PDF(Pubmed)
Abstract：
The World Health Organization (WHO) recommends an evidence-based package of care to reduce mortality and morbidity among people with advanced HIV disease (AHD). Adoption of these recommendations by national guidelines in sub-Saharan Africa is poorly documented. We aimed to review national guidelines for AHD management across six selected countries in sub-Saharan Africa for benchmarking against the 2021 WHO recommendations.
We reviewed national guidelines from six countries participating in an ongoing randomized controlled trial recruiting people with AHD. We extracted information addressing 18 items of AHD diagnosis and management across the following domains: [1] Definition of AHD, [2] Screening, [3] Prophylaxis, [4] Supportive care, and [5] HIV treatment. Data from national guideline documents were compared to the 2021 WHO consolidated guidelines on HIV and an agreement score was produced to evaluate extent of guideline adoption.
The distribution of categories of agreement varied for the national documents. Four of the six countries addressed all 18 items (Malawi, Nigeria, Sierra Leone, Uganda). Overall agreement with the WHO 2021 guidelines ranged from 9 to 15.5 out of 18 possible points: Malawi 15.5 points, Nigeria, and Sierra Leone 14.5 points, South Africa 13.5 points, Uganda 13.0 points and Botswana with 9.0 points. Most inconsistencies were reported for the delay of antiretroviral therapy (ART) in presence of opportunistic diseases. None of the six national guidelines aligned with WHO recommendations around ART timing in patients with tuberculosis. Agreement correlated with the year of publication of the national guideline.
National guidelines addressing the care of advanced HIV disease in sub-Saharan Africa are available. Besides optimal timing for start of ART in presence of tuberculosis, most national recommendations are in line with the 2021 WHO standards.
We reviewed national guidelines from six countries participating in an ongoing randomized controlled trial recruiting people with AHD. We extracted information addressing 18 items of AHD diagnosis and management across the following domains: [1] Definition of AHD, [2] Screening, [3] Prophylaxis, [4] Supportive care, and [5] HIV treatment. Data from national guideline documents were compared to the 2021 WHO consolidated guidelines on HIV and an agreement score was produced to evaluate extent of guideline adoption.
The distribution of categories of agreement varied for the national documents. Four of the six countries addressed all 18 items (Malawi, Nigeria, Sierra Leone, Uganda). Overall agreement with the WHO 2021 guidelines ranged from 9 to 15.5 out of 18 possible points: Malawi 15.5 points, Nigeria, and Sierra Leone 14.5 points, South Africa 13.5 points, Uganda 13.0 points and Botswana with 9.0 points. Most inconsistencies were reported for the delay of antiretroviral therapy (ART) in presence of opportunistic diseases. None of the six national guidelines aligned with WHO recommendations around ART timing in patients with tuberculosis. Agreement correlated with the year of publication of the national guideline.
National guidelines addressing the care of advanced HIV disease in sub-Saharan Africa are available. Besides optimal timing for start of ART in presence of tuberculosis, most national recommendations are in line with the 2021 WHO standards.
摘要：
背景：世界卫生组织（WHO）建议采用基于证据的一揽子护理措施，以降低晚期HIV疾病（AHD）患者的死亡率和发病率。撒哈拉以南非洲国家准则对这些建议的采纳记录很少。我们旨在审查撒哈拉以南非洲六个选定国家的AHD管理国家指南，以根据2021年的世卫组织建议制定基准。
方法：我们回顾了来自参与一项正在进行的招募AHD患者的随机对照试验的六个国家的国家指南。我们提取了涉及以下领域的18项AHD诊断和管理的信息：[1]AHD的定义，[2]筛选，[3]预防，[4]支持性护理，[5]艾滋病毒治疗。将来自国家指南文件的数据与2021年世卫组织艾滋病毒综合指南进行了比较，并产生了协议评分以评估指南采用的程度。
结果：协议类别的分布因国家文件而异。六个国家中有四个处理了所有18个项目(马拉维，尼日利亚,塞拉利昂，乌干达)。与世卫组织2021年指南的总体协议在18个可能的点中从9到15.5不等：马拉维15.5分，尼日利亚,塞拉利昂14.5分，南非13.5分，乌干达13.0分，博茨瓦纳9.0分。据报道，在存在机会性疾病的情况下，抗逆转录病毒治疗（ART）的延迟存在大多数不一致之处。六个国家指南中没有一个与世卫组织关于结核病患者ART时机的建议一致。协议与国家指南发布年份相关。
结论：有关于撒哈拉以南非洲晚期HIV疾病护理的国家指南。除了在存在结核病的情况下开始ART的最佳时机，大多数国家建议符合2021年世卫组织标准。
方法：我们回顾了来自参与一项正在进行的招募AHD患者的随机对照试验的六个国家的国家指南。我们提取了涉及以下领域的18项AHD诊断和管理的信息：[1]AHD的定义，[2]筛选，[3]预防，[4]支持性护理，[5]艾滋病毒治疗。将来自国家指南文件的数据与2021年世卫组织艾滋病毒综合指南进行了比较，并产生了协议评分以评估指南采用的程度。
结果：协议类别的分布因国家文件而异。六个国家中有四个处理了所有18个项目(马拉维，尼日利亚,塞拉利昂，乌干达)。与世卫组织2021年指南的总体协议在18个可能的点中从9到15.5不等：马拉维15.5分，尼日利亚,塞拉利昂14.5分，南非13.5分，乌干达13.0分，博茨瓦纳9.0分。据报道，在存在机会性疾病的情况下，抗逆转录病毒治疗（ART）的延迟存在大多数不一致之处。六个国家指南中没有一个与世卫组织关于结核病患者ART时机的建议一致。协议与国家指南发布年份相关。
结论：有关于撒哈拉以南非洲晚期HIV疾病护理的国家指南。除了在存在结核病的情况下开始ART的最佳时机，大多数国家建议符合2021年世卫组织标准。
