDS related conditions (P = 0.043) as one of the final discharge diagnosis. CONCLUSION: A significant proportion of patients admitted with HIV infection were the newly diagnosed and severely immuno-suppressed. An opportunistic infection continues to be the commonest discharge diagnosis, although there was a growing trend in the proportion of the discharge diagnosis being HAART toxicity and Non-AIDS related conditions. Over all hospitalization of HIV infected persons still carries a significant risk of mortality.

Changing HIV infection-related mortality rate and causes of death among persons with HIV infection before and after the introduction of highly active antiretroviral therapy: analysis of all HIV-related deaths in Barbados, 1997-2005.

OBJECTIVES: To compare the trends in death rates and the causes of deaths before and after the introduction of highly active antiretroviral therapy. METHODS: This is a retrospective study based on chart review of all HIV-related deaths between January 1997 and December 2005. RESULTS: The HIV-specific death rate declined from 34.12 per 100,000 adult population during 1997-1999 to 17.21 per 100,000 adult population during 2003-2005 when highly active anti-retroviral therapy was available. The proportion of all HIV-related deaths among persons newly diagnosed with HIV during the terminal hospitalization decreased from 93% during 1997-1999 to 28% during 2003-2005. Opportunistic infection was at least one of the causes of death in nearly half of all cases. CONCLUSIONS: Although, the HIV-specific death rates have declined significantly since the introduction of highly active antiretroviral therapy, HIV infection continues to contribute to the premature deaths among adults, mainly because of the late presentation.

Follow-up of HIV-infected women diagnosed by antenatal screening in Barbados from 1996-2004.

A follow-up study was undertaken to analyze the impact of the early diagnosis of HIV in women by antenatal voluntary counseling and testing (VCT) by way of making a difference to their health status and the social behavior of these women. This is a descriptive study. The study population included all HIV-infected women in this country who were diagnosed to be HIV infected by way of VCT during 1996-2004. Sixty-one (37.4%) never attended the HIV clinic for their care or treatment. The median delay between the time of diagnosis of HIV infection and the time of their presentation to the follow-up clinic was 36 months. Of the 79 women who reported to have been sexually active only 33 had a steady partner; 54 had had one or more casual sex partners at some point in time since their HIV diagnosis. One third never used condoms with their steady partner and one sixth never used condoms with casual partners. Overall, 89 women had one or more repeated pregnancy, mostly from different partners. In conclusion, many of the women diagnosed from antenatal VCT fail to utilize the available health care facilities and continue to engage in risk-taking behaviors.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004.

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6%) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4%) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4%) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

Profile of Hospitalized HIV-Infected Persons in the Highly Active Antiretroviral Therapy Era in Barbados.

OBJECTIVES: To investigate the reasons for hospitalization and its outcome in the era of highly active antiretroviral therapy (HAART) in Barbados. This report also describes the profiles of the HIV-infected persons who were hospitalized in the HAART era. METHODS: The authors examined the admission case notes to conduct an observational, retrospective study of all HIV-infected patients admitted to the Queen Elizabeth Hospital (QEH) during September 1, 2004, through March 31, 2005. Data collected included patients' profile, including the date of diagnosis of HIV infection. Outcome of the current admission in terms of discharge or death and the final diagnosis at the time of discharge or death was noted. RESULTS: Over the 6-month period, there were 160 adult admissions to the QEH where HIV/AIDS was at least one of the final diagnoses. Eighty-four (52.5%) admissions were in persons who were known to be HIV infected prior to the current admission, where a diagnosis of HIV infection was made for the first time during the current hospitalization in the remaining 76 (47.5%) cases. Nearly two thirds of those hospitalized and who had a CD4 count done had CD4 counts of < 200. Overall, opportunistic infection was the most common (38.1%), at discharge or as a final diagnosis, followed by serious bacterial infections, anemia, and HIV nephropathy. The outcome of these admissions was death in 30 (18.7%) cases, whereas the patient was discharged in the remaining 130 (81.3%) cases. CONCLUSIONS: A significant proportion of the hospitalized HIV-infected persons in the HAART era is newly diagnosed. The majority of those hospitalized had severe immunodeficiency, and consequently opportunistic infection was the most common final diagnosis.

Antenatal voluntary counseling and testing for HIV in Barbados. Success and barriers to implementation.

OBJECTIVE: To determine the success of voluntary counseling and testing (VCT) for HIV and to identify the barriers to implementation when VCT is offered as a package integrated with antenatal care. METHODS: In this descriptive study we investigated antenatal VCT and HIV testing in all post-parturient women at the Queen Elizabeth Hospital, Bridgetown, Barbados, who gave birth between April and September 2002. Data were collected retrospectively from the antenatal care record and by recall during one-on-one interview. RESULTS: Of 1 342 women surveyed, 954 (71.1%) received antenatal counseling and were offered an HIV test. Of the 954 women offered HIV test after counseling, 914 (95.8%) agreed to have the test. Among the women surveyed, 1 106 (82.4%) had a documented HIV test, 914 (85.7%) were tested after documented pretest counseling, and another 192 (14.3%) were tested without documented pretest counseling. Overall, 822 of the 1 342 women surveyed (61.2%) had a documented HIV test result in their antenatal case record at the time of delivery. Of the 1 106 women who had a documented HIV test, the test results were unavailable at the time of delivery in only 284 (21.2%). Among the reasons for unavailability of a documented HIV test result, the most common (45.0%) was that no test was done, followed by unclear documentation of the result. CONCLUSIONS: Twenty-nine percent of surveyed women failed to receive antenatal VCT and this is a cause of concern, for both the high coverage and good quality counseling are key to the overall success and cost effectiveness of the VCT program. Fourteen percent of the women surveyed who did not receive VCT were tested for HIV, a situation that is undesirable because some women may be tested without understanding the full implication of this policy, and as a result the overall impact of VCT may be reduced.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6%) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4%) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4%) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

Uptake of health care services and health status of HIV-infected women diagnosed through antenatal HIV screening in Barbados, 1996-2004 / Utilización de los servicios de atención sanitaria y estado de salud de las mujeres seropositivas al VIH diagnosticadas mediante el tamizaje prenatal para el VIH en Barbados, 1996-2004

OBJECTIVES: To study utilization of HIV-related health care services and to describe the health status of HIV-infected women diagnosed through antenatal voluntary counseling and testing (VCT) for HIV infection in Barbados. METHODS: This is a descriptive study. The study population includes all HIV-infected women in Barbados diagnosed as HIV-infected through VCT for HIV infection during 1996-2004. RESULTS: The median duration of HIV infection from time of diagnosis to the time of this report for the 163 women diagnosed during the study period was 72 months (low range, 9 months; high range, 117 months). Of the 163 women, 102 (62.6 percent) had attended the centralized HIV/AIDS clinic for follow-up (care, treatment, and monitoring), whereas 61 (37.4 percent) had never attended the clinic. The median time lag between diagnosis of HIV infection and first presentation to the HIV/AIDS clinic was 36 months (low range, 1 month; high range, 114 months). Of the HIV-infected women who attended the HIV/AIDS clinic, more than one-fourth had severe immunodeficiency at the time of their first follow-up visit. Of the 53 women undergoing highly active anti-retroviral therapy (HAART) at the time of the study, 23 (43.4 percent) began the therapy within three months of their first follow-up visit. CONCLUSIONS: Early HIV diagnosis through antenatal VCT is not enough to ensure that women with HIV will get adequate and timely HIV-related health care. These women suffer significant premature mortality, largely related to inadequate follow-up.

OBJETIVOS: Estudiar la utilización de los servicios de atención sanitaria relacionados con el VIH y describir el estado de salud de las mujeres infectadas con este virus, diagnosticadas mediante el asesoramiento y la prueba de detección del VIH de carácter voluntario (APDV) durante el período prenatal en Barbados. MÉTODOS: Este es un estudio descriptivo. La población de estudio abarcó a todas las mujeres infectadas por el VIH, diagnosticadas en Barbados mediante el APDV en 1996-2004. RESULTADOS: La mediana de la duración de la infección por el VIH -desde el diagnóstico hasta el momento de este informe- en las 163 mujeres diagnosticadas durante el período de estudio fue de 72 meses (nivel bajo: 9 meses; nivel alto: 117 meses). De las 163 mujeres, 102 (62,6 por ciento) asistieron a la clínica centralizada para el VIH/sida para su seguimiento (atención, tratamiento y monitoreo), mientras que 61 (37,4 por ciento) nunca asistieron a la clínica. La mediana del lapso entre el diagnóstico de la infección por el VIH y la primera presentación a la clínica para el VIH/sida fue de 36 meses (nivel bajo: 1 mes; nivel alto: 114 meses). Más de la cuarta parte de las mujeres infectadas que acudieron a la clínica presentaban inmunodeficiencia grave en el momento de su primera consulta de seguimiento. De las 53 mujeres que se sometieron al tratamiento antirretroviral de gran actividad (HAART) durante el estudio, 23 (43,4 por ciento) comenzaron el tratamiento en los tres meses siguientes a su primera visita de seguimiento. CONCLUSIONES: El diagnóstico temprano mediante el APDV no garantiza que las mujeres con VIH reciban una atención adecuada y oportuna para tratar esa infección. Estas mujeres sufren una mortalidad significativamente prematura, en gran parte debido al inadecuado seguimiento.

Antenatal voluntary counseling and testing for HIV in Barbados: success and barriers to implementation / Asesoramiento y prueba detectora de VIH de carácter voluntario en el período prenatal en Barbados: resultados y barreras al cumplimiento

OBJETIVO: Determinar los resultados del asesoramiento y de la prueba detectora de infección por VIH aceptados voluntariamente (APV) e identificar las barreras que impiden llevar el APV a la práctica cuando se ofrece como parte integral de la atención prenatal. MÉTODOS: En este estudio descriptivo investigamos los antecedentes de APV prenatal y de haber recibido la prueba detectora de infección por VIH en todas las mujeres que habían dado a luz en el Hospital Reina Isabel en Bridgetown, Barbados, entre abril y septiembre de 2002. Se recolectaron datos retrospectivamente a partir de las fichas de atención prenatal y por recordación durante entrevistas de cara a cara. RESULTADOS: De las 1 342 mujeres entrevistadas, a 954 (71,1%) se les había dado asesoramiento prenatal y se les había ofrecido la prueba detectora de infección por VIH. De las 954 mujeres encuestadas a quienes se les ofreció la prueba después del asesoramiento, 914 (95,8%) la aceptaron. De las mujeres encuestadas, 1 106 (82,4%) tenían documentada en su ficha una prueba detectora de infección por VIH, 914 (85,7%) recibieron la prueba después de un asesoramiento documentado, y otras 192 (14,3%) recibieron la prueba sin ninguna documentación de haber recibido un asesoramiento previo. En total, 822 (61,2%) de las 1 342 mujeres entrevistadas tenían documentado en su ficha el resultado de la prueba detectora de VIH en el momento de dar a luz. De las 1 106 mujeres con documentación de haber recibido la prueba, 284 (21,2%) no tenían anotado el resultado en el momento de dar a luz. La falta de un resultado documentado se debió principalmente a que la prueba nunca se realizó (45,0%), y en segundo lugar, a la falta de certeza en cuanto a la documentación. CONCLUSIONES: Veintinueve por ciento de las mujeres encuestadas no recibieron APV, lo cual es alarmante porque la alta cobertura y la buena calidad son imprescindibles para que el APV dé buenos resultados y rinda la debida eficacia en función de su costo. Catorce por ciento de las mujeres encuestadas que no quisieron recibir ningún asesoramiento recibieron la prueba detectora de infección por VIH. Esta situación no es aconsejable porque significa que a algunas mujeres se les aplica la prueba sin que entiendan a fondo las implicaciones de esta política. Esto, a su vez, podría reducir el impacto general del APV.

Objetivo. Determinar los resultados del asesoramiento y de la prueba detectora de infección por VIH aceptados voluntariamente (APV) e identificar las barreras que impiden llevar el APV a la práctica cuando se ofrece como parte integral de la atención prenatal. Métodos. En este estudio descriptivo investigamos los antecedentes de APV prenatal y de haber recibido la prueba detectora de infección por VIH en todas las mujeres que habían dado a luz en el Hospital Reina Isabel en Bridgetown, Barbados, entre abril y septiembre de 2002. Se recolectaron datos retrospectivamente a partir de las fichas de atención prenatal y por recordación durante entrevistas de cara a cara. Resultados. De las 1 342 mujeres entrevistadas, a 954 (71,1%) se les había dado asesoramiento prenatal y se les había ofrecido la prueba detectora de infección por VIH. De las 954 mujeres encuestadas a quienes se les ofreció la prueba después del asesoramiento, 914 (95,8%) la aceptaron. De las mujeres encuestadas, 1 106 (82,4%) tenían documentada en su ficha una prueba detectora de infección por VIH, 914 (85,7%) recibieron la prueba después de un asesoramiento documentado, y otras 192 (14,3%) recibieron la prueba sin ninguna documentación de haber recibido un asesoramiento previo. En total, 822 (61,2%) de las 1 342 mujeres entrevistadas tenían documentado en su ficha el resultado de la prueba detectora de VIH en el momento de dar a luz. De las 1 106 mujeres con documentación de haber recibido la prueba, 284 (21,2%) no tenían anotado el resultado en el momento de dar a luz. La falta de un resultado documentado se debió principalmente a que la prueba nunca se realizó (45,0%), y en segundo lugar, a la falta de certeza en cuanto a la documentación. Conclusiones. Veintinueve por ciento de las mujeres encuestadas no recibieron APV, lo cual es alarmante porque la alta cobertura y la buena calidad son imprescindibles para que el APV dé buenos resultados y rinda la debida eficacia en función de su costo. Catorce por ciento de las mujeres encuestadas que no quisieron recibir ningún asesoramiento recibieron la prueba detectora de infección por VIH. Esta situación no es aconsejable porque significa que a algunas mujeres se les aplica la prueba sin que entiendan a fondo las implicaciones de esta política. Esto, a su vez, podría reducir el impacto general del APV.

Antenatal voluntary counselling and testing for HIV in Barbados. Success and barriers to implementation

Objective. To determine the success of voluntary counseling and testing (VCT) for HIV and to identify the barriers to implementation when VCT is offered as a package integrated with antenatal care. Methods. In this descriptive study we investigated antenatal VCT and HIV testing in all post-parturient women at the Queen Elizabeth Hospital, Bridgetown, Barbados, who gave birth between April and September 2002. Data were collected retrospectively from the antenatal care record and by recall during one-on-one interview. Results. Of 1, 342 women surveyed, 954 (71.1 percent) received antenatal counseling and were offered an HIV test. Of the 954 women offered HIV test after counseling, 914 (95.8 percent) agreed to have the test. Among the women surveyed, 1, 106 (82.4 percent) had a documented HIV test, 914 (85.7 percent) were tested after documented pretest counseling, and another 192 (14.3 percent) were tested without documented pretest counseling. Overall, 822 of the 1, 342 women surveyed (61.2 percent) had a documented HIV test result in their antenatal case record at the time of delivery. Of the 1, 106 women who had a documented HIV test, the test results were unavailable at the time of delivery in only 284 (21.2 percent). Among the reasons for unavailability of a documented HIV test result, the most common (45.0 percent) was that no test was done, followed by unclear documentation of the result. Conclusions. Twenty-nine percent of surveyed women failed to receive antenatal VCT and this is a cause of concern, for both the high coverage and good quality counseling are key to the overall success and cost effectiveness of the VCT program. Fourteen percent of the women surveyed who did not receive VCT were tested for HIV, a situation that is undesirable because some women may be tested without understanding the full implication of this policy, and as a result the overall impact of VCT may be reduced (AU)

Knowledge, attitudes and practices of young persons with Diabetes and their caregivers in Jamaica

In the Caribbean diabetes is a leading cause of chronic ill health. It is rated between the fourth and fifth cause of mortality. The prevalence and incidence continue to rise. Insulin Dependent Diabetes (IDDM) is not as prevalent as non insulin dependent diabetes (NIDDM) but the mortality risk of IDDM is higher than of NIDDM. The quantitative cross sectional study was conducted from February to April 1998 to determine the knowledge, attitudes, and practices of young persons with diabetes, and their caregivers. The data was collected by telephone survey which were used as interviews to 27 young diabetics and 27 caregivers. Respondents were members of the Junior Diabetes Association and Camp Yellow Bird, as well as out-patients of the University Hospital and Bustamante Hospital for Children. The survey showed that the majority of caregivers and young diabetics had fairly good knowledge, attitudes and practices. The scores ranged from 51 percent for young diabetics to 70.3 percent for caregivers. The majority of young diabetics and their caregivers were concerned about the future of young diabetics. There were some areas which needed strengthening, such as education of self monitioring of blood glucose, insulin administration and the problems often seen as young diabetics (AU)

Knowledge, attitudes and practices of young persons with diabetes and their caregivers in Jamaica

In the Caribbean diabetes is a leading cause of chronic ill health. It is rated between the fourth and fifth cause of mortality. The prevalence and incidence continue to rise. Insulin dependent diabetes (IDDM) is not as prevalent as non insulin dependent diabetes (NIDDM) but the mortality risk of IDDM is higher than of NIDDM. The quantitative cross sectional study was conducted from February to April 1998 to determine the knowledge, attitudes, and practices of young persons with diabetes, and their caregivers. The data was collected by telephone surveys which were used at interviews to 27 young diabetics and 27 caregivers. Respondents were members of the Junior Diabetes Association and Camp Yellow Bird, as well as out-patients of the the University Hospital and Bustamante Hospital for Children. The surveys showed that the majority of caregivers and young diabetics had fairly good knowledge, attitudes and practices. The scores ranged from 51 percent of young diabetics to 70.3 percent for caregivers. The majority of young diabetics and their caregivers were concerned about the future of young diabetics. There were some areas which needed strengthening, such as education on self monitoring of blood glucose, insulin administration and the problems often seen as young diabetics.(AU)