Impact of a Training Project for Primary Health-care ... · Impact of a Training Project for...
1
Impact of a Training Project for Primary Health-care Providers (FOCO Project) in the HIV Screening and HIV Late Diagnosis Perez-Elías MJ 1 , Samperiz G 2 , Dalmau D 3 , Romero A 4 , De la Fuente B 5 , de los Santos I 6 , Lopez JC 7,8 , Arazo P 2 , Estrada V 9 , Lozano F 10 , Pastor M 11,8 , Ocampo A 12 , Arrillaga A 13 , Fuster- Ruiz de Apodaca MJ 8 , Galindo MJ 14,8 & Grupo de Trabajo para el Diagnóstico Precoz del VIH en Atención primaria 1 H. Ramón y Cajal, Madrid , 2 H. Miguel Servet, Zaragoza, 3 H. Universitari Mutua Terrassa, Barcelona 4 H. Puerto Real, Cádiz, 5 H. Cabueñes, Gijón 6 H. La Princesa, Madrid, 7 H. Gregorio Marañón, Madrid, 8 SEISIDA, 9 H. Clínico, Madrid, 10 H. Valme, Sevilla , 11 Euskalsida, 12 H. Alvaro Cunqueiro, Vigo, 13 Plan Autonómico del Sida del País Vasco, 14 H. Clínico, Valencia OBJECTIVE Reducing HIV late diagnosis remains an epidemiological challenge. The objective of this project was to promote early HIV diagnosis through the training of primary health-care providers (PHCP). METHODS • HIV specialists conducted training sessions in 108 primary care centers (PCC) from six Spanish regions during 2016 and 2017, and with 1804 PHCP involved. • The intervention was evaluated using a pre-experimental design collecting the dependent variables both in the six months before and after the intervention. Number of requests for HIV tests from the PCC trained and clinical data of new HIV diagnosed patients were collected. • Parametric and non-parametric tests were used to assess differences between pre and post-intervention data. City Hospital Nº PCC trained Researcher Barcelona Mutua Terrassa 9 Dr. David Dalmau Cádiz Puerto Real 9 Dr. Alberto Romero Gijón Cabueñes 14 Dr. Belén de la Fuente Madrid La Princesa 10 Dr. Ignacio de los Santos Ramón y Cajal 20 Dr. María Jesús Pérez Gregorio Marañón 5 Dr. Juan Carlos López Clínico 1 Dr. Vicente Estrada Valencia Clínico Universitario 29 Dr. María José Galindo Zaragoza Miguel Servet 11 Dr. Piedad Arazo &Gloria Samperiz Total 9 hospitals 108 PCC Table 1. Distribution of PCC trained among cities RESULTS 15000 15500 16000 16500 17000 17500 18000 18500 19000 19500 20000 No. HIV test PRE No. HIV test POST 16833 19793 Fig 5. Number of HIV test performed before and after the intervention Number of HIV tests performed was higher after the intervention (p<.0001). Positive test results were 0.37% and 0.31% in the pre and post-intervention periods respectively. 0 5 10 15 20 25 CD4 % *, ** 19.23 24.57 19.95 25 Mean PRE Mean Post Median PRE Median Post Fig. 1-3. Differences in clinical variables in pre and post intervention periods 0 50 100 150 200 250 300 350 400 450 500 CD4 count 395.52 435.79 372 444 Mean PRE Mean Post Median PRE Median Post • Clinical data of 132 new HIV diagnosed patients were collected (67 pre and 65 post). • Percentage of lymphocytes CD4 mm3 were significantly higher (p=.011) and the median of absolutes lymphocytes was marginally higher (p=.083) after the intervention. A total of 44.4% versus 36.1% of the patients in the pre and post-intervention periods were diagnosed with <350 CD4 mm3. • †The number of AIDS-related events was marginally lower after the intervention (p=.09). CONCLUSIONS 0 1 2 3 4 5 6 7 8 9 10 PRE POST 8 2 AIDS-related events† Fig. 4. Number of visits to PCC in pre and post-intervention periods of New Diagnosed HIV patients´ 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 Nº visits to PCC (total sample) Nº visits to PCC (among those with pathologies related to HIV) 4.2 6.3 3.8 5.0 3 6 3 4 Mean PRE Mean POST Mediana PRE Mediana Post • There were no significant differences in the mean of visits to PCC during the two previous years to HIV diagnosis. • In 34.3% and 38.5% of patients of pre and post-intervention periods, the pathologies because they visited PCC were related or suggestive to HIV. • One patient who had visited six times PCC in the two previous years due dermatological problems died two months after the diagnosis. • Data available in clinical records showed that while one patient visits PCC due sexually transmitted infections in the pre-intervention period, there were 12 patients in the post period. • Previous negative HIV test were known in 44.8% and 33.8% of patients from both periods respectively. The pathologies of 42.3% of patients who had a previous HIV test more than two years were related to HIV, while they were in the 30.8% of the patients who had a previous HIV test of fewer than two years. • The new HIV diagnosed patients in the post-intervention period showed better immunological status than those in the pre-intervention period. • We found a relevant number of missed opportunities for HIV diagnosis especially among those patients who visited PCC due to pathologies related or suggestive to HIV. • Number of HIV test performed was higher after the intervention. • Training PHCP in the HIV screening and late diagnosis could be useful to increase HIV screening and to reduce late HIV diagnosis. Working Group for Early HIV Diagnosis in Primary Care: Ignacio Ramón Ferrando, Concha Santos, Jesús Sanz, Maria Jesús Vivancos. Working Group for Early HIV Diagnosis in Primary Care: Ignacio Alastrue, Piedad Arazo, Arantxa Arrillaga, Amparo Bueno, David Dalmau, Vicente Estrada, Belén de la Fuente, Ignacio de los Santos, María José Galindo, Lucio García-Fraile, Cristina Gómez, Ramón Ferrando, Ana Ferrer, Roser Font, María José Fuster, Juan Carlos Lopez, Fernando Lozano, Antonio Ocampo, Marta Pastor, María Jesús Pérez Elías, Alberto Romero, Gloria Samperiz, Matilde Sanchez, Concha Santos, Jesús Sanz, Maria Jesús Vivancos. Project supported by Janssen Cilag, S.A. Authors’ contact: [email protected] P043
Transcript of Impact of a Training Project for Primary Health-care ... · Impact of a Training Project for...
Impact of a Training Project for Primary Health-care Providers (FOCO Project) in the HIV Screening and HIV Late Diagnosis
Perez-Elías MJ1, Samperiz G2, Dalmau D3, Romero A4, De la Fuente B5, de los Santos I6, Lopez JC7,8, Arazo P2, Estrada V9, Lozano F10, Pastor M11,8, Ocampo A12, Arrillaga A13 , Fuster-Ruiz de Apodaca MJ8, Galindo MJ14,8 & Grupo de Trabajo para el Diagnóstico Precoz del VIH en Atención primaria
1 H. Ramón y Cajal, Madrid , 2H. Miguel Servet, Zaragoza, 3 H. Universitari Mutua Terrassa, Barcelona 4H. Puerto Real, Cádiz, 5H. Cabueñes, Gijón 6H. La Princesa, Madrid, 7H. Gregorio Marañón, Madrid, 8SEISIDA, 9H. Clínico, Madrid, 10H. Valme, Sevilla, 11 Euskalsida, 12 H. Alvaro Cunqueiro, Vigo, 13Plan Autonómico del Sida del País Vasco, 14H. Clínico, Valencia
OBJECTIVE OBJECTIVE
Reducing HIV late diagnosis remains an epidemiological challenge. The objective of this
project was to promote early HIV diagnosis through the training of primary health-care
providers (PHCP).
METHODS METHODS
• HIV specialists conducted training sessions in 108 primary care centers (PCC) from
six Spanish regions during 2016 and 2017, and with 1804 PHCP involved.
• The intervention was evaluated using a pre-experimental design collecting the
dependent variables both in the six months before and after the intervention. Number
of requests for HIV tests from the PCC trained and clinical data of new HIV diagnosed
patients were collected.
• Parametric and non-parametric tests were used to assess differences between pre
and post-intervention data.
City Hospital Nº PCC trained Researcher
Barcelona Mutua Terrassa 9 Dr. David Dalmau
Cádiz Puerto Real 9 Dr. Alberto Romero
Gijón Cabueñes 14 Dr. Belén de la Fuente
Madrid La Princesa 10 Dr. Ignacio de los Santos
Ramón y Cajal 20 Dr. María Jesús Pérez
Gregorio Marañón 5 Dr. Juan Carlos López
Clínico 1 Dr. Vicente Estrada
Valencia Clínico Universitario 29 Dr. María José Galindo
Zaragoza Miguel Servet 11 Dr. Piedad Arazo &Gloria
Samperiz
Total 9 hospitals 108 PCC
Table 1. Distribution of PCC trained among cities
RESULTS RESULTS
15000 15500 16000 16500 17000 17500 18000 18500 19000 19500 20000
No. HIV test PRE No. HIV test POST
16833
19793
Fig 5. Number of HIV test performed before and after the intervention
Number of HIV tests performed was higher after the intervention (p<.0001). Positive
test results were 0.37% and 0.31% in the pre and post-intervention periods
respectively.
0
5
10
15
20
25
CD4 % *, **
19.23
24.57
19.95
25
Mean PRE Mean Post Median PRE Median Post
Fig. 1-3. Differences in clinical variables in pre and post intervention periods
0
50
100
150
200
250
300
350
400
450
500
CD4 count
395.52 435.79
372
444
Mean PRE Mean Post Median PRE Median Post
• Clinical data of 132 new HIV diagnosed patients were collected (67 pre and 65 post).
• Percentage of lymphocytes CD4 mm3 were significantly higher (p=.011) and the median of absolutes lymphocytes was marginally higher (p=.083) after the intervention. A total of
44.4% versus 36.1% of the patients in the pre and post-intervention periods were diagnosed with <350 CD4 mm3.
• †The number of AIDS-related events was marginally lower after the intervention (p=.09).
CONCLUSIONS CONCLUSIONS
0
1
2
3
4
5
6
7
8
9
10
PRE POST
8
2
AIDS-related events†
Fig. 4. Number of visits to PCC in pre and post-intervention periods of New Diagnosed HIV patients´
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
Nº visits to PCC (total sample) Nº visits to PCC (among those with pathologies related to HIV)
4.2
6.3
3.8 5.0
3
6
3 4
Mean PRE Mean POST Mediana PRE Mediana Post
• There were no significant differences in the mean of visits to PCC during the two previous
years to HIV diagnosis.
• In 34.3% and 38.5% of patients of pre and post-intervention periods, the pathologies
because they visited PCC were related or suggestive to HIV.
• One patient who had visited six times PCC in the two previous years due dermatological
problems died two months after the diagnosis.
• Data available in clinical records showed that while one patient visits PCC due sexually
transmitted infections in the pre-intervention period, there were 12 patients in the post
period.
• Previous negative HIV test were known in 44.8% and 33.8% of patients from both periods
respectively. The pathologies of 42.3% of patients who had a previous HIV test more than
two years were related to HIV, while they were in the 30.8% of the patients who had a
previous HIV test of fewer than two years.
• The new HIV diagnosed patients in the post-intervention period showed better immunological status than those in the pre-intervention period.
• We found a relevant number of missed opportunities for HIV diagnosis especially among those patients who visited PCC due to pathologies related or suggestive to HIV.
• Number of HIV test performed was higher after the intervention.
• Training PHCP in the HIV screening and late diagnosis could be useful to increase HIV screening and to reduce late HIV diagnosis.
Working Group for Early HIV Diagnosis in Primary Care:
Ignacio Ramón
Ferrando, Concha
Santos, Jesús Sanz, Maria Jesús Vivancos.
Working Group for Early HIV Diagnosis in Primary Care:
Ignacio Alastrue, Piedad Arazo, Arantxa Arrillaga, Amparo Bueno, David Dalmau, Vicente Estrada, Belén de la Fuente, Ignacio de los Santos, María José Galindo, Lucio García-Fraile, Cristina Gómez, Ramón
Ferrando, Ana Ferrer, Roser Font, María José Fuster, Juan Carlos Lopez, Fernando Lozano, Antonio Ocampo, Marta Pastor, María Jesús Pérez Elías, Alberto Romero, Gloria Samperiz, Matilde Sanchez, Concha
Santos, Jesús Sanz, Maria Jesús Vivancos.
Project supported by Janssen Cilag, S.A. Authors’ contact: [email protected]
P043
