Palliative Medicine 02/2013; 27(2):101-2. DOI:10.1177/0269216312473058 · 2.86 Impact Factor
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ABSTRACT: We describe the outcomes of a program in which antiretroviral therapy (ART) is offered to human immunodeficiency virus (HIV) infected patients in South Africa admitted with tuberculosis (TB) or other opportunistic infection (OI) as part of in-patient care.
Patients admitted with HIV and concurrent TB or other OI were initiated on early in-patient ART. The primary and secondary endpoints were respectively 24-week mortality and 24-week virologic suppression. Multivariable logistic regression modeling explored the associations between baseline (i.e., pre-hospital discharge) characteristics and mortality at 24 weeks.
A total of 382 patients were prospectively enrolled (48% women, median age 37 years, median CD4 count 33 cells/mm(3)). Acute OIs were pulmonary TB, 39%; extra-pulmonary TB, 25%; cryptococcal meningitis (CM), 10%; and chronic diarrhea, 9%. The median time from admission to ART initiation was 14 days (range 4-32, IQR 11-18). At 24 weeks of follow-up, as-treated and intention-to-treat virologic suppression were respectively 57% and 93%. Median change in CD4 cell count was +100 cells/mm(3), overall 24-week mortality was 25% and loss to follow-up, 5%. Excess mortality was not observed among patients with CM who initiated early ART. A longer interval between admission and ART was associated with mortality (>21 days vs. <21 days after admission OR 2.1, 95%CI 1.2-4.0, P = 0.016).
For HIV-infected in-patients with TB or an acquired immune-deficiency syndrome defining OI, we demonstrate the operational feasibility of early ART initiation in in-patients.
The International Journal of Tuberculosis and Lung Disease 07/2012; 16(7):917-23. DOI:10.5588/ijtld.11.0651 · 2.32 Impact Factor
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ABSTRACT: We aimed to assess the postgraduate palliative care distance education programme of the University of Cape Town (UCT) in terms of its perceived ability to influence palliative care delivery.
A mixed-methods approach, consisting of two surveys using open-ended and multiple-choice options, was conducted from January to December 2007 at the UCT School of Public Health and Family Medicine. All students registered in the programme from 2000 - 2007 were invited to participate; 83 (66.4% of all eligible participants) completed the general survey, and 41 (65.7%) of the programme's graduates completed the graduate survey. The survey scores and open-ended data were triangulated to evaluate UCT's palliative care postgraduate programme.
General survey scores of graduates were significantly higher in 5 of the 6 categories in comparison with current students. The graduate survey indicated that curriculum and teaching strengths were in communication and dealing with challenging encounters. Graduates also stressed the need to develop a curriculum that incorporated a practical component.
In addition to current postgraduate training, palliative care education in South Africa should be extended to undergraduate medical students, as the benefits of UCT's programme were limited to a small cohort of practitioners.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 01/2011; 101(1):42-4. · 1.63 Impact Factor